With nursing homes now on the front lines to contain the coronavirus pandemic, federal inspection records show Illinois’ facilities have been among the worst in the nation for an important measure of patient protection: following rules to contain infections.
An analysis by the Chicago Tribune raises new concerns about how well the homes can protect more than 80,000 residents under their care. While the industry has stressed its beefed-up response to screen for and contain any spread, advocates for residents worry about an industry that has sometimes struggled to properly care for residents -- even before the emergence of a pandemic that particularly endangers older, more frail residents.
“This is an extraordinary circumstance,” said AARP Illinois State Director Bob Gallo. “And judging by the track record we’ve seen before, compliance needs to be ensured."
The Tribune analysis studied federal inspection data on infection control for facilities certified by Medicare and Medicaid, representing the vast majority of nursing homes. The analysis found that 89% of Illinois homes -- 642 of 723 -- have been cited at least once since 2016 for violating infection control regulations. Only two states, Michigan and California, fared worse, and just barely.
The best-scoring states still had problems with infection control, but in those states just a third of their homes were cited for such infractions, the analysis found.
Federal officials this month ordered stricter enforcement of infection-control rules at nursing homes, with the CDC releasing a study Wednesday that emphasized the importance of keeping the disease out of facilities and from spreading within them.
“Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19,” the study noted.
The Illinois Department of Public Health did not say how it’s changing its inspection process, beyond issuing new guidance to homes, but it has said it’s working with homes to limit visitors and screen workers.
“Long-term care residents are our most vulnerable population and at the greatest risk of severe illness,” the department’s director, Ngozi Ezike, said at a Wednesday briefing.
‘Like you’re a bunny’
The Tribune analysis found that most Illinois long-term care facilities have been cited at least twice since 2016 for either failing to have a program or implement one for preventing infections and keeping them from spreading.
The findings don’t surprise Francine Rico, who has been a certified nursing assistant at a South Shore home for 22 years and also serves on the executive committee of the union representing many Chicago-area workers, SEIU Healthcare Illinois.
Rico said there’s simply too few employees.
“You feel like you’re a bunny moving down a track because you can’t take care of these residents properly because you’ve got so many of them,” she said, adding the pandemic could exacerbate the problems.
“It’s devastating. It’s scary right now. We need the people to hear us crying. We are crying. We are crying for our residents. We are crying for us.”
Among homes cited twice since 2016 is the Willowbrook facility that housed the first Illinois nursing home resident to test positive for COVID-19. By Wednesday, the state announced, the home had 32 additional residents testing positive, plus 13 members of the staff.
The home, Chateau Nursing and Rehabilitation Center, was cited in 2017 for multiple infection-control mistakes. Among them, records show: The facility’s assistant director of nurses, also described as an infection-control nurse, violated federal rules while trying to administer medicine to a patient with a drug-resistant infection.
A year later, inspectors reported that staff members didn’t wash their hands or change gloves enough, and found one resident’s bedding was wet with a “brownish liquid substance.” The staff told inspectors it was from an hour-old spill from rectal-bag tubing. The resident’s relative complained to inspectors of finding a similar spill 1 \u00bd weeks earlier and “was very concerned about infection control.”
“She (the patient) has been to the ICU (intensive care unit) twice already for infection,” the relative told the inspector, according to the inspection report. “I don’t see things sanitized, considering it is an infection control room. The beds are not made, and there is dust all over the side tables.”
The home -- rated “below average”’ for overall care by federal regulators -- is one of at least 18 in Illinois and Indiana managed by Extended Care Consulting, according to state records.
Extended Care issued a statement that did not directly address the citations but said it continues to work with government health officials and remains diligent about infection control.
“Our staff continue to work diligently to ensure the health and welfare needs of our residents are being met,” the statement said.
Even before the pandemic, infection control had long been a hot topic in the health care industry amid a series of investigations and studies linking widespread failures to more illness or death. Among them was a 2002 Tribune report on the deadly spread of infections in hospitals, and a 2017 report by Kaiser Health News on how nursing homes repeatedly violated infection control rules with little punishment.
But the plight of nursing home residents has become a top concern of health officials amid the coronavirus outbreak. The dangers were shown in one early U.S. cluster spawned at the Life Care Center of Kirkland, near Seattle. As of Wednesday, federal authorities linked 23 deaths to the facility. It noted the virus had infected 81 of roughly 130 residents, along with 34 health care workers and 14 visitors to the facility.
Federal officials have taken the COVID-19 threat to nursing homes so seriously that on March 4 they directed inspectors to stop doing “non-emergency” reviews of facilities and “turn their focus on the most serious health and safety threats like infectious diseases and abuse” with a specific focus on infection-control procedures.
Those procedures have been required since 2016 in an attempt to quickly identify and contain the spread of infections and communicable diseases to protect residents, staff, volunteers and visitors. Rules for homes include exactly where and when to take off gloves or put them on, where and for how long to wash hands, and how to sanitize equipment.
At the Seattle-area home where COVID-19 spread, records show the facility was cited last year for several poor infection-control practices, including staffers not wearing enough protective gear, a poorly ventilated laundry room that could spread germs and a kitchen worker using the same gloves to handle residents’ dirty dishes and then to clean dishes.
During that review, inspectors noted the facility had two flu outbreaks in one month that sickened a combined 17 residents and seven staffers. A Washington Post investigation has since documented how the home incorrectly assumed it was having another flu outbreak as COVID-19 took hold there.
Still, if that facility were in Illinois, its citation record for infection control would be among the better places -- with just one violation issued since 2016.
One home, seven citations
In the Chicago area, the Tribune found 77 facilities with three or more citations since 2016. Of those, nine had five or more citations.
One had seven, the most of any in the region. Regulators have given that facility, Aperion Care Forest Park, its worst overall care rating of “much below average.”
Inspectors in 2017 saw workers there repeatedly failing to wash hands as they moved between patients, according to an inspection report.
Eight months later, inspectors returned to find a housekeeper who didn’t wear protective gear when mopping a room where a patient was specially isolated to avoid disease spread, then using the same mop and bucket solution to clean other rooms, records show.
A month after that, the facility’s nursing director and a staffer were observed changing a soiled incontinence pad of a patient isolated for infection control. The staffer used the same gloves to wipe the patient, change the pad and touch doorknobs, a curtain and side rails. The nursing director also wiped the patient with towels that had been placed directly on the patient’s dresser.
Another patient in isolation was found in her wheelchair with urine- and stool-stained pants. Two staffers changed her and cleaned her, but didn’t change gloves, touching not only the patient’s body but bed controls, doorknobs and a bedside table, inspection records show.
Three more times in 2018, inspectors cited the facility for employees not washing hands or changing gloves and repeatedly not wearing protective gear for patients being isolated to stop disease spread.
During the facility’s most recent review, Jan. 9, an inspector watched licensed practical nurses take the blood pressure of six patients without sanitizing the device between patients, or even after one nurse dropped the device on the floor.
The facility is part of a chain of nearly 50 facilities across Illinois, Indiana and Missouri. When asked about the citations, the chain’s spokeswoman, Heather Levine, did not directly respond but said the chain “completes monthly handwashing competencies with our staff.”
In an email, she said the chain has an infection preventionist who is helping the chain implement CDC recommendations for homes to battle the virus. The chain, she wrote, uses “strict handwashing procedures,” requires that staff wear protective gear, barred visitors and screens staff members for illness.
Her statement echoed one posted earlier online for residents’ families: “We are taking a proactive approach in protecting our residents and your loved ones."
An industry under scrutiny
Pat Comstock, who leads the trade group Health Care Council of Illinois, told the Tribune in a statement that, even amid the pandemic, the group’s 300-plus member facilities “have the highest expectations and safeguards in place, always focused on providing the best care for elderly and infirm residents."
She said: “It is true the coronavirus has put additional stress on existing workforce shortages, but the same could be said for so many in the healthcare industry today.”
Still, those who’ve long railed against industry practices -- from a major workers union to advocates for the elderly -- question the coronavirus-fighting capability of Illinois nursing homes.
Longtime attorney Steven Levin, who specializes in nursing-home abuse and neglect, said the industry’s problems with controlling infections comes down to a business model built on overworked, low-paid workers.
“The staff doesn’t have time to wash their hands. The staff doesn’t have the time to use realistic precautions when dealing with residents in isolation. The staff may be coming to work sick because they’re receiving such a small wage that they can’t afford to take time off from work,” he said.
“When you tax an already strained system, and now you’re asking them to do something extraordinary in difficult situations. … Sometimes those systems fail,” he said.
AARP Illinois is calling for the state to ensure homes keep minimum staffing and immediately tell the state when they can’t. The group also wants the state to mandate paid leave so sick workers can stay home without fear of missing payment on bills or losing jobs.
In addition, AARP Illinois is pushing the state to work with families and caregivers to be able to stay in contact during the lockdowns and to mandate that facilities tell residents’ families immediately if a resident or staffer has tested positive for the virus or been put in quarantine because of exposure.
“This is a time of crisis,” Gallo said. “Hopefully we all come together to address the situation.”
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