Report: Nursing home experts neglected

State focused on hospitals in early days of pandemic

Connecticut officials were so focused on the potential impact of COVID-19 on hospitals that they neglected suggestions and guidance from the nursing home industry in the early stages of the coronavirus pandemic, a new report released Thursday says.

The report, prepared at the request of the state, analyzed Connecticut’s response as COVID19 devastated nursing homes from March through June. More than 3,000 nursing home residents — about 70% of the state’s death total from coronavirus — were claimed by the deadly virus.

“The earliest response to COVID-19 in Connecticut did not include these perspectives (referring to long-term care providers) and, as a result, those settings were somewhat neglected due to the focus on hospitals,” the report from a private consulting company, Mathematica, concluded.

The 157-page final report from the New Jersey consulting firm makes several short-term and long-term recommendations, including many it says the state should implement to prepare for an anticipated second wave of the virus. The report acknowledges that some of their recommendations have already been adopted.

It also reached several conclusions about which facilities had the most deaths, and what were the critical factors in allowing it to spread.

The report’s recommendations include:

Requiring a full-time infection prevention expert in nursing homes and increasing minimum required staffing levels.

Make sure all nursing home staff

have access to appropriate PPE and have guaranteed paid sick leave.

Developing a framework to guide visitor policies on the facility or community level, rather than one standard for the entire state.

The report also reached several conclusions about why some facilities had higher death and infection rates than others. One key factor, the report found, was staffing levels — nursing homes with high staffing ratings had significantly fewer cases and deaths per licensed bed.

Homes with l arge numbers of patient leaving the facility for cancer or dialysis treatment were also at higher risk. Also, nursing homes situated in towns that had more cases experienced more cases and deaths.

The report also said the state needs to focus better on ensuring that residents are getting visitation privileges from their loved ones and that a one-size fits all policy isn’t necessarily the best way to do that.

“The prevalence of symptoms of depression increased by 15 percent and rates of unplanned weight loss nearly doubled right after the peak of the COVID-19 outbreak,” the report said. “These outcomes suggest measuring COVID-19 cases and deaths alone does not capture the full impact of the pandemic on residents’ well-being.”

Mathematica officials conducted 52 interviews from state officials to nursing home providers to employees and families who had loved ones in long-term care facilities. They issued an interim report in mid-August that concluded the state’s “existing emergency response and surveillance systems were insufficient for the COVID-19 outbreak.”

Governor disputes conclusions

Gov Ned Lamont, in a statement, called the report “a transparent look at how our state responded to COVID-19 within our long term care facilities.” At his daily press briefing he went intop more detail — disputing the assessment that the state didn’t focus enough on long-term facilities early on in the pandemic.

“We really looked at the hospitals very early on just given nature of spread what we saw going on in Italy and some other places where hospitals were overwhelmed,” Lamont said. “Weworkedhandandglove with hospitals to make sure we had a coordinated response but I don’t think that was at the expense of the nursing homes.”

Lamont added the state was one of the first to bar visitors from nursing homes and one of the first to have COVID-only facilities. He also said that hospitals were better at procuring their own PPE than were the nursing homes. “We had to get the masks to the nursing homes as best we could,” Lamont said.

Interim DPH Commissioner Dr. Diedre Gifford said that the report correctly stated that Connecticut, like everyone else, was learning at the beginning of the pandemic.

“Wewere learning about this virus as it was happening,” Gifford said. “We took steps as we learned that they needed to be taken and as we learned about the nature of the infectivity and the spread and where it was happening we took those steps.”

Connecticut, with the highest death rate in the Northeast in its longterm care facilities, hired the company to asses its response to the pandemic. The state paid $450,000 for the report.

Nearly three-quarters of deaths due to COVID-19 have been in long-term care facilities, which includes both nursing homes and assisted living facilities. There have been 3,259 deaths as of last Thursday in long-term care facilities in Connecticut which accounts for more than 70 percent of the state’s deaths.

Second wave possible

A key element of the report is the anticipation of a second wave of COVID19 hitting nursing homes, with a number of steps recommended to minimize infection and death. The recommendations cover staffing, protective equipment and visitation rules, among other issues.

The report contained 23 short-term recommendations and Gifford said DPH was already implementing 14 of the 15 recommendations that focused on the state. The other recommendations were for long-term care providers.

Gifford state DPH officials will be reviewing the 22 long-term recommendations, including the suggestion that the department work more closely with long-term care providers in planning.

“What I found very reassuring about the report was the strategies that we have been putting in place to prepare for a second phase were validated by the report,” Gifford said. “We will be looking more closely at the long-term recommendations as we move into the fall.”

Lamont ordered the review so that the state could prepare for a possible second wave of the virus and to analyze why the death toll was so high and what may have gone wrong.

The situation in nursing homes vastly improved once the state started a testing regiment that led to every nursing home resident getting multiple COVIDtests. The increased testing, which started in late May, allowed facilities to identify asymptomatic carriers of the virus and isolate to keep the virus from spreading.

Thestate later also implemented a testing program for all employees of longterm care facilities. The massive testing initiative slowed the deaths in longterm care facilities down considerably to only a few a week compared to weeks in April and May where 50 or more long-term care residents were dying.

But even still there have been outbreaks.

This week, DPH investigators are dealing with an outbreak at the Harrington Court nursing home in Colchester where 57 people, including 45 residents, have tested positive for the virus. Last month more than three dozen people were infected, and at least three died, during an outbreak at the Three Rivers Healthcare Center in Norwich.

The review also found that for-profit nursing homes fared far worse than non-profit ones with 60% of the COVID cases and deaths occurring in for-profit institutions. Larger national chains also fared worse than independently owned facilities — large chains had 40% more deaths.

The two leaders of state’s nursing home associations, Matthew Barrett and Mag Morelli, issued a joint statement Thursday reiterating Gifford’s comment that the DPH has already begun to work with the nursing home sector to implement many recommendations found in the report. Barrett heads the for-profit association, while Morelli leads the non-profit group.