As coronavirus threatens NC nursing homes, have they planned for the worst?

As coronavirus threatens NC nursing homes, have they planned for the worst?
Health officials have announced an eighth case of the novel coronavirus (COVID-19) in North Carolina on Wednesday. (Source: WBTV)

NORTH CAROLINA (News & Observer) - Federal regulators last year ordered nursing homes to prepare for emerging infectious diseases.

Outbreaks of Ebola and Zika had prompted the U.S. Centers for Medicare & Medicaid Services to deem planning for an epidemic “critical.”

Nursing homes were supposed to update their emergency plans. But not everyone complied.

The plan that Elizabeth City Health and Rehabilitation recently submitted to emergency management officials outlines what to do if terrorists set off a “dirty bomb,” but says nothing about how to protect elderly residents from a pandemic, a more likely disaster.

With the novel coronavirus evading facilities’ efforts to keep it out, sloppy preparation could prove deadly.

Eighty percent of those who have died from COVID-19 were 65 or older, a preliminary analysis of U.S. data by the Centers for Disease Control and Prevention shows. People with underlying health conditions, a description that fits nearly all nursing home residents, are at particular risk.

“The grim reality is that, for the elderly, COVID-19 is an almost perfect killing machine,” Mark Parkinson, the president and CEO of the American Health Care Association, the primary nursing home trade group, said in a recent interview with CNN.

Roughly 20-30% of nursing home and assisted-living center residents infected with the virus will die, Parkinson’s group and the National Center for Assisted Living have estimated.

The virus can spread rapidly once it’s inside an elder-care facility.

At Life Care Center of Kirkland in Washington state, the initial epicenter of the U.S. outbreak, 81 residents were infected, a CDC investigation found. Staff and visitors were infected too. More than two dozen people died.

It’s unclear right now how many North Carolina facilities are battling an outbreak. The CDC and state health officials have not responded to The News & Observer’s requests for information.

Two assisted-living facilities in the Triangle have said a resident tested positive. But Robert Brown, a spokesman for the North Carolina Health Care Facilities Association, said Thursday that he has heard of no positive tests for COVID-19 in nursing homes here to date.

EMERGENCY PLANS FALL SHORT

The quality of emergency plans at elder-care facilities in North Carolina varies widely.

Assisted-living facilities must have a disaster plan, but they are not subject to any minimum standards. The plans are frequently cursory, as short as six pages.

Nursing homes that accept Medicare payments have to comply with much more stringent regulation. In February 2019, CMS added “emerging infectious diseases” to the threats they must consider.

To evaluate facilities’ readiness, The News & Observer requested disaster plans from officials in 20 counties.

So far, the newspaper has received only one nursing home plan that discusses when and how to use personal protective equipment to prevent spreading infection during an outbreak.

That document, for Trinity Grove, a Lutheran Services Carolinas facility in Wilmington, dedicates five pages to how to prepare for and respond to a pandemic, including how to deal with staff who fall ill.

Three plans reviewed by the newspaper don’t mention emerging infectious diseases at all.

An executive for SanStone Health and Rehabilitation said omitting discussion of pandemics from a document sent to local emergency managers doesn’t mean Elizabeth City Health and Rehabilitation is unprepared.

“I can assure you our center has extensive plans in place related to this emerging infectious disease threat, and I am happy to state we currently have no issues,” Darin Hopping, a regional manager for the company, wrote in an email. “Internal policies, procedures and general practices currently in place are compliant with CMS and state guidance, and are not required to be given to the public.”

Hopping declined to provide copies of those documents.

The company that manages Greendale Forest Nursing and Rehabilitation, a Snow Hill facility, also defended its readiness and did not provide an updated plan.

“We would like to stress that our foremost goal in everything we do is to provide for and protect the safety and well-being of our residents, staff and community,” Principle Long Term Care said in a written statement. “To this end, our Centers have in place effective and approved infection control protocols.”

The company said it has converted an old warehouse into a mask factory and partnered with a brewery to manufacture hand sanitizer.

Management of The Citadel Elizabeth City did not respond to repeated interview requests.

Industry representatives point out that nursing homes’ preparation for threats like COVID-19 is not limited to their emergency plans. They must also have someone on staff, at least part time, called an “infection preventionist.” And some nursing homes limited outside visitors even before that became required.

“While we are facing many unforeseen challenges, including limited access to personal protective equipment and staffing shortages, we are continuing to take proactive steps to prevent COVID-19 from getting into nursing facilities and from spreading if it does get in,” Adam Sholar, president and CEO of the North Carolina Health Care Facilities Association said in a prepared statement.

‘THESE STANDARDS HAVE MEANING’

North Carolina penalizes very few nursing homes for inadequate emergency preparedness.

But that doesn’t mean that facilities are ready for the worst, experts say.

Inspectors here have issued just 35 citations for emergency preparedness deficiencies since November 2017, with most of those citations indicating a failure to meet multiple planning requirements. Two nursing homes were cited twice.

South Carolina issued 105 deficiencies to 44 facilities in the same time period. Virginia issued dramatically more. Both states have significantly fewer nursing homes than North Carolina.

“That’s concerning,” Cas Shearin, the director of investigations and monitoring for Disability Rights NC, said of North Carolina’s numbers.

The data “could tell you two things,” Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy, said. “It could tell you that North Carolina facilities don’t have as many problems, that they’re doing a better job. That’s a possibility. The other possibility is that the state’s just not citing these deficiencies.”

Federal audits of how emergency preparedness rules are enforced in other states have found that inspectors overlooked many problems. Each of the states audited so far — Texas, California, New York and Missouri — have citation rates higher than North Carolina.

The North Carolina Department of Health and Human Services, whose employees perform the inspections, said that surveys were done according to federal training and guidance.

When the rules aren’t enforced, Edelman said, they risk becoming meaningless.

“These standards have meaning,” she said. “They are to protect public health and safety.”

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