Articles Posted in coronavirus

A new report by the Associated Press illustrates the devastating toll of the Covid-19 pandemic on nursing home residents across the country. The tragedy is not limited to Covid-19 deaths themselves, but also to deaths from other causes that ballooned as staff dealt with Covid-19 patients. One expert cited in the report estimated that “for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes.” Ultimately, they concluded, there may have been more than 40,000 more “excess deaths” in nursing homes since March, compared to the same period in previous years.

The expert, professor Stephen Kaye at the University of California, San Francisco, attributes the spike in excess deaths to staffing issues at nursing homes. By comparing death rates at nursing homes that experienced outbreaks to nursing homes that didn’t, he found that “the more the virus spread through a home, the greater the number of deaths recorded for other reasons,” which suggests that healthcare workers were “consumed” caring for Covid-19 patients—and/or contracted the illness themselves—and therefore unable to devote adequate care to residents without Covid-19. Kaye suggests this effect was compounded by longstanding staffing issues at nursing homes: “In 20 states where virus cases are now surging,” the report observes, “federal data shows nearly 1 in 4 nursing homes report staff shortages.” Continue reading

Carmel Richmond Healthcare and Rehabilitation Center has suffered 58 fatalities due to Covid-19, according to state health records released on July 30, 2020. The nursing home has also received 7 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on July 31, 2020. One of those citations involves findings of infection control deficiencies. The Staten Island nursing home’s citations resulted from a total of three surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not properly prevent and control infection. Section 483.65 of the Federal Code requires nursing homes to maintain an infection control program designed to stave off the development and transmission of disease. An October 2016 citation found that Carmel Richmond Healthcare and Rehabilitation Center did not ensure such. The citation specifically describes a Certified Nursing Assistant neglecting to take off his gloves after providing incontinent care to a resident, and a Registered Nurse placing “soil linens on top of the resident overbed table.” As for the CNA, the citation states that he had provided the resident with perineal care “when it became evident that he would need more towels and linens,” removed and disposed of his gloves, and left the room; however, according to the citation, he “Did not wash his hands after removing his gloves and proceeded to remove clean linens from the linen room.” He also did not wash his hands with soap and water after providing care, according to the citation. In an interview, he told a health department surveyor “that he completed CNA training two months ago and was hired at the facility through an agency,” that he forgot to wash his hands. As for the RN, the citation states that she put the soil linens on the resident’s overbed table, and that she said in an interview “that she was aware that she should not have placed the soiled linen on top of the residents overbed table.”

2. The nursing home did not conduct accurate resident assessments. Section 483.20 of the Federal Code stipulates that nursing homes must conduct resident assessments that “accurately reflect the resident’s status.” An October 2019 citation found that Carmel Richmond Healthcare and Rehabilitation Center did not ensure such. The citation specifically describes a resident with no pressure ulcer during the assessment period who “was documented… as having an unhealed Stage 2 pressure ulcer.” In an interview, a Registered Nurse said that the resident had “no pressure ulcer at present but only skin redness on the left buttock.” A plan of correction undertaken by the facility included the review and correction of the resident’s assessment.

Cortlandt Healthcare suffered 12 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 18 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020, including one citation over its infection control practices. The Peekskill nursing home’s citations resulted from a total of two surveys by state inspectors. The violations they describe include the following:

1. The nursing home fell short in its infection prevention practices. Section 483.80 of the Federal Code requires nursing home facilities to create and maintain programs designed to prevent and control infection, and to create a safe and sanitary environment for residents. A March 2017 citation found that Cortlandt Healthcare failed to ensure such. The citation states specifically that the nursing home “did not ensure that it implemented a system of surveillance and investigation to identify possible communicable diseases before they can spread to other persons in the facility for seven residents.” It goes on to state that the facility failed to report “cases of skin infection resembling scabies” to state health authorities. It goes on to describe residents with rash and itching symptoms that led the facility to suspect a scabies infestation. In an interview, the facility’s Director of Nursing said that Cortland Home had “no existing policy and procedure for reporting, investigating, and controlling scabies infestation before they can spread to other persons in the facility.” One of the residents suffering from the symptoms “was reported crying hysterically and stated she can’t take the itching anymore.” A plan of correction undertaken by the facility included the placement of affected residents on isolation precautions and the development of new facility policy.

2. The nursing home did not properly store and label medications. Section 483.45 of the Federal Code requires nursing homes to label drugs and biologicals “in accordance with currently accepted professional principles, and include… the expiration date when applicable.” An August 2018 citation found that Cortlandt Healthcare did not comply with such. The citation states specifically that the facility did not “ensure that medications were discarded and prevent their potential use beyond the expiration” in connection to one of three medication carts, in which an opened vial of a redacted medication “was found in use after the recommended discard date.” In an interview, the facility’s Licensed Practical Nurse in charge of medication administration “did not give any explanation was to why the expired… vial was not discarded after the 28 days.” A plan of correction undertaken by the facility included the discarding of the expired vial.

Elderwood at Waverly suffered 19 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 17 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020. It was additionally the recipient of a 2019 fine in connection to findings in a 2018 survey that it violated unspecified health code provisions. The Waverly nursing home’s citations resulted from a total of six surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not properly supervise residents to prevent accidents. Section 483.25 of the Federal Code requires nursing homes to ensure resident environments are kept as free as possible of accident hazards, and that residents received “adequate supervision and assistance devices to prevent accidents.” A January 2019 citation found that Elderwood at Waverly failed to ensure residents received an adequate level of supervision with the use of assistance devices. The citation specifically describes a resident with “moderate cognitive impairment” who required the assistance for transfers and walking. “The resident utilized a wheelchair and walker, was not steady when moving fro a seated to standing position and for surface to surface transfers,” according to the citation, which goes on to describe an instance in which the resident was observed “self-propelling from the dining room to her room using doorways and handrails to assist” and with her feet under her wheelchair’s leg rest foot plates; it also describes another instance in which she stood from her wheelchair to move to the other side of a table in the dining room, and another in which she self-propelled with her feet under her wheelchair’s leg rests. In an interview, the facility’s Director of Therapy stated that “any resident who self-propelled in a wheelchair with their legs and feet should not have leg rests on the chair due to the risk to fall and impeding mobility.” A plan of correction undertaken by the facility included a revision of the resident’s care plan concerning the use of leg rests.

2. The nursing home did not protect residents from abuse. Section 483.12 of the Federal Code requires nursing homes to protect each resident’s right “to be free from abuse, neglect, misappropriation of resident property, and exploitation.” An October 2018 citation found that Elderwood at Waverly failed to ensure such. The citation specifically describes a resident who “was observed on video being hit by facility staff.” According to the citation, a Registered Nurse “bent to kiss the resident on her forehead” after administering medication, at which point the resident struck theRN in the face, and the RN “responded by grabbing and slapping the resident’s left arm.” A plan of correction undertaken by the facility included the termination of the RN.

New York State Veterans Home at Montrose: Infection Citation, Covid Deaths

New York State Veterans Home at Montrose suffered 13 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 26 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020. One of those citations detailed findings of deficient infection control practices. The Montrose nursing home’s citations resulted from a total of five surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not employ adequate measures to prevent and control infection. Under Section 483.80 of the Federal Code, nursing home facilities are required to establish and maintain a program to prevent and control infection, one that is adequately designed to ensure residents a safe and sanitary environment. An August 2016 survey found that New York State Veterans Home at Montrose did not ensure the effective establishment and/or maintenance of an infection prevention and control program. The survey lacks additional detail on the citation, though it specifies that the scope of the deficiency was “widespread” and “pervasive throughout the facility”; that it had caused no actual harm and put no residents in immediate jeopardy, although it “has caused minor discomfort and has the potential to cause more than minimal harm”; and that it was corrected by the facility as of November 5, 2016.

Long Island State Veterans Home suffered 66 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 10 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020. The Stonybrook nursing home’s citations resulted from a total of two surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not take adequate steps to prevent accidents. Section 483.25 of the Federal Code stipulates that nursing homes must ensure resident environments remain as free from accident hazards as is possible, and that residents receive adequate supervision to prevent accidents. An August 2016 citation found that Long Island State Veterans Home failed to ensure such for one resident. The citation specifically describes a resident who “was observed during a meal being fed by a family member using unsafe techniques.” It goes on to state that the resident was “seated with his head slightly extended,” while the family member was standing over the resident “Forcing his hands down on the table with her left hand while feeding the resident with a spoon.” In an interview, the facility’s Charge Nurse Registered Nurse told a surveyor that the family member “does feed the resident for lunch and dinner three times a week.” In a separate interview, the family member said “she holds his hands down as a distraction so he will eat the food off the spoon.” A plan of correction undertaken by the facility included the education of the family member regarding safe feeding practices.

2. The nursing home did not ensure the reporting of medication irregularities. Section 483.45 of the Federal Code provides for the regular review of resident drug regimens by a licensed pharmacist, and requires the pharmacist to report any irregularities to the resident’s attending physician. A March 2019 citation found that Long Island State Veterans Home did not ensure such. The citation states specifically that a resident received 2.5 milligrams of a redacted medication every eight hours when necessary for 14 days, “without supporting documentation for the use.” The citation additionally states that there was “no documented evidence the Pharmacy Consultant” reported the irregularity to the resident’s physician. The citation states that this deficiency had the “potential to cause more than minimal harm.”

A new edition of the Long Term Care Community Coalition Elder Justice Newsletter asks a simple question: does providing a nursing home resident breakfast in their soiled bed constitute harm? How about failing to provide a stop date for a resident’s psychotropic medication?

“No Harm” deficiencies refer to citations of rule violations at nursing homes in which health inspectors determined that the violations caused “no harm” to residents. As the LTCCC notes, data provided by the Centers for Medicare & Medicaid Service, which mandate minimum standards of care for nursing homes participating in their programs, show that more than 95% of nursing home health citations describe “no harm” deficiencies. The LTCCC argues, however, that these no harm citations reflect systemic failures to recognize the suffering of nursing home residents, which in turn results in systemic failures to hold nursing homes accountable through financial penalties. “In the absence of a financial penalty,” the newsletter states, “nursing homes may have little incentive to correct the underlying causes of resident abuse, neglect, and other forms of harm.”

The newsletter proceeds to provide instances of health violations in which regulators determined that no harm was done to the resident in question. For example:

Schulman and Schachne Institute for Nursing and Rehabilitation suffered 26 fatalities from Covid-19 as of June 23, 2020, per state records. The nursing home also received 12 citations finding it violated public health code between 2016 and 2020, according to health records accessed on June 24, 2020. One of those citations concerned infection control procedures. The facility has also received a 2012 fine of $12,000 in connection to findings in a 2010 inspection that it violated health code provisions regarding accidents and the maintenance of residents’ nutritional status. The Brooklyn nursing home’s citations resulted from a total of 3 surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not take adequate measures to prevent infection. Section 483.80 of the Federal Code stipulates that nursing homes must establish and maintain an infection prevention and control program in order to ensure residents a safe and sanitary environment. A February 2018 citation found that Schulman and Schachne Institute for Nursing and Rehabilitation did not ensure such. The citation states specifically that a surveyor observed an uncovered oxygen mask and tubing “wrapped around the metered oxygen valve, and exposed to room air.” The surveyor also observed two residents’ Foley catheter tubes touching the facility’s floor. Both were in contravention of infection prevention and control best practices. A plan of correction undertaken by the facility included the re-education of relevant staff.

2. The nursing home did not ensure physician consults were completed in a timely manner. Section 483.30 of the Federal Code stipulates that nursing homes must ensure a residents’ primary care physicians review the resident’s program of care in a timely fashion, including specialist consultations. A June 2017 citation found that Schulman and Schachne Institute for Nursing and Rehabilitation did not ensure such. The citation states specifically that when a resident requested a podiatry consult and subsequently received it, their primary physician was not made aware of it until over a week later. As such, the citation states, a treatment recommended by the podiatrist was not promptly implemented. A plan of correction undertaken by the facility included the implementation of a policy to address prompt notification of primary care physicians regarding consultants’ recommendations.

The Phoenix Rehabilitation and Nursing Center suffered 17 fatalities from Covid-19 as of June 23, 2020, per state records. The nursing home also received 32 citations finding it violated public health code between 2016 and 2020, according to health records accessed on June 24, 2020. One of those citations concerned infection prevention and control deficiencies. The facility has also received a 2010 fine of $4,000 in connection to findings in a 2009 inspection that it violated health code provisions regarding accidents and administrative practices. The Brooklyn nursing home’s citations resulted from a total of 5 surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not adequately implement infection prevention and control protocols. Under Section 483.80 of the Federal Code, nursing homes must create and maintain infection prevention and control programs. An October 2019 citation found that The Phoenix Rehabilitation and Nursing Center did not ensure such. The citation states specifically that employees did not wear proper personal protective equipment when they entered the room of a resident on contact precautions, and that the facility’s Infection Prevention and Control Program had not been reviewed and/or revised since a redacted year. The citation goes on to describe a Licensed Practical Nurse entering the room of a resident on contact precautions with only a mask over her nose and mouth, and no gown. She was observed checking a resident’s identification band and applying a cuff to the resident’s arm “without the use” of gloves she was holding in one of her hands, which she through away after checking the resident’s blood pressure. The resident was observed coughing and covering her mouth, according to the citation, but “was not encouraged or reminded to wash her hands after coughing into her hand.” The resident was observed wiping her nose with a tissue, placing it on a table, and then extending her fingers for a fingerstick test, but the LPN “did not encourage the resident to wash her hands after wiping her nose and before doing the fingerstick test,” according to the citation. A plan of correction undertaken by the facility included the educational counseling of relevant staff.

2. The nursing home did not follow food safety standards. Section 483.60 of the Federal Code stipulates that nursing homes must store and prepare food “in accordance with professional standards for food service safety.” An October 2019 citation found that The Phoenix Rehabilitation and Nursing Center did not ensure such. The citation states specifically that internal temperatures of cold foods were not maintained at professional standards. An observer noted various sandwiches at temperatures above the standard maximum temperature of 41 degrees Fahrenheit, the citation states. In an interview, the facility’s Food Service Director said that “the sandwiches should be stored in the 2 inch pan shingles in the refrigerator.” A plan of correction undertaken by the facility included the discarding of the offending sandwiches and the replacement of the sandwich refrigerator.

Autumn View Health Care Facility has received 18 citations over violations of public health code between 2016 and 2020, according to health records accessed on July 13, 2020. The Poughkeepsie nursing home’s citations resulted from a total of four surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not employ adequate infection control procedures. Section 483.80 of the Federal Code mandates that nursing homes must establish and maintain infection prevention and control procedures so as to ensure residents a safe and comfortable environment. A July 2019 citation found that Autumn View Health Care Facility did not ensure such. The citation states specifically that while caring for a resident, a Certified Nursing Assistant “did not change gloves and wash hands after cleaning feces prior to washing another area on the resident.” The citation goes on to state that the CNA touched surfaces in the room with contaminated gloves. According to the citations, all of the above conduct was in contravention of facility infection prevention and control policy. A plan of correction undertaken by the facility included the disinfection of surfaces in the room and the counseling of the CNA.

2. The nursing home did not take adequate measures to protect residents from abuse. Section 483.12 of the Federal Code stipulates that nursing homes must ensure residents are free from abuse, including verbal abuse. A May 2018 citation found that Autumn View Health Care Facility did not ensure such for one resident. The citation states specifically that a Certified Nursing Assistant “verbally and mentally abused the resident and used an obscene gesture toward the resident.” According to the citation, another CNA witnessed the incident, but did not immediately report it to facility staff. A plan of correction undertaken by the facility included the counseling and disciplining of the offending CNA.

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