CDC ‘Mortality’ Report Cites Nursing Home Risks as Cases Mount

(Bloomberg) -- Seattle-area nursing homes – including the Kirkland, Washington facility that’s been linked to 35 deaths – were probably vulnerable to the spread of the Covid-19 virus in part because staff members worked while displaying symptoms, according to a report released Wednesday by the U.S. Centers for Disease Control and Prevention.

Inadequate equipment likely played a role as well, as did a delay in recognizing the illness for what it was, according to the agency’s “morbidity and mortality” report. The findings may shed light on how long-term care facilities should respond to the threat the virus poses to their residents.

Already this week, nursing homes in Illinois, Georgia and Florida have reported confirmed cases of the new coronavirus to authorities. The virus is particularly dangerous for elderly people.

The CDC’s report provided the results of an outreach effort that contacted roughly 100 long-term care facilities in King County, Washington, including nine that had one or more confirmed Covid-19 cases as of March 9.

Emblem of Threat

The report doesn’t name any of the centers in question. But its description of “facility A” matches the experience of the nursing home operated by Life Care Centers of America Inc., which has become emblematic of the threat that the virus poses to residents of long-term care facilities. Officials at the center didn’t respond to requests for comment.

In addition to symptomatic workers, the agency cited four other factors that “likely contributed to the vulnerability of these facilities”:

* staff members who worked in more than one facility;
* inadequate familiarity and adherence to standard, droplet, and contact precautions and eye protection recommendations;
* challenges to implementing infection-control practices including inadequate supplies of personal protective equipment and items such as alcohol-based hand sanitizer;
* delayed recognition of cases because of low index of suspicion, limited testing availability, and difficulty identifying persons with Covid-19 based on signs and symptoms alone.

The effect of such delayed recognition became clear on Wednesday as Seattle-area health officials reported that a man in his 80s who had died at Life Care on Feb. 28 had Covid-19. That’s the same day the nursing home originally found out it had its first case. In other words, by the time officials were aware of the infection, it was already fatal.

In compiling their findings, CDC officials focused on several facilities that had “evidence of a cluster of respiratory illness” to seek information about their infection-control strategies and use of protective equipment, according to the report.

“Based on this information, the long-term care facilities were prioritized by risk for Covid-19 introduction and spread, and highest priority facilities were visited by response personnel for provision of emergency on-site testing and infection control assessment, support, and training,” the report says.

Gaining Foothold

The Trump administration has announced an effort to focus nursing-home inspections on infection-control measures to try to counter the virus’s spread. But reports from several states show that Covid-19 has already gained a foothold in other centers.

As of Wednesday, there were confirmed or suspected cases of coronavirus in 19 long-term care facilities in Florida, according to a spokesperson for the state’s Agency for Health Care Administration, which regulates such centers. A facility in DuPage County, Illinois, has 22 confirmed cases, Illinois Governor J.B. Pritzker said Tuesday. Two centers in Georgia have reported cases as well.

Long-term care advocates say that federal regulators and state inspectors have failed to hold nursing homes to appropriate standards of infection control – and often failed to exact meaningful penalties for violations.

In April 2019, inspectors cited the Life Care Center in Kirkland for a deficiency related to its “infection prevention and control program” for leaving soiled respiratory supplies, including an oxygen mask and tubing, on top of a resident’s bed mixed in with bedding and socks, even though the patient had recently been diagnosed with pneumonia, according to Medicare.gov.

The following day, a staff member entered that patient’s room without donning personal protective equipment despite a sign directing staff and visitors to wear masks, gowns and gloves when entering the room. The issues with infection and hygiene were rated 2 out of 4 on a scale measuring harm, meaning they represented “minimal harm or potential for actual harm.” The issues were listed on the site as having been corrected in late May 2019.

The Kirkland site was cited for 18 health violations in all during a 2019 inspection, a rate more than twice the national average for nursing homes. It’s below Washington state’s average level, which is 20.4 citations, according to data from Medicare.gov.

Overall, the center received an “average,” or three of five stars, on its health inspection rating on the federal website. The facility’s overall rating on a variety of criteria was five stars, or “much above average.”

©2020 Bloomberg L.P.