Nursing homes under the microscope

May 13--State and federal reports reviewed by the Lewiston Tribune indicate about half of the 82 nursing homes in Idaho were cited for being deficient in infection prevention and control during their most recent inspections.

A look further back shows the numbers increase substantially. According to a ProPublica database, 88 percent of the Medicare-certified nursing homes in Idaho and 86 percent in Washington have had at least one such citation in the past three years. Nationally the number is 75 percent, according to the nonprofit investigative news organization.

Debby Ransom of the Idaho Department of Health and Welfare isn't surprised by those statistics.

"It's the No. 1 citation in the nation across the board for all nursing facilities," Ransom said. "It's the No. 1 citation in Idaho for our Idaho facilities."

Protocols to control infectious disease at nursing homes, where residents are especially vulnerable to COVID-19, are receiving extra scrutiny during the pandemic, with multiple examples of tragic outcomes across the country.

Amanda Scott, long-term care ombudsman at the Idaho Commission on Aging, finds the number of deficiencies troubling.

"Nationally, infection control has been an issue," Scott said. "I think it needs to be brought to a higher priority, and I really believe this COVID-19 outbreak is probably going to bring it to a higher level of priority."

Nursing homes that accept Medicare payments must be inspected on a regular basis to remain certified. In Washington, one of the three Medicare-certified nursing homes in Asotin and Whitman counties was found to have some level of infection control and prevention deficiency during its latest inspection.

Of the 11 Medicare-certified nursing homes within the five-county Public Health -- Idaho North Central District, eight were cited for deficiencies during their last inspection. That includes both Life Care Center of Lewiston, where 18 people have died in a COVID-19 outbreak, and Lewiston's Royal Plaza, which has had one case of COVID-19.

Nevertheless, Life Care Center of Lewiston has an overall rating by Medicare as "much above average" and an "above average" rating for health inspections.

Royal Plaza also has an overall "much above average" rating and an "average" rating for health inspection.

Tim Killian, a public information liaison working for Life Care Centers of America, said the inspections are important but noted the citations are often for minor lapses. For example, during Life Care of Lewiston's latest inspection, a nursing assistant was cited for using a napkin to wipe food residue off a resident's hand but not sanitizing the hand, despite not knowing the source of the residue.

"One thing that gets lost when all we talk about is deficiencies and infection control -- the public is sometimes thinking it's much more substantial issues," said Killian, who argues linking the spread of COVID-19 and inspection deficiencies is unfair.

"COVID-19 spread in ways that go beyond normal infection control within a nursing home, and I think sometimes when the story gets written it leaves the impression if we had just been perfect with our guidances that we already have we could have stopped COVID-19," he said. "And that just simply isn't true."

Across Idaho, at least 21 of the more than 400 long-term care facilities -- a designation that includes not only nursing homes but also assisted-living facilities and intermediate care centers -- have had at least one resident or staff member test positive for COVID-19. In those facilities, 244 residents or staff members have either tested positive for the illness or been declared probable, and 34 people have died of COVID-19.

In Washington, there have been more than 2,800 cases and 500 deaths at long-term care centers.

Nursing home residents who become ill with infectious diseases like COVID-19, or even the flu, are particularly vulnerable to bad outcomes.

"Besides being the oldest of the old and needing so much hands-on care, they also have more chronic health conditions. That is why they are there. They need 24-hour-a-day, seven-days-a-week care," said Catherine Van Son, an associate professor at the Washington State University College of Nursing in Vancouver.

That includes help with hygiene, eating, dressing and basic mobility. Van Son said many residents are in cognitive decline, making it more difficult to prescribe social distancing.

Despite the challenges, Ransom said there is evidence outbreaks in such situations can be controlled. Of the 21 long-term care facilities in Idaho that have had COVID-19 cases, 10 have been declared free of the viral illness, and eight of those were able to contain it to just one person. That's the case at Royal Plaza where an outbreak was confined to one resident, said Executive Director Mary Egeland.

"It resolved, and all is well with that resident," Egeland said.

An outbreak is considered resolved when facilities go more than 28 days without a new case. Life Care Center of Lewiston hasn't reached that point, but Killian said things are improving.

"We tend to see an initial wave of strong and very symptomatic illness," he said. "That wave passes, and we tend to see a lot of patients who tested positive and then recover, and we feel like we are in that phase at this point in that facility."

Robert Vande Merwe, executive director of the Idaho Health Care Association, said caregivers must negotiate a maze of regulations to avoid inspection citations.

"Most citations for inadequate infection control plans are related to paperwork and documentation rather than a lack of actual infection control practices," Vande Merwe said in a written statement.

Ransom said the frequency with which nursing homes are cited for infection prevention issues boils down to human error and often centers on hand hygiene or wound and catheter care.

"Sometimes we get in a pattern, or things aren't available, or we aren't thinking and (we) miss steps," she said.

Van Son is defensive of nursing homes, where she worked as a nursing aide for 10 years before becoming a nurse and eventually earning a doctorate. She said the system needs more resources.

There is a higher patient-to-staff ratio in nursing homes compared to hospitals, less personal protective equipment available, less training for the aides and nursing assistants, who are often underpaid, and a shortage of funding for the facilities.

"It's not that they don't want to provide the best care and they don't want to protect the residents, as well as themselves, but they are set up in a system (in which) there is no way they can humanly do that," she said. "We as a society still suffer from ageism. We do not think well of getting older. We do not honor and revere elders. Reimbursement rates are poor. It's not set up for them to succeed."

Like Scott, she hopes if anything good comes out of the COVID-19 pandemic it will be a reexamination of how we take care of elderly people and how we reward caregivers, whom she calls unsung frontline heros.

"We have to figure out a way to honor them, pay them well and give them health insurance and meet their needs so they will come and meet the needs of the residents."

Barker may be contacted at [email protected] or at (208) 848-2273. Follow him on Twitter @ezebarker.

___

(c)2020 the Lewiston Tribune (Lewiston, Idaho)

Visit the Lewiston Tribune (Lewiston, Idaho) at www.lmtribune.com

Distributed by Tribune Content Agency, LLC.