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Abuse and Danger in Nursing Homes Due to Covid - Healthcare Quality Improvement Campaign
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The issues of abuse and danger in nursing homes have long been a concern of patients and loved ones alike. With the recent addition of the Covid-19 pandemic to the mix, we have the makings of an emergency unlike any the nursing homes, their residents and families have ever faced.

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As a precaution against infection, family members are often restricted by nursing home administrations from visiting their loved ones during this Covid emergency. This situation is very anxiety-provoking for both patient and family because family members are not able to adequately oversee patient care or visit with their loved one.

In order to gain access to the patient, the family may require the services of a nursing home abuse attorney.

Deaths in nursing homes attributed to Covid have amounted to 56,196 as of August 31, 2020. Over 200,000 documented cases of Covid in nursing homes have been received by the CDC, with another 129,000 possible cases.

The deaths in nursing homes represent about 40% of Covid deaths reported to CDC.

Then there are thousands of seriously ill “long-haulers,” who have had the disease for months. These patients are not usually taken into account by policy makers. The statistics that are reported are deaths and recoveries.

To make matters worse, the elderly and disabled are often marginalized. If advanced age or disability makes one invisible, which we believe it does, then it can be, and is frequently said, that “only” the elderly or already sick are at risk of dying of Covid.

Further, we believe that the elderly and disabled do matter, and we will tirelessly advocate for their fair treatment.

There are some important ways that nursing homes have failed their patients. Three are listed below.

Patients Are Not Adequately Segregated.

Both staff and patients have suffered unnecessarily from administration’s failure to separate Covid and non-Covid patients. Although the Center for Medicare and Medicaid Services (CMS) has inspected all the nursing homes for compliance with their Covid infection guidelines, they found three times the rate of non-compliance they found in 2019.

CMS fines hospitals and nursing homes for non-compliance, yet the average fine in 2020 to date was only $55,000. Some exceptions are notable – for example, a Miami Springs nursing home was found to be placing at-risk patients (who had been directly exposed to the infection) in the rooms of healthy residents. In this case, a fine of $235,000 was levied, and admissions were halted.

All Covid cases must be reported, and although most nursing homes are compliant, reporting deficiencies were found. These omissions amounted to approximately 3300, and fines imposed totaled $5.5 million.

Here’s another example of the mishandling of the pandemic. An assistant director of nursing at an Iowa nursing home reported in May that there were no Covid cases in the facility, whereas the truth is that a few weeks later there were 61 Covid patients there, nine of whom had died. This had occured in spite of a doctor’s order to isolate patients, which was not followed.

Staff May Spread Infection

Staff may spread infection through poor hygiene. Often, nursing home staff are part-time workers and generally underpaid, which means they may find a second job at another nursing home or other long-term care facility.

Even though staff are routinely tested, the tests aren’t read fast enough to stop the spread of the virus in the case of an asymptomatic worker. Or worse, a worker may know they are infected, but go to work anyway because they need the money.

CMS has been increasing their oversight and have visited nearly all nursing homes during the pandemic. However, this has put pressure on the organization to keep up, and the visits are not as thorough as the usual yearly inspections.

The National Bureau of Economic Research has reported that an average of 15 different facilities in any locality are linked through workers.

Three times the rate of “immediate risk” situations were found, compared to 2018.

State Officials Deliberately Place Covid Patients

Covid-infected patients have been deliberately placed by state officials, who have the power to dictate to nursing homes and hospitals what patients they will and will not accept. This practice obviously endangers other patients as well as staff.

There are a few different ways nursing homes have failed patients, two in particular that are due to facility failures, and one that is largely government created. These three forms of nursing home abuse are detailed below.

Nursing Home Abuses That Have Led to Patient Deaths
1. Failure to separate patients. Nursing staff and patients alike have faced danger and even death due to the failure of facilities to separate their Covid patients from the general population. Hospitals and nursing homes failed their patients early on by not complying with guidelines, and generally just failing to exercise common sense. Negligence and malfeasance both seem to be at work.

The Center for Medicare and Medicaid Services have taken the lead since March in trying to inspect nursing homes and keep up with the dangers. Almost all nursing homes have been inspected at some point in order to assess compliance with infection control guidelines. Immediate risks were found at triple the rate that infection risks were found in general in 2019. The term “immediate jeopardy” is defined by a situation where noncompliance with CMS requirements is likely to cause serious injury, serious harm, serious impairment, or death to a resident. Yet the average fine assessed to nursing homes was only $55,000.

Furthermore, these infection control visits are far less comprehensive than typical annual visits, and many layers of danger to residents may be overlooked.

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Most nursing homes have been facially compliant with reporting of Covid numbers, but 3300 deficiencies have been found and these nursing homes have been issued a total of $5.5 million in fines.

In addition to poor sanitation, a key way that nursing homes put their residents at risk has been by failing to keep infected individuals separate from healthy populations. Numerous examples can be found online. For example a nursing home in Miami Springs, Florda found that 11 roommates of patients who tested positive for Covid, that is, patients who were highly at risk of having been infected themselves regardless of whether testing showed it yet, were placed in the rooms of healthy patients, drastically increasing the risk of the spread of the disease. CMS dealt harshly with this facility, levying a $235,000 penalty and ending admissions to the home.

This kind of nursing home abuse has been rampant throughout the pandemic. In one case of utter denial, an Iowa assistant director of nursing at a nursing home insisted at the end of May that they did “not have any Covid in the building.” Despite the orders of a community doctor to isolate several patients with obvious signs of illness, including fevers and falling oxygen levels, the assistant director refused to do so and within weeks, 61 patients were shown to have the virus and nine people had died.

It is fairly well known that physical isolation of Covid patients is the best way to prevent the spread of the illness, with quarantines being imposed in certain situations. So, it seems unbelievable that such simple protocols weren’t followed in nursing home situations.

2. Facility workers spreading the virus
The virus raced through nursing homes early on, and states like Florida began restricting visitation from family and friends. Unfortunately for residents, these steps were not enough. It became obvious that something else was causing the spread of the virus at breakneck speed. Staff, who are poorly paid and artificially kept as part-time workers, are often forced to work at more than one facility. A recent change in guidelines means that asymptomatic people are not recommended to be tested – yet asymptomatic people can easily spread the disease. Asymptomatic staff awaiting test results or who have not been properly tested can take the virus with them from facility to facility. They can do so unwittingly, not yet knowing their sick, or more outrageously, knowing they are ill and not wanting to miss a paycheck. A recent report by the National Bureau of Economic Research found that the average nursing home is linked to 15 other facilities through their staff. In some areas, restrictions have been put on workers working at more than one facility, but with there being such high demand for workers especially during these difficult times, governments and facilities in most areas have not found a way to implement such strict rules.

Yet a solution to the spreading of Covid between facilities by staff members must be a priority. Everyone is put in danger with systems being what they currently are.

3. Government deliberately placing covid patients in nursing homes

With all the risks listed above, a nursing home doesn’t seem like the best place for a sick person to be. While nursing homes may have exercised bad, and even malicious, judgment, even nursing homes making positive efforts were thwarted by government confusion and bad policy. Although it had been known for many years that a pandemic was likely at some point, the government seemed entirely ill-prepared.

In New York, California, and New Jersey, early on the state ordered that nursing homes must readmit residents sent to hospitals with the coronavirus and accept new patients as long as they are deemed “medically stable.” Other states later followed suit. States say they were following federal orders.

Some states designated certain nursing facilities solely for Covid patients, a logical step that surely saved many lives.

Government and military regulations were typically unbending and created catch-22 situations. In New York, a ship had been deployed from the federal government to take pressure off hospitals and nursing homes, but federal rules made it impossible to utilize the ship to any logical end. The federal government wouldn’t allow Covid patients on board, apparently intending for other overflow from the hospitals to go there, but that did little to relieve the pressure when the large majority of patients in the hospitals were Covid patients. Eventually New York and the federal government worked it out so the ship could be used for Covid patients, but how many people died first?

Patients were released to nursing homes during times when personal protective equipment was not being adequately supplied, and the surge in patients was causing staff to interact with larger numbers of patients, increasing the risk of spreading infection. Hospitals were sometimes unable or unwilling to ensure the “stable” patients being released to nursing homes were noninfectious.

Some facilities in some areas were allowed an exemption if they could show that they could not care safely for the Covid patients—surely the case in places where the facilities were operating at 50% staffing—but not all facilities filed for such exemptions.

Other issues in nursing homes during the pandemic

Rates of infection were high in nursing homes even before the pandemic. There were real concerns about protocol and follow-through.
The journalist Ed Yong calls the country’s response to the pandemic a “serial monogamy” of solutions; ineffective because the country seems to only be able to focus on one reductive solution at a time, rather than recognizing multiple steps are required at once to prevent more infections and deaths. Nursing home care, from federal, state and local government to internal policies, needs to follow this warning. There has been a significant deficiency in getting nursing homes the PPE that is absolutely essential to protecting the staff and residents at nursing home. Testing, retesting, contact tracing, protective equipment (some is better than none), isolation and separation, are all only parts of what must be a multi-faceted, organized effort to implement life-saving policies and protocols. Protecting workers who get sick can prevent poor decision-making that leads to spread of illness.

If you think nursing home abuse contributed to your loved one’s death, or if you have concerns about medical, sexual, financial, or emotional abuse in a nursing home, contact one of our attorneys here for advice.

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