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| Failure to wash hands is a frequently cited infection control violation at New York nursing homes. (The Plain Dealer/Lisa DeJong)The Plain Dealer |
SYRACUSE, N.Y. – While New York’s nursing homes say they are prepared to protect elderly residents from coronavirus,
government inspection reports show more than half the state’s nursing
homes have histories of failing to prevent the spread of infectious
disease.
Of
621 New York nursing homes, 329 were cited for one or more infection
control violations between 2017 and 2019, according to the federal
Centers for Medicare & Medicaid Services. Inspectors cited 11 of
Onondaga County’s 14 nursing homes for infection problems over the
three-year period. A recent analysis by Kaiser Health News found 61% of nursing homes nationwide were flagged for infection violations during the same time frame.
These
violations include lapses such as not wearing gloves, masks and gowns
when caring for residents with contagious diseases and not washing
hands. Infection control problems are the most frequently cited nursing
home deficiency nationwide.
The
federal government recently ordered nursing home inspectors to focus
almost exclusively on infection control practices following the deaths of 18 Seattle nursing home residents who
got the virus. Older people with chronic medical conditions are at
extremely high risk of getting the virus and developing serious
complications.
“I
would argue that on balance nursing homes are among the most prepared
to handle viral situations,” said Steven Hanse of the New York State
Health Facilities Association, a nursing home trade group. He said
nursing homes have rules designed to limit the spread of diseases like
coronavirus.
But inspection reports show those rules are frequently broken.
*After
two residents at The Centers at St. Camillus nursing home in Syracuse
were diagnosed with the flu last May, signs were posted on their doors
to alert nurses and aides to don gloves, masks and gowns before entering
the residents’ rooms. That precaution is designed to protect health
care workers and prevent the spread of infection to other residents.
But
three aides and a nurse went in and out of both residents’ rooms
several times without wearing the garb, even though there was a supply
of gloves, masks and gowns on a cart in the hallway, according to an inspection report.
During
the same inspection, a nurse was observed handing out drugs to eight
residents without washing her hands as required before and after giving
each resident medications.
*After
cleaning a resident’s bedsore at the Jewish Home of Central New York in
September, a nurse failed to remove her gloves, wash her hands and don a
new pair of gloves before applying a fresh dressing to the resident’s
wound. Skipping that hand hygiene could have contaminated the wound and
caused an infection, an inspection report said. The Jewish Home also was cited in 2018
for failing to make sure its drinking water system was free of
Legionella, a type of bacteria that can cause Legionnaires’ disease, a
potentially deadly pneumonia-like illness.
*During
flu season, the state requires unvaccinated nursing home employees who
work near residents to wear face masks. Four unvaccinated staff members
at Bishop Rehabilitation and Nursing Center in Syracuse were observed
during a 2017 inspection
wearing masks incorrectly or not at all. One nurse aide without a flu
mask was coughing. A nurse was observed passing out medications to
residents with a flu mask below her nose. The mask requirement is
intended to prevent unvaccinated workers from transmitting the flu to
residents. Bishop, formerly known as James Square, was cited for
infection control violations four times between 2017 and 2019.
Central
Park Rehabilitation and Nursing Center in Syracuse was cited for a
similar mask violation in 2017. A certified nurse aide wearing a mask
below her nose told an inspector she was sick and the mask was bothering
her. “During the interview, the CNA sniffled continuously,” the report said.
*Catheter
bags that collect urine are supposed to be clipped to the side of
nursing home residents’ beds. A 2018 inspection at the Onondaga Center
for Rehabilitation and Nursing in Minoa found a resident’s catheter bag
and tubing lying on the floor. A catheter bag left on the floor can get
dirty and cause infection, the report said. Someone could also
accidentally trip on the bag and accidentally pull out the resident’s
catheter, the report said.
*Loretto was cited
in 2017 after a nurse reattached a part of a resident’s tracheostomy
tubing after the part fell on the floor and became contaminated. The
tracheostomy tube was inserted in the resident’s neck to provide
humidified oxygen. A small plastic bottle attached to the tube to trap
excess water became disconnected and dropped to the floor. A nurse
picked it up and reattached it to the patient’s tube. She then went and
got a new water trap to replace the contaminated one. A nurse manager
told the inspector that was OK because the contaminated part was only
reconnected for a minute. But an infection control nurse said the
contaminated water trap should have been thrown away and not reused.
*Glucometers
used to test nursing home residents’ blood sugar levels are supposed to
be cleaned after every use. Elderwood nursing home in Liverpool was cited in 2017 after nurses failed to use a Chlorox bleach wipe to clean the devices after testing two residents’ blood sugar levels.
The
only three Onondaga County nursing homes not cited for violating
infection control rules over the last three years are the Nottingham and
Iroquois, both in Jamesville, and Syracuse Home Association in
Baldwinsville.
Officials
of St. Camillus and Bishop said they are closely following state and
federal guidance on how to protect their residents from coronavirus.
Richard
Mollot of Long Term Care Community Coalition, a Manhattan-based nursing
home consumer advocacy group, said the prevalence of infection control
violations is a symptom of widespread substandard care in nursing homes.
He
cited federal Centers for Disease Control and Prevention statistics
that show an estimated one million to three million serious infections
occur annually in nursing homes and assisted living facilities, killing
as many as 388,000 residents.
Mollot
said the infection control problem combined with inadequate staffing at
many nursing homes could have “catastrophic implications for residents”
during the coronavirus outbreak.
Hanse
of the New York State Health Facilities Association said “while some
folks may not follow the rules,” state nursing homes are paying more
attention than ever to infection control because of coronavirus.
Last
week the federal government ordered nursing home inspectors to focus
almost entirely on infection control to stop the spread of coronavirus.
Connie
Steed, president of the Association of Professionals in Infection
Control and Epidemiology, welcomes that move. “There does need to be
more emphasis on it than there has been,” she said.
But she’s concerned about another federal proposal that could weaken infection control at nursing homes.
Since
2016 the government has required nursing homes to have an infection
preventionist in their facilities at least on a part-time basis.
Infection preventionists are experts on preventing and controlling the
spread of infectious diseases in health care facilities.
The
Centers for Medicare & Medicaid Services issued a proposed rule in
July that would allow nursing homes to have an infection preventionist
who only devotes “sufficient” time to infection control and prevention.
“What a nursing home administrator thinks is sufficient may not be truly sufficient,” she said.
To
keep coronavirus out of their facilities, the nursing home industry is
taking steps to curtail visitors. Loretto in Syracuse, for example, is
prohibiting anyone who has recently traveled internationally from
visiting its residents.
Bishop
Rehabilitation and Nursing Center has begun taking the temperature of
everyone entering its building as part of a screening process. Elderwood
in Liverpool is also screening everyone who enters its facility and
asking friends and family to postpone visiting residents unless it’s
absolutely necessary.
Hanse
said nursing home visits should be limited “… only to those individuals
whose entry is essential to the provision of care to residents.”
“The
over 80 population is the most sensitive to harm from coronavirus,” he
said. “We need to do everything we can to protect them.”
These Onondaga County nursing homes were cited for infection control violations from 2017 through 2019.
Bishop Rehabilitation and Nursing Center, 4 violations
Centers at St. Camillus, 2 violations
Elderwood at Liverpool, 2 violations
Jewish Home of Central New York, 2 violations
Onondaga Center for Rehabilitation and Nursing, 2 violations
Central Park Rehabilitation and Nursing Center, 1 violation
Loretto, 1 violation
Sunnyside Care Center, 1 violation
The Cottages at Garden Grove, 1 violation
Upstate University Hospital at Community General, 1 violation
Van Duyn Center for Rehabilitation and Nursing, 1 violation
Coronavirus in NY: Most nursing homes dogged by poor infection control
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