OLD SAYBROOK — Over the last three weeks, 69 residents have tested positive and 19 have died from COVID-19 at Apple Rehab, a 120-bed care facility. That’s 74 percent of the total cases and 95 percent of the deaths in Old Saybrook as of June 9, according to the Connecticut River Area Health District.
Although the results of a recent inspection, part of the state’s effort to inspect all nursing homes for deficiencies in health and safety standards during the COVID epidemic, are still pending, the facility has been cited and fined a number of times in the past.
In October of 2019, Apple Rehab Saybrook was fined $9,955 for 14 deficiencies. In August and September of 2018, the facility was fined $13,627 and was deemed as an immediate danger to resident health and safety. In 2017, the facility was charged $7,150 after inspection.
By comparison, the 132-bed Gladeview Healthcare & Rehabilitation in Old Saybrook, chose to accept no new patients during the COVID-19 outbreak and has reported no cases of COVID. In 2018, 2017 and 2016 Gladeview was cited for minor deficiencies, but never received a fine for noncompliance with health and safety standards.
Apple Rehab Saybrook could not be reached and Gladeview Healthcare & Rehabilitation declined to comment for this story.
Troubles in the industry
Unfortunately, the troubles at Apple Rehab Saybrook are not unique to the industry. To date, 70 percent of COVID-19 linked deaths in the state have occurred in a nursing home, assisted living or senior care facility. That state data that does not include additional staff cases.
Since April 10, when the biweekly inspections began, more than 100 out of 215 long-term care facilities across Connecticut have been cited for deficiencies. Those facilities are now required to submit plans of action to address these concerns.
State officials are now grappling on a policy level — and on a care level — with what went wrong and how to prevent future nursing home outbreaks if a second wave of COVID-19 hits in the fall.
“Obviously nursing homes were the tragic center for our state and the other 49 states in terms of fatalities,” said Governor Ned Lamont at a press conference on Tuesday. “If there is a chance that there could be a spike in the fall we need to prepare for that.”
In response, Lamont has ordered an independent, third-party review of procedures to address the COVID-19 pandemic inside nursing homes and assisted living facilities.
That decision to opt once again for a third-party contractor rather than a task force of state legislators to address a response to COVID was met with frustration from State Rep. Devin Carney, who represents Old Saybrook.
“I have suggested that he form a task force to figure out how to proceed, but as far as I’ve heard he’s decided not to involve legislators,” said Carney. “He should be involving legislators. We hear what’s going on. We are the ears on the ground.”
The Office of the Governor declined to comment on Carney’s request.
Applications for the third-party contract are being accepted now and one will be chosen by the end of June, according to Josh Geballe, the chief operating officer for the State.
The policies and the problem
The State of Connecticut has taken several steps through executive orders to prevent the spread of COVID-19 to nursing homes, including banning visitors, providing millions of units of personal protective equipment, offering $125 million worth of financial aid packages, carrying out routine inspections and mandating employee testing, but the Lamont administration chose not to prevent nursing homes from taking in patients testing positive for COVID-19 after they had been discharged from a hospital.
Most nursing homes, like Gladeview HealthCare & Rehabilitation in Old Saybrook, nevertheless chose not to accept patients testing positive for COVID-19.
“We were hearing anecdotally that it was a trend for nursing homes not to take COVID patients,” said Av Harris, director of government relations and communications for the Connecticut Department of Public Health “It actually became a problem with bed space in the acute care hospitals, because nursing homes wouldn’t take them.”
In New York, this bottleneck in part led Governor Andrew Cuomo to sign an executive order mandating that nursing homes accept COVID-19 positive patients. In contrast, in Florida, Governor Ron DeSantis, ordered nursing homes to refuse patients who tested positive and instead established intermediary recovery centers to care for those discharged from hospitals.
In Connecticut, five recovery centers were organized between mid-April and the first of May to help ease expected capacity concerns on the hospitals, but nursing homes were never banned from accepting positive patients. These recovery centers remain open, but Harris was unsure for much longer.
“We are on the downward slope of the first wave of the pandemic right now, but every epidemiologist is expecting there to be a second wave and possibly a third wave. We are discussing the question, ‘do we dismantle some of the infrastructure because the intensity of the first wave is waning at this point or not,’” Harris said. “We know that it’s a model that has worked, but I don’t have an answer to if it will continue right now.”
On April 5, at the same time that care facilities in Connecticut were allowed the option of accepting patients testing positive for COVID-19, Lamont signed an executive order granting healthcare facilities immunity from civil liability for injury or death during the state’s COVID-19 emergency.
Although the order was intended to protect nursing homes acting properly, but coping with an unprecedented health emergency, explained state Long Term Care Ombudsman Mairead Painter, in effect the order took away the rights of nursing home residents who may be experiencing inadequate care or treatment.
“It’s challenging and nobody knew this was coming. People responded to the best of their abilities. But we want to know that — when it is appropriate — residents and family members have access to respond to concerns and mistreatment,” said Painter. “We would like to see the Governor reverse that order. We want people to feel protected.”
Especially in the case of nursing homes with a history of deficiencies, Painter said that residents and families deserve the right to sue if they were injured, become ill or die because of unsafe conditions. “This blanket policy makes it very challenging because a lot of situations that are coming up are not COVID-related,” Painter said. “We support nursing home residents having the right to accountability when appropriate.”
To date, Lamont has not indicated when that grant of immunity will be repealed.