Nursing homes and their residents are vulnerable to serious harm as the coronavirus spreads, and federal data show that infection control has been a problem at nursing homes across Kentucky.
Kentucky nursing homes have the third highest rate of serious deficiencies per facility in the country, according to a ProPublica analysis of Centers for Medicare and Medicaid Services data. And the virus can have major impact even at nursing homes with strong safety records: At least 19 people have died and at least 70 staff members have displayed coronavirus symptoms in connection with an outbreak at the Life Care Center in Kirkland, Washington.
The Life Care Center is a five-star nursing home, meaning the Centers for Medicare and Medicaid Services deemed it much better than the average nursing home.
Nursing homes in Kentucky, however, have long been struggling with staffing shortages and quality of care issues.
In Louisville, federal data show that most nursing homes have struggled with being prepared for, or dealing with, issues around infection. Inspectors flagged deficiencies related to infection control at 38 of Jefferson County’s 45 federally regulated nursing homes in at least one inspection since 2017.
Kentucky’s Long Term Care Ombudsman Sherry Culp said most of these deficiencies were isolated incidents that presented minimal or no immediate harm to residents. The ombudsman is a state program to advocate for residents of nursing homes and other long term care facilities.
Culp said facilities should take extra precaution as the disease spreads and build in extra time for things like washing staff and resident’s hands.
“Proper hand washing is one of the things that has come up repeatedly in the education of the general public and hand washing has been a problem in nursing facilities,” Culp said.
Inspectors observed such a deficiency at Landmark of Louisville Rehabilitation and Nursing in August of 2019 when a unit manager handled soiled dressing and cleaned a wound without washing hands or changing gloves. This violated the facility’s infection control policy.
John Stare, a spokesperson for Landmark of Louisville, provided a statement to KyCIR which says the facility “is well aware” of the global concerns about the coronavirus that causes COVID-19.
“We are taking a very aggressive and proactive approach in preventing and, if necessary, defending against the virus through intense monitoring, screening, education and awareness, and appropriate prevention and management,” the statement said, while adding that Landmark of Louisville has implemented coronavirus plans based on guidelines from the Centers for Disease Control.
Betsy Johnson, the president of the Kentucky Association of HealthCare Facilities and the Kentucky Center for Assisted Living, said long-term care facilities are required to have an infection prevention and control program. If a federal inspector tracks a deficiency, that doesn’t necessarily mean a facility has a failed infection control program, Johnson said.
“It just means you are in a situation where these things happen.
“You can have a five-star building doing everything correct and right and still potentially have an outbreak in that building,” Johnson said. “It reflects nothing on that building as far as their quality or their ability to control those types of things.”
The Centers for Disease Control has issued guidance to long-term care facilities to take extra precautions to prevent the spread of coronavirus. In Kentucky, Gov. Andy Beshear and the Kentucky Department of Health on Sunday advised nursing homes to restrict visitors who may bring the coronavirus into facilities.
On Tuesday, he went a step further: during his press briefing, Beshear issued "strong guidance" to nursing homes and long-term care facilities to restrict visitors.
"Part of what we are announcing today is that we are restricting visitors to our long term care facilities," said Eric Friedlander, acting Cabinet for Health and Family Services Secretary. "We are asking people not to visit. If it's an end of life situation, obviously that's different. But we are asking our facilities to make sure that they are sure of their infection control procedures, make sure that they are confident in their emergency procedures."
Johnson’s association has scheduled weekly calls with the Kentucky Office of Inspector General, which regulates nursing homes. They began coordinating with state public health officials last week, after the outbreak was discovered at the Washington nursing home.
None of the six cases in Kentucky, as of Monday night, had any ties to nursing homes. But Johnson said the facilities are already facing some challenges.
Johnson said her association has heard from member facilities running low on protective gear like respiratory masks, which are already in short supply thanks to a difficult flu season.
Both Culp and Johnson agree the primary concern facing Kentucky’s nursing homes in the coming weeks will be the availability of qualified staff. Kentucky’s nursing homes are chronically short-staffed.
If staff start showing symptoms of the coronavirus disease and can’t come to work, that will make it all the more difficult to provide quality care.
“If those folks are getting sick and not showing up to work based on the recommended protocol then we are going to be having some serious issues that we will need to address,” Johnson said.
This story has been updated to include comments from Tuesday's press briefing.
