Written: 6/25
Nursing homes are fighting battles on multiple fronts...
While we continue to advance our advocacy on racism in healthcare, we take a moment to provide context to the incredibly troubling situation for nursing homes and skilled nursing facilities in California and the U.S.
We highlight these issues, not to degrade, but to help nurses understand the cracks in our public health and healthcare system during COVID-19.
It's a detailed and somewhat lengthy issue, so let's dive in...
-Your ANA\California Team
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NURSING HOMES
Deja vu anyone? California is breaking records for COVID-19 cases again... and the United States isn't in great shape either.
California broke its previous record for the highest number of new Coronavirus cases in a single day, with
more than 6,000 reported
Monday. Over 2,000 of those came from Los Angeles County with
pandemic-related news reporting on hospitalizations, nursing homes, renters, and prisons, too.
This is only adding to nursing homes' difficult position as they face many internal and external battles, including...
- Increases in deaths and new cases,
- Incorrect data,
- Staffing issues,
- Infection control,
- Evictions of vulnerable patients, and
- Lawsuits.
Wait, just now??? On June 4th, the Centers for Medicare & Medicaid Services (CMS) posted its first set of federal COVID-19 nursing home data on a
new website. Although it captures data from all states, 12% of the nation’s 15,400 Medicare and Medicaid homes have not submitted figures for the count.
One step forward, two steps back... Saugus Rehab and Nursing Center in Saugus, Massachusetts, heard that the new Medicare website reported her facility had 794 confirmed cases of COVID-19 and 281 cases among staff with no deaths overall.
The facilities'
actual
numbers reported 45 residents had tested positive, 19 among staff, and five residents died...
The data is being called
"insanely wrong"
and a
"tangled mess." California Oregon, Oklahoma, New Jersey, and Pennsylvania nursing homes and SNFs are just some who echoed this sentiment.
Now, let's layer in infection control...
Approximately 82% of the nearly 1,200 nursing homes - 976 separate facilities - in California have been cited with
some sort of infection prevention and control violation
in the past two years. Now an overwhelming number of those violations are relatively minor missteps, like failing to wash hands or improperly handling food trays, it raises concerns about the overall safety of these sites.
The federal government determines the severity of violations based on letter grades from A (minimal harm) to L (immediate jeopardy). The Sacramento Bee pulled the data together for you in
this table, sort-able by Grade, City and Name. 18 facilities report J, K or L ratings.
Nursing homes also lack efficient testing capabilities. In specific, Los Angeles County officials have acknowledged that their testing of residents and staff at nursing homes is
taking too long. Following a Los Angeles Times investigation, it was found that it took the county health department more than a week to provide tests for employees at Norwalk Skilled Nursing & Wellness Center after a resident tested positive.
Since that resident became ill in mid-May, the home has suffered a serious outbreak of COVID-19, with at least 43 residents and 34 employees infected, L
os Angeles County data show
. At least six have died. The situation underscores how quickly the Coronavirus can spread in skilled nursing homes and how essential early, widespread testing is.
But nursing homes are also facing a new issues...
30% of Certified Nursing Assistants (CNAs) are choosing unemployment during the pandemic because they make more money,
according to IntelyCare, a national staffing agency.
In a typical nursing home, about two-thirds of the workforce are CNAs. "Without them, you've got administrators, cafeteria workers, you've got all sorts of nurses performing the CNA duties. And then you just have people that aren't getting attention because there's just not enough people working,"
said David Coppins, CEO of IntelyCare.
According to data recently released by the Centers for Medicare & Medicaid Services, state inspectors have been
onsite at almost 95%
of California nursing homes since March 1. This sends mixed signals as Kaiser Health News reported public health officials telling inspectors to
close cases without fully investigating them.
"Those visits do not involve the same
in-depth attention
as routine survey inspections," says Tony Chicotel, a staff attorney for the nonprofit California Advocates for Nursing Home Reform. He said three to five investigators
typically spend a few days talking with residents and family members, interviewing and observing staff, and inspecting the kitchen and the grounds. By contrast, he said, infection control visits focus on hand washing, personal protective equipment and isolation of infectious residents.
So why have these facilities still been receiving new patients? Short answer: Incentives.
Reported just 3 weeks ago by Politico,
Coronavirus-positive patients can bring in double or more the funding of other residents. States including California, Massachusetts, Michigan and New Mexico, wanting to relieve pressure on crowded hospitals, are providing extra incentives for nursing homes to accept such patients.
Some may draw a line between these incentives to
this article's frustrating and saddening title.
An 88-year-old with dementia at Lakeview Terrace here in Los Angeles, California, was deposited at an unregulated boardinghouse — without bothering to inform his family.
A Lakeview official said the company’s evictions were appropriate and weren’t an attempt to free space for Covid-19 patients. But similar scenes are playing out at nursing homes nationwide in New York, New Jersey, Connecticut and Pennsylvania.
More than 6,400 discharges, many to homeless shelters, were reported from 18 states recently
according to the New York Times
. The Times contacted more than 80 state-funded nursing-home ombudsmen in 46 states for a tally of involuntary discharges during the pandemic at facilities they monitor.
Note: There is no national data on the number of nursing home residents who have been moved into homeless shelters, motels and other facilities.
You guessed it... Queue, up the lawsuits... a
La Jolla facility was served recently. The lawsuit, among the earliest of its kind in California, accuses The Springs at Pacific Regent and its owner of negligence in responding to the novel coronavirus.
In fact, just search "lawsuits against california nursing homes" in Google, add you'll see plenty of advertisements from law firms...
Whew... that was a lot...
So where do we go from here? Advocacy, of course, some of which is easier said than done.
- Review infection prevention and control training and policies.
- Secure timely testing of patients and employees.
- Bolster nursing staff for at-risk facilities.
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ADVOCACY HOUR UPDATE
During our second Advocacy Hour on Tuesday, one of our members asked, "Where do you get your information?"
So here's some of our common sources for California's COVID-19 information...
For Californians... the
California Department of Public Health releases new information everyday, in a structured format that allows you to quickly and continually update yourself on the state's numbers. Note: Data is reporting on the previous day.
"From the horse's mouth..." A colloquial saying that we also pay strong attention to California Governor Newsom's press briefings as we're able to get timely information about the state's inner efforts. Like his recent
emergency budget declaration on today, June 25th, from the
Office of the Governor website. But also via
ABC 7 News who regularly broadcasts his public briefings.
...Not to mention white papers, case studies, investigative journalism, and tips from media. You'll find we cite many sources through our hyperlinks in the Pioneer.
You can always ask us, too.
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What is the Advocacy Hour?
Every Tuesday @ 3:30pm we hold an open Q&A session for your voice to be heard. We're hear to listen to you and help develop advocacy plans.
We'll ask questions to better understand the issues you care about, the decision makers involved, and how we can support you in creating the change you wish to see.
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NEXT WEEK...
Wonder how California decides who and how care facilities receive procured PPE? How has care management changed since COVID-19? And how does that influence the care continuum?
ANA\California is searching for answers to these questions asked during our Advocacy Hour. Stay tuned for next week's Pioneer newsletter...
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Hello. We're ANA\California.
We enhance the health and well-being of Californians and advance the profession of nursing by advocating for legislation, regulation, and policies. We focus on improving quality care, quality experiences, quality nurses, and the quality of our profession. We're the ANA\California Team and we're here for you. How can we help?
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-- Your ANA\California Team
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