As State Officials Commission Study of Nursing Homes, COVID-19 Infections Slow

In the last week, just 61 new cases of COVID-19 were diagnosed in nursing homes and assisted living facilities in Connecticut, evidencing a drop in the spread of the virus among the state’s hardest-hit population.

Of those 61 cases, one was diagnosed at Aaron Manor Nursing and Rehab Center in Chester, where there have been 31 cases, six were at Essex Meadows Health Center, where there are now 16 cases and two were at Apple Rehab in Old Saybrook, where there are now 69 cases.

Between mid-March and mid-June, at least 9,720 residents of nursing homes and assisted living facilities tested positive for the disease and 2,461 died from the disease. 

At the same time, hospitals across Connecticut continued to discharge COVID-19 positive patients, still contagious with the disease, to nursing homes with established coronavirus wards, and when staff members were not routinely tested for the infection.

The decline in new COVID-19 cases in care facilities comes as the spread of the infection across the state has slowed and follows more than a month of weekly infection-control inspections performed in-person by the state Department of Public Health, with help from the National Guard. To date, most care facilities have been inspected five times and every staff member has been tested for COViD-19.

“Our nursing homes are doing really well on getting the staff and patients tested,” said Tom Balcezak, chief medical officer at Yale New Haven Health. “If they are unable to show that their staff is negative for 14 days in a row then they have to start over again with testing.”

Regular testing of staff mandated, through executive order by Gov. Ned Lamont is critical in preventing the spread of COVID-19 to vulnerable nursing home patients, according to the state Department of Public Health.

Although infections are dropping statewide, some nursing homes that accept COVID-19 patients continue to receive citations for failing to meet state and federal regulations, including proper infectious disease control measures, designed to help keep residents and staff safe.

According to state guidelines, infectious COVID-19 patients are supposed to have rooms confined to separate units, floors or areas of the facility with clear markings to show staff and other residents where the active virus is present.

Staff and patients on a COVID unit are supposed to wear masks and other appropriate personal protective equipment.

In addition, for patients with dementia, or other cognitive impairments, the state requires a staffing ratio should be no less than one staff person to six residents. 

Violations of the above, for example a 1 to 9 staff-patient ratio for cognitively impaired patients at Apple Rehab in Old Saybrook and staff interacting with COVID-19 patients without wearing a mask at Essex Meadows Health Center, are some of the most common seen violations during weekly inspections.

These guidelines, according to Yale-New Haven Health, are what is helping to prevent the spread of COVID-19 at nursing homes and in hospital settings. 

Although some nursing homes have received financial penalties for non-compliance, penalties rarely total more than $10,000, if they are assessed at all.

“Not all deficiencies result in fines and fines can vary … there are limits on how much we can fine the nursing homes” said Av Harris, director of government relations and communications for the Department of Public Health. “With these fines, it’s not the money that will hurt them, you just don’t want the bad marks. It’s a heavier symbolic value than a financial burden.”

According to Harris, the real motivator for complying with state and federal regulations is attracting new residents.

“Nobody wants to be found in violation, It’s bad for business,” Harris said.

According to public health officials, penalties are assessed given the amount judged necessary to insure immediate and continued compliance, the character and degree of impact of the violation, the conduct of an individual cited and any prior violations by the facility.

Whether or not fines will increase or intermediate recovery centers for contagious patients will be re-established, has yet to be decided, according to Harris, and is the subject of a third-party review commissioned by the Gov. Ned Lamont in preparation for a possible second wave. The findings of that study are expected by the end of the summer.

Impact on other residents

In some states, long-term residents dependent on Medicaid have been subjected to involuntary discharges that leave the vulnerable and elderly to seek shelter elsewhere.

According to Mairead Painter, the state ombudsman for long-term care, despite reports, that is not the case in Connecticut. 

On June 5, at the urging of Painter, Lamont issued an executive order suspending involuntary discharges from nursing homes, except under emergency situations reviewed by the Department of Public Health and the Department of Social Services.

“Our state has been working on this issue for a number of years, so we had some mechanisms in place before the executive order,” said Mairead Painter, the state ombudsman or long-term care.

For the last year, according to Painter, diversion nurses working for the Department of Mental Health and Addiction Services have worked with nursing home and residential care facilities on conflict resolution and alternative options to avoid involuntary discharges. 

Painter said that although one patient has sought legal assistance, for other residents her office has been able to facilitate what she describes as positive outcomes.

“I would prefer to never see involuntary discharge. I would like to see that there was an appropriate plan for everyone and that’s why we’ve been working really hard to come up with different options even before COVID,” Painter said. “But we can only do what the resident directs us to do.”