Report: Limit staff to work at 1 nursing home
A policy consultant’s interim report on the response to the coronavirus pandemic in Connecticut’s nursing homes recommends that facilities create longer shifts to limit staff departures and arrivals, and assign them to the same units each day.
And, the report warns, state officials should prepare for the possibility of a so-called second wave of the virus, particularly in lining up recovery centers for COVID-positive patients to be transferred in order to keep the virus out of long-term care facilities.
Looking back, the state Department of Public Health was not prepared for the pandemic when it comes to long-term care facilities, according to the report, part of a $450,000 state contract with New Jersey-based Mathematica.
A total of 3,228 residents of nursing homes and assisted living facilities died in Connecticut as of Aug. 13, the latest date with totals available. Most were in nursing homes. That represents 73 percent of all Connecticut deaths — one of the highest percentages in the nation.
The report also recommends that the state Department of Public Health limit the number of workers who have jobs in multiple nursing homes; and to continue regular testing of staff, residents and outside personnel who visit facilities.
The report warned of the potential for further outbreaks under a state policy that allows facilities that have not had a COVID-19 case for two weeks, to skip further testing. That could allow asymptomatic cases to spread to others in the vulnerable Long Term Care (LTC) community.
The report pointed out that the initial responses to the COVID-19 outbreak were “undermined by gaps in scientific knowledge about how the virus spreads, the range and severity of symptoms (especially in older adults), and underlying factors that might place an individual at greater risk.”
Other findings:
The state’s emergency response and surveillance systems were not prepared for the COVID-19 pandemic.
While the DPH had a “robust” emergency response plan for hospitals, it “did not explicitly address LTC facilities” including assisted living locations.
Emergency state plans assumed adequate supplies of personal protective equipment (PPE) “and that only non-infected staff would work in health care facilities.”
In January, six of nine positions in the state Office of Public Health Preparedness and Response were vacant, indicating “insufficient capacity to monitor and manage emergencies at the start of the pandemic.”
During the outbreak, the DPH had to change the way it monitors infections, and develop new systems to monitor COVID-19.
“Current policy does not require ongoing testing of residents or staff who have previously tested positive for COVID-19,” the report, released Tuesday, said. “As new evidence emerges on how long immunity lasts, DPH should revisit this guidance and consider broader testing among people who have previously tested positive, particularly if community prevalence rates increase.”
The consultants reported that while one-third of state nursing homes had very few or no fatalities, half of those who died resided in about 26 percent of the facilities.
State Sen. Kevin Kelly, R-Stratford, ranking Republican on the General Assembly’s Aging Committee, said Tuesday that he believes the interim report “only scratched the surface” on the vulnerability of the nursing homes.
“The overall findings of Mathematica's initial review are alarming and only begin to touch on the many concerns I have heard from nursing homes, residents and their families,” Kelly said. “I have heard from nursing homes and residents' families about continued issues with quality of PPE, delays in mandating and making testing available that I hope Mathematica will investigate these issues in the coming days. It's clear the greatest generation paid the greatest price during this pandemic. We need urgency in correcting these issues and many others so that what happened this spring never happens to our most vulnerable again.”
The report does not name individual care facilities.
Nursing homes that are parts of chains, however, had about 40 percent more COVID-19 fatalities than those owned independently. And facilities with higher-rated staffs had fewer infections and fatalities.
In three years of inspections prior to the coronavirus pandemic, 68 percent of state nursing homes were cited for deficiencies in infection control.
Nursing home industry and company officials told Mathematica that high staff turnover was a problem, with a low statewide unemployment rate and staff positions filled by inexperienced workers, or left unfilled. Low pay was also cited.
During the pandemic, facilities experienced higher employee absences because of childcare needs in their homes. Others had preexisting conditions that caused fear of contracting the disease.