As COVID-19 Ravages Through Nursing Homes, Federal Government Considers Relaxing Infection Control Regulations

As nursing home residents continue to die at an alarming rate from COVID-19, the federal government is steamrolling forward with proposed rules that would relax infection control requirements at nursing homes and other long-term care facilities.

The rules, proposed by the Centers for Medicare and Medicaid Services (CMS) in July 2019, would eliminate the requirement that nursing homes employ a part-time infection preventionist (IP), replacing it with a vague requirement that an IP devote “sufficient time” to a facility. To be clear: The proposal was made before the pandemic. But CMS recently defended it, saying that it aims to reduce regulatory burden and strengthen infection control, according to a May 5 report by USA Today.

Andrew K. Mitnick, a partner at Feldman Shepherd Wohlgelernter Tanner Weinstock Dodig LLP, whose practice focuses on nursing home and long-term care facility neglect and abuse, has weighed in strongly against the proposal.

“Lax infection controls pre-existed and really exacerbated the COVID-19 problem in the vulnerable nursing home population,” Mitnick said. “It is unconscionable that the federal government is considering loosening infection control regulations at all, let alone during a pandemic that is killing our Greatest Generation,” he said.

How Many Nursing Home Residents Are Dying from COVID-19?

As of May 14, COVID-19 killed 30,130 residents and staff members in long-term care facilities in 35 states that publicly report fatality data, according to data published by the Kaiser Family Foundation. Pennsylvania reported 2,896 long-terms care facility deaths, while New Jersey reported 5,016 deaths, according to the foundation. Subsequently, Pennsylvania reported 3,086 COVID-19 nursing home and assisted living facility COVID-19 deaths in data released by the state Department of Health on May 19.

The foundation reports that in 38 states there were 152,118 cases of COVID-19 in long-term care facilities. Pennsylvania reported 14,599 long-term care facility cases, while New Jersey reported 26,763. All told, 41 percent of COVID-19 deaths in 36 states are in long-term care facilities, according to the Kaiser Family Foundation.

The May 19 data from the Pennsylvania Department of Health show that across Pennsylvania there have been about four dozen long-term care facilities in which at least 20 residents died of COVID-19. Twenty-eight of those facilities are in Philadelphia and its suburbs. The data, as reported by The Philadelphia Inquirer, indicate that there are 16 nursing homes in Montgomery, Delaware, Bucks, Chester and Philadelphia counties that have seen more than 100 resident cases. Seven facilities have seen 30 or more deaths, including both residents and employees.

Nursing homes in Philadelphia and its suburban counties with the highest coronavirus death counts include:

• Parkhouse Rehabilitation and Nursing Center, in Montgomery County: 136 resident cases; 13 employee cases; 48 deaths
• Broomall Rehabilitation and Nursing Center, in Delaware County: 139 resident cases; 22 employee cases; 40 deaths
• Neshaminy Manor Home, in Bucks County: 96 resident cases; 43 employee cases; 39 deaths
• Manorcare Health Services, in Delaware County: 151 resident cases; 31 employee cases; 34 deaths
• Saunders House, in Montgomery County: 119 resident cases; 32 deaths
• Immaculate Mary Center for Rehabilitation and Healthcare, in Philadelphia County: 91 resident cases; 0 employee cases; 32 deaths
• Oakwood Healthcare and Rehabilitation Center, in Philadelphia County: 91 resident cases; 0 employee cases; 30 deaths.

The newly released Pennsylvania data also show that nursing homes and assisted living facilities account for more than 68 percent of the state’s coronavirus-related fatalities. The data from the Kaiser Family Foundation show that 52 percent of New Jersey’s COVID-19 deaths have occurred at long-term care facilities.

How Many Nursing Homes Residents Fall Victim to Infectious Diseases?

According to the Centers for Disease Control and Prevention, 1 to 3 million serious infections occur every year in nursing homes, skilled nursing facilities and assisted living facilities. As many as 380,000 people die of infections in long-term care facilities every year.

Between 2016 and January 2020, health inspectors cited about 75 percent of nursing homes nationwide for failing to have or follow a plan to prevent the spread of infectious diseases, according to an investigative report by ABC Eyewitness News. The news organization analyzed inspection data obtained from CMS, focusing on infection control problems. It found that out of 695 nursing homes in Pennsylvania, 515 were cited with at least one infection deficiency. Out of 363 nursing homes in New Jersey, 262 were cited with at least one infection deficiency.

The violations ranged in severity. Many of the cases involved employees failing to wash their hands, failing to wear the proper protective gear, or allowing medical equipment to touch the ground. In nearly all of the cases, state health departments indicated nursing homes had corrected the concerns and re-trained their staff following the citations.

Aside from COVID-19, other infections commonly contracted by nursing home residents include pneumonia, urinary tract infections (UTI), diarrheal diseases, staph infections, and skin and soft tissue infections, Mitnick said.

How Can Nursing Homes Prevent COVID-19 and Other Infections?

The Association for Professionals in Infection Control and Epidemiology recommends the following infection prevention and control techniques for nursing home employees:

• Cleaning hands before and after touching another resident
• Cleaning and disinfecting environmental surfaces
• Removing soiled items (like used tissues or adult diapers from the environment)
• Wearing personal protective equipment (such as gloves, a gown, or a mask)

During the pandemic, CMS has advised nursing homes to:

• Restrict visitors, with exceptions for end-of-life situations
• Restrict volunteers and nonessential healthcare personnel and other personnel
• Cancel all group activities and communal dining
• Implement active screening of residents and healthcare personnel for fever and respiratory symptoms

CMS has additionally suspended non-emergency nursing home inspections across the U.S., which it says will allow inspectors to focus on COVID-19 issues.

Mitnick expressed concerns over the suspended inspections.

“While I appreciate all attempts to contain COVID-19, we have lost an important set of eyes that was protecting our moms, dads and grandparents,” Mitnick said. “Inspections are particularly important when family members, who are often the first line of defense against nursing home neglect and abuse, and who often assist their loved ones with feeding, grooming, and other daily living activities, cannot get into these facilities,” he said

What Should I Do If I Believe My Loved One Has Been Harmed by Inadequate Infection Control at a Nursing Home?

Mitnick recommend contacting a nursing home and long-term care abuse attorney immediately if you believe your loved one has been seriously injured or killed by a long-term care facility’s inadequate infection control to ensure that the victim’s and family’s legal rights are protected.

“The dangers of poor infection control are well-known to the operators of long-term care facilities,” Mitnick said. “There is simply no excuse for failing to adhere to well-established standards of care.”