Nursing homes had problems controlling infections before all this

Jackson Manor, one of Signature HealthCare's 42 facilities in the state, had a major outbreak.

"Many Kentucky nursing homes failed at infection prevention and control even before the novel coronavirus blazed through them over the last two months, infecting more than 1,000 of their residents and staff as of Friday and killing more than 120," John Cheves reports for the Lexington Herald-Leader, after checking the homes' inspection records from April 2016 to December 2019.

"Among the places cited for errors as routine as a lack of hand-washing are seven of the 10 long-term care facilities now hardest hit by covid-19, such as Rivers Edge Nursing and Rehabilitation Center in Jefferson County, Signature HealthCare at Summit Manor in Adair County and Signature HealthCare at Jackson Manor in Jackson County."

But people who were looking for a nursing home for themselves or a loved one in the last year would have to dig deep, like Cheves did: "State regulators almost never issued a serious penalty for infection control violations, so they seldom resulted in fines or affected the federal government’s five-star rating system that the public uses to compare the quality of nursing homes."

Cheves examined the 333 infection-control citations issued to Kentucky nursing homes from April 2016 to December 2019. He summarizes with examples: "Nursing home employees failed to wash their hands, change gloves and disinfect equipment and supplies while walking from room to room among elderly and ailing residents, even when they handled urine and feces and cared for infectious patients in isolation, according to its own citations. . . . Aides passed out food, drinks and pills to residents with their unwashed bare hands while also touching their own faces, hair and communal objects such as light switches and refrigerator door handles, according to inspection reports. Feces-stained bed sheets were put on residents’ bed tables where personal items were kept. Residents’ surgical wounds were not properly cleaned and dressed."

Yet, the state Cabinet for Health and Services "nearly always determined there was 'minimal harm'," a key to keeping the violations from being considered serious and resulting in fines. Infection-control citations are among the most commonly issued to nursing homes, as well as among the least penalized, Cheves was told by Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, which lobbies for better care for the elderly and disabled.

“We have a lot of nursing homes that get cited for infection control deficiencies year after year, and for really basic stuff like nursing aides not washing their hands between rooms. But our regulatory system is pretty toothless, so we haven’t been solving the problem,” Edelman said. “Unfortunately, at a time like this, during a pandemic, we’re all seeing the results.”

The health cabinet "declined to say whether the state did enough in the past to enforce infection control at nursing homes or whether it would take more aggressive steps in the future," Cheves writes. A cabinet official told him that it follows U.S. Centers for Disease Control and Prevention-recommended protocols for infection control.

“Awareness of confirmed cases of COVID-19 in our commonwealth and in long-term care settings has resulted in the escalation of safety and infection control protocols and expanded emergency-scenario planning,” spokeswoman Susan Dunlap wrote. “Long-term care facilities are anticipating changes to CDC guidelines with respect to safety and infection prevention based on new learnings from combating the novel coronavirus. When these are issued, CHFS will follow them.”

Cheves reports, The U.S. Centers for Medicare & Medicaid Services sent a team of inspectors to the country’s hardest-hit nursing homes. They found that in 36 percent of the facilities, staff were not following proper hand-washing guidelines, and in 25 percent, staff failed to properly use personal protective equipment, such as masks, gloves and gowns, even when they had it."