Nursing homes fail infection control

Dozens are found to have deficiencies in protection

Sixty-four nursing homes in Maryland failed to take sufficient infection control measures to protect residents from the coronavirus, according to state inspection records provided to The Baltimore Sun.

Ten have faced significant fines based on the inspection surveys, from $70,000 to $380,000, including two previously reported by The Sun. The 54 others were ordered to develop a plan to fix the problems.

Forty-five facilities received smaller fines for not completing mandatory testing and not reporting records to the state.

The large number shows the challenges in protecting a particularly vulnerable population and that more attention is needed, observers say. Seniors, many of whom have underlying health conditions, have made up a disproportionate share of deaths in Maryland from COVID-19, the coronavirus-related disease.

“In the pre-COVID world when the state conducted infectious disease surveys or inspections, they were really focused on a limited number of things potentially affecting a small number of staff, residents or patients,” said Joseph DeMattos Jr., president of Health Facilities Association

of Maryland, which represents skilled nursing and rehabilitation centers.

“In the new normal of COVID, the surveys and inspections focus on protocols related to a virus that potentially impacts all of the workers, residents and patients in the nursing home. That has been a challenge for the nursing homes.”

State health officials say all 226 of the state’s certified nursing homes have now been surveyed, including more than 90 conducted from July 21 to Aug. 16, the records of which the state provided to The Sun after a public records request.

The top fine of $380,000 was levied against the Charles County facility Sagepoint Nursing and Rehabilitation Center in May after at least 37 people died from the virus. It was the first large fine issued by the department, and at the time, officials there said they had taken aggressive measures to protect residents.

Nine other homes faced significant fines related to the surveys between May and mid-August, records show, including Pleasant View Nursing Home in Mount Airy, which was fined $70,000 in June, after experiencing one of the state’s earliest large outbreaks.

Another was Collingswood Rehabilitation and Healthcare Center in Rockville, which was fined $275,000 in June.

Collingswood said in a statement that officials did not agree with the state’s assessment.

“Collingswood Rehabilitation & Healthcare Center is committed to the effective care of our residents as well as compliance with all applicable regulatory requirements,” said Jenelle Onyenemezu, Collingswood’s administrator, in a statement. “We believe the facility is in compliance and are continuing to cooperate with the regulatory process while pursuing an appeal.”

Others with significant fines were:

■ Potomac Valley Rehabilitation and Healthcare in Rockville, fined $120,000 in June.

■ Kensington Healthcare Center in Kensington, fined $294,000 in July.

■ Brinton Woods Nursing & Rehabilitation Center in Sykesville, fined, $315,000 in July.

■ St Joseph’s Ministries in Emmitsburg, fined $280,000 in July.

■ Cadia Healthcare in Hagerstown, fined $215,000 in July.

■ Overlea Health and Rehabilitation Center on Belair Road in Baltimore, fined $150,000 in July.

■ Heritage Harbour Health and Rehabilitation Center in Annapolis, fined $78,000 in August.

“The safety of our residents, associates and potential visitors is our top priority,” said Molly Gaus, a spokeswoman for Ascension Living, which operates St. Joseph’s. “We continue to work in collaboration with local and state officials to maintain the well-being and safety of those we serve. Thanks to our focus on infection prevention, our residents have remained free of COVID-19.”

None of thee other centers responded to a request for comment Wednesday.

An additional 13 homes did not complete mandatory testing and faced resulting fines ranging from $4,000 to $20,000, according to records.

Republican Gov. Larry Hogan ordered all the nursing homes to regularly test staff and residents, though state funding for the staff tests ended mid-August.

There also were 32 facilities that were fined $250 for not making necessary records reports to the state electronic records system, called CRISP.

According to the inspection surveys, deficiencies at the nursing homes included such things as failing to keep incoming residents who potentially carried the virus separate from other residents, or lax cleaning and hand hygiene that subjected staff and residents to potential infection. Many of the facilities have reported infections.

Some facilities were cited for deficiencies unrelated to the virus but uncovered during the inspection visits, such as lack of proper care for residents or recordkeeping troubles.

State figures now show that there have been15,137 cases among nursing home and other senior living facility residents and 2,130 deaths — nearly three in five of all related deaths in the state.

More than 130 senior living facilities have reported cases, state data shows.

Nursing homes were responsible for some of the biggest outbreaks early in the pandemic, turning focus and resources to the facilities.

The state inspectors from the Office of Health Care Quality, however, got off to a slow start inspecting the facilities because of a lack of protective gear for inspectors, records reviewed by The Sun have shown.

The particular threat to seniors means the state should have done more to offer guidance and funding to the facilities, said state Sen. Clarence Lam, a Howard County Democrat and physician who has closely followed the state’s response.

He said Hogan announced a “strike team” to aid nursing homes in April, yet some of the deficiencies cited by the health department were found as late as August. That means the efforts did little to curb the conditions that have led to infections and deaths, he said.

“The number of deficiencies is surprising given that there has been so much attention to COVID in nursing homes,” he said. “Why hasn’t the state done more to help these facilities get a grasp of this problem? … There is a lot to be concerned about.”

Lam said he’s also heard from constituents who have been largely kept out of the facilities for safety but also received insufficient information about their relatives.

Kristi Halford said she has been concerned about the well-being of one of her relatives in a Baltimore-area facility because family members have not been allowed much access during the pandemic. Normally, she said they serve as advocates for routine care.

Halford said her uncle had an eye infection go unattended, and that he’s gone without baths because he needs assistance. One day he went without meals because his bell failed to call an attendant. Since the pandemic, staff also has taken longer to return family calls and she’s noticed more worker turnover.

“I understand COVID is challenging for everyone, but the lack of compassion and transparency with families is just ridiculous,” she said.

“For many residents like my uncle, they don’t want to be a bother so they just deal with it,” Halford said. “So when they do tell you about some of the things happening, it really is heart-breaking knowing what they’ve experienced and being helpless to do anything about it. Under COVID restrictions we have to trust our loved ones are being cared for properly because visitation is limited.”