IPCWell - Infection Control Consultant & Expert - United States

The recently published CNN article “Government action took months as nursing home workers died during the pandemic” showcases who the government and general public really think is to blame for the surge of COVID-19 in nursing homes.

The article featured a short video summarizing the unfortunate circumstances that faced Life Care Center of Kirkland, a nursing home that just happened to be the first U.S. epicenter of the COVID-19 pandemic. At least 39 people died in relation to COVID-19 linked to this nursing home. It is important to remember that during the beginning of the pandemic much was not understood about transmission of the virus and supply chains could not keep up with the demand for PPE. Additionally, testing for COVID-19 took multiple days, not the minutes that testing takes now with rapid-testing technologies. Life Care Center of Kirkland knew it needed help to combat this newly discovered virus. They reached out to government agencies requesting help but unfortunately received very little aid. The facility was blamed for the rapid spread of COVID-19 and was threatened with a loss of funding and fined over $600,000 by state and federal inspectors. The facility appealed and a state administrative judge determined that the state “provided relatively little evidence that the facility actually failed to meet any expected standard of care or failed to follow public health guidelines”. The federal case is still pending. This video characterizes the lack of support that nursing homes have been receiving from the beginning of this pandemic.

Unfortunately, rather than focusing on the troubles that have been impacting nursing homes, the rest of the article ends up focusing on the woes distressing the governing agencies, specifically OSHA. The stance of the article is that the federal agencies were not fast enough to “swiftly crack down” and hold nursing homes accountable during the COVID-19 pandemic. The article argues that if government agencies had issued more citations and had more staff available then they would have been able to better protect healthcare workers.

Wait…what? Hold the nursing homes more accountable? Seems like a contradictory story to me. Nursing homes were asked to fight the battle of this pandemic without adequate staffing, appropriate gowns, and without N-95 masks to protect themselves. When they were provided N-95 masks, they didn’t have a process for having all of their staff to be N-95 fit tested. These are not instances in which we should be implementing punitive damages for facilities who were drowning. Instead, we should have been offering them help support during these unprecedented times.

The article goes on to say that “PPE such as N-95 masks were being hidden from staff.”  Rationed is more the reality. Often, the facility had to lock away its supply of masks as they would often go missing. In some cases, nursing homes couldn’t even get real N-95 masks as all they were sent were KN-95 masks which do not provide the proper seal around the mouth and nose. When they were sent NIOSH approved N-95 masks they were only provided 1 size which left many workers unable to wear them appropriately, rendering them ineffective. Let’s stop BLAMING our nursing homes and focus on solutions. The lack of state and federal support certainly come up when attempting to locate accountability, but everybody was scrambling to fight this pandemic without an organized, coordinated response. Even though I see the government’s response of providing punitive damages rather than support and training exacerbating the situation, I certainly am not in the business of pointing fingers.

The facts remain that the feds announced on June 4, 2020 that they were suspending state and federal annual surveys and focusing on infection control surveys. In fact, over 80 million dollars was spent by the end of July to conduct these infection control surveys. The effort wasn’t collaborative to help the nursing home, but was punitive, a “gotcha” play. The article goes onto describe that over 3,400 nursing homes across the country were fined for infection control violations as of the end of July which resulted in over 15 million dollars in civil penalties. Again, this is just the facts. It would not be surprising if that number has doubled or tripled since this time.

One nursing home administrator told me that his staff was spending hours and hours to abide by the regulatory of paperwork instead of spending the time fighting the infectious disease.

Just as was described with the Kirkland Life Care facility, thousands and thousands of nursing homes across the country have had state and federal surveyors come onsite to nursing homes during their darkest hour. Only 1 new case of COVID-19 triggers an on-site survey. Surveyors come in and look for fault instead of areas where support is needed. Is issuing tens of thousands of dollars in fines to the nursing homes when they, in many situations, were powerless to control the circumstances they were experiencing the best way to combat a pandemic? Is it a system that places the health of the resident above all else? Or is it a system that purely shifts culpability?  Which system do we want our loved ones to be cared for in?