Study: Nursing outbreaks mirror community spread
Nearly a year into the coronavirus pandemic, experts now say the spread of COVID-19 within communities that host nursing homes may be a better indicator of how the deadly virus will affect long-term care residents than traditional quality ratings and inspection reports.
Nursing homes were hard hit with thousands of cases and deaths in the early months of the pandemic. In Connecticut, nursing home deaths make up 57 percent of the state’s total death toll.
“The strongest predictor of whether or not we’ll see cases in [a particular setting] is community spread,” said David Grabowski, a professor of health care policy at Harvard Medical School and co-author of a recent paper on the spread of COVID at nursing homes.
“COVID-19 cases in nursing homes are related to facility location and size and not traditional quality metrics such as star rating and prior infection control citations,” Grabowski said.
A Hearst Connecticut Media investigation of infection control violations at nursing homes showed little correlation between deficiencies found by federal inspectors and the number of residents who died after contracting the coronavirus.
For example, the Riverside Health and Rehabilitation Center in East Hartford has not received an infection control violation since 2017, federal inspection records show. Still, the four-star rated facility lost 76 patients to COVID last year — the most in Connecticut.
By contrast, the Monsignor Bojnowski Manor nursing home in New Britain — a five-star rated facility with no COVID deaths as of Jan. 12 — was cited last year for violating infection procedures during the height of the pandemic.
Inspection records show that seven of the 10 nursing homes with the most COVID deaths were cited at least once during prior years for inadequate infection control procedures, and four received one or more violations in 2020.
A review of 10 of the 18 nursing homes where no one died of COVID showed that nine of those facilities received at least one infection control violation in past years and four were cited in 2020.
To date, 3,728 residents at the state’s 213 nursing homes have died of complications related to COVID-19. In all, 6,553 Connecticut residents had died of COVID as of Jan. 12.
Matt Barrett, president of the Connecticut Association of Health Care Facilities, said community spread is
the most relevant factor in how severely a nursing home has been impacted by COVID.
“In areas where the COVID-19 numbers are high, facility staff contract the virus, and because of the asymptomatic spread, they bring it into the facility,” Barrett noted.
All nursing homes were locked down as the pandemic spread, meaning only employees could enter. Families were prevented from visiting loved ones.
Lots of violations
The Hearst review found that federal inspectors at the Abbott Terrace Health Center in Waterbury cited the facility four times in 2020 for inadequate infection procedures, and once in 2019 and 2017.
The April 2020 violations include failing to ensure residents wore masks and not maintaining social distancing.
As of Jan. 12, 52 patients at the two-star rated facility
have died from COVID.
Yet similar infection protocol violations were found at the Chestelm Health & Rehabilitation Center in East Hampton, a five-star rated facility that has not lost a patient to COVID.
Inspectors in May 2020 cited Chestelm for not separating COVID and nonCOVID patients and for inadequate use of personal protective equipment.
Dr. Vivian Leung, director of the infection program for the state Department of Public Health, acknowledged the impact of community spread.
“Our epidemiologists, like epidemiologists across the country and those at CDC, have found that community incidence is a major contributing factor to nursing home cases,” Leung said. “We cannot effectively protect our most vulnerable unless we control community spread.”
Leung added, “These outbreaks are multi factorial, but the link to community
incidence when controlling for other factors is clear. Not even vaccination alone can prevent these outbreaks, as vaccination is not 100 percent.”
COVID spread
The recent study by Harvard University, conducted with support from the National Institute on Aging and National Institutes of Health, examined COVID-19 outbreaks in New York, Detroit and Cleveland.
The study found that the intensity of COVID-19 outbreaks in nursing homes mirrored the rate of spread among the general population near the facility.
Other researchers offered similar assessments.
“If you’re in an environment where there are a lot of people in the community who have COVID, the patients in the building are more likely to have COVID,” said Vincent Mor, a professor for health services and policy at School of Public Health at Brown University.