Zach Obront, Authority Magazine

Our elderly loved ones deserve to live out their final days with dignity and respect, not to be left alone to die in a broken system. But even before the COVID-19 pandemic, infectious diseases ran rampant in US nursing homes.

Between one and three million infections resulted in 380,000 deaths among nursing home residents each year. That’s over 1,000 people per day. All because the nursing home industry has been struggling with infection prevention and control practices (IPC) for decades.

In BROKEN, Dr. Buffy Lloyd-Krejci exposes an industry in dire need of a massive policy overhaul. Through interviews with patients, healthcare workers, advocate groups, and regulatory agencies, she discovers the critical flaws in a system that was set up to fail — and offers a bold vision for change.

I recently caught up with Buffy to learn more about why she wrote the book and the ideas she shares with others.

Why did you write this book?
Before the COVID-19 pandemic, long-term care facilities, commonly known as nursing homes, did not have a strong focus on infection control practices. It was no surprise that the Centers for Disease Control and Prevention (CDC) estimated that nearly three million severe infections led to 380,000 deaths each year. That’s more than a thousand deaths per day.

While these statistics are scary, the most maddening aspect of these numbers is the estimated percentage of preventable infections. Conservative estimates say 40 percent,
while some suggest up to 70 percent of infections, are preventable. Even on the low end, we are talking about saving four hundred lives every day. The consequences of not having infection control as a priority is dire.

The time is long past due to provide safe and effective care to our long-term care residents and a safe environment for the dedicated staff. As an expert in long-term care infection prevention and control, I have supported hundreds of nursing homes across the country and have witnessed the devastating consequences of COVID-19.

If you have a loved one now in the care of a nursing or rehabilitation home, this book will equip you to understand the true nature of that environment and what you can do to advocate change when necessary.

Now is the time to create change and to have our voices heard. Together, we can assist in shifting punitive strategies of control to a culture of collaboration and support, a culture that provides the best opportunity to give residents the care they deserve — and the working conditions expert caregivers are worthy of receiving.

What’s an idea you share that is really important for your readers to know?

As COVID-19 began ravaging nursing homes, the federal government had a tremendous responsibility to step up and provide a coordinated effort to protect the most vulnerable. However, the national response efforts were confusing and erratic, especially the government position of “enhanced enforcement,” which incorrectly assumed an iron fist would ensure that nursing homes provided the highest level of care to their residents.

Every year, a CMS-certified nursing home undergoes a federal survey, a much-anticipated event that can make or break a facility. These facilities are evaluated for compliance by an annual, unannounced state survey. In addition to the state verifying nursing home compliance, they recommend appropriate enforcement actions.

A state survey is the greatest source of stress for a nursing home. If the facility is found non-compliant, it can be denied reimbursement for payment or shut down. In March of 2020, CMS announced the suspension of “routine” annual state surveys and an “exclusive focus on immediate jeopardy situations and infection control inspections.”

Industry leaders would agree these policies were at best premature, and at worst probably dangerous. Despite this, CMS plowed ahead with a plan of allocating $80 million in state and federal funding to conduct surveys rather than COVID infection “surge” teams. That would be like firefighters showing up to your house while it’s ablaze, and instead of using water hoses, they’d fine you for faulty sprinkler systems.

This, during a time when these particular flames were unlike any ever seen, and the guidance in using your sprinkler systems had been confusing and sometimes impossible to implement. A time when you couldn’t get water to fill your sprinkler systems due to supply chain issues.
Policymakers were funding the citations instead of the water hoses necessary to put out the flames. It seemed backward — it was backward.

We must do better. We must transform the long-term care industry into a supportive healthcare system that provides safer, more reliable care for our loved ones.

How will following your advice improve your readers’ lives?

COVID-19 did not cause the issues addressed in this book. This global pandemic has merely been the catalyst for the world to see a broken healthcare system in dire need of repair. If we don’t take action now while we are awake and aware, then we will go back to “business as usual.”

I am already starting to see this in many nursing homes.

Infection preventionists are once again being pulled to work the floor instead of being dedicated to the infection prevention and control program. Infection control practices — such as handwashing, wearing the appropriate personal protective equipment such as gowns, the appropriate process for cleaning and disinfecting the environment of care — are becoming lax again.

It is my hope and prayer that this book will inspire you to take action, whether your loved one is in a nursing home or not. Chances are that someday you will need this kind of care. I’ve supplied resources that can support you in taking action, and I encourage you to use and share these resources.

Even if you don’t have a lot of time, these small steps collectively can set into motion lasting changes that will make life better for nursing home residents and their families, throughout the country.