“It’s just kind of this perfect storm. It’s just the nature of the beast. This is the worst situation for a virus like this,” said Dr. David Hill, professor of medical science and director of global public health at Quinnipiac University Frank H. Netter MD School of Medicine.
Indeed, nursing homes care for an extremely frail population, many with underlying health conditions. The problems are compounded by staff shortages, lack of personal protective gear and proper staff training to care for residents in a pandemic. Even restricting visitors to emergency personnel only by mid-March could not stop COVID-19 from spreading rapidly among the state’s nursing home population.
On April 1, the state reported that 36 of the state’s 215 facilities had at least one confirmed case of COVID-19. On that date, there were 124 reported cases among nursing home residents and 13 had died. By April 17, the number of facilities with COVID-19 cases had tripled to 108, with 1,713 cases and 379 deaths. Those deaths represented 40% of the state’s COVID-19 deaths. But newspapers have reported higher death totals at some nursing homes.
Quinnipiac University School of Medicine Photo.
David Hill of the Frank H. Netter, MD School of Medicine at Quinnipiac University, said that there will be some silver linings through all the challenges facing nursing homes now.
Nursing homes, by and large, aren’t equipped to control communicable diseases quickly. Many have two-bed rooms, for instance, making it difficult to isolate residents who are ill. Often, staff members work more than one job, sometimes at multiple facilities, increasing the risk of staff contracting a disease and bringing it into a nursing home. The elderly tend not to exhibit typical symptoms of ailments; in particular, they’re less likely to have fevers than their younger counterparts, which can make COVID-19 more challenging to detect, Hill said. A lack of testing also is problematic.
“A nursing home right now is the worst place you can be during this pandemic,” said Dr. Richard Feifer, chief medical officer of Genesis HealthCare, which operates nursing homes nationwide, including 17 in Connecticut. “In many cases, it’s been impossible [to prevent the spread of the coronavirus], despite extensive measures.”
Connecticut nursing facilities have struggled with infection-control practices over the years. Of the 108 nursing homes with reported cases of COVID-19, 75 have been cited for infection-control violations previously (from 2017 to 2019), according to a C-HIT analysis of data from the Centers for Medicare and Medicaid Services (CMS).
Some facilities have been cited more than once, including RegalCare at New Haven, which has been cited four times; RegalCare at Southport, four; Whispering Pines of East Haven, three; and Salmon Brook Rehab and Nursing of Glastonbury, three. The violations include staff members failing to wash their hands, change gloves in between resident care or properly clean equipment after each use.
Staffing levels have been a mixed bag for the state’s nursing homes, CMS data show. Of the 108 facilities with COVID-19 cases, 25 have staff ratings below average or much below average. The remainder had ratings of average or above, data reported by Nursing Home Compare show. Even homes such as Caleb Hitchcock Health Center of Bloomfield, Edgehill Health Center of Stamford, and Nathaniel Witherell of Greenwich, with top 5-star ratings for overall performance and staffing, were not able to keep out COVID-19.
“The challenge with nursing homes is you have lots of very high-risk individuals together in close proximity with limited staff, staff that may not be salaried, and staff is caring for multiple patients,” Hill said. “This is kind of the perfect setting to spread a contagious organism.”
Nursing homes may have protocols for handling communicable diseases, Hill noted, but they’ve never experienced a pandemic like this, so “there probably aren’t robust, tried and true policies.” he said.
To help facilities with staffing needs, supplies of personal protection equipment and screening, the state has increased Medicaid reimbursements 15%, providing an additional $65 million. Also, the state will reimburse at $400 per day for COVID-positive residents in non-COVID recovery facilities. This rate is in effect for a maximum of 30 days per bed and will cost an estimated $15.4 million.
This week, the state announced that it will visit and inspect every nursing home in the state for infection-protection protocols. Also, CMS issued guidelines requiring nursing homes to report to CMS all virus infections and to notify residents and their families within 12 hours of a facility’s first positive COVID-19 test.
The state has partnered with Athena Health Care Systems to operate COVID-19 recovery centers for patients who are discharged from the hospital and need non-acute care.
The plan has its supporters and detractors, including some concerned about patient safety.
“I think that Connecticut is moving in the right direction by separating COVID-19-positive and negative individuals,” said Richard Mollot, policy researcher and executive director of the national Long Term Care Community Coalition in New York City. “However, this needs to be done thoughtfully, carefully, and with vigorous monitoring to ensure that it is done in the least harmful way possible.”
C-HIT.org Photo.
Two Woodbridge residents greet workers at The Willows nursing facility each day to show their appreciation. The facility is owned by Genesis HealthCare.
Lisa Freeman, executive director of the Connecticut Center for Patient Safety, said, “As a family member, I would be very concerned if my parent or spouse was moved to a location that I had little choice in, although it might be the best option. However, it seems clear that the safety of patients and staff, as well as providing the best environment for recovery and health, should drive the decision on this question.”
Mollot said, “It was probably never possible to protect residents 100%, but the slow and uneven pace of recognizing the obvious risk posed to residents undoubtedly resulted in unnecessary suffering and death. That being said, it is not too late to save many residents’ lives and families’ heartbreak.”
The weeks before Connecticut’s decision to lock down nursing homes, there was confusion and uncertainty nationwide about how fast the virus would spread, Hill said.
“I don’t think Connecticut took any longer time [to restrict visitors] than any other place,” Hill said, “and I think our governor has been really responsive all along the way during this outbreak.”
In hindsight, visitors should have been barred sooner, but that alone wouldn’t have curtailed the virus, Freeman said.
“Restricting visitors is one strategy, but without a comprehensive strategy, it is the equivalent of locking up a house and leaving the windows open,” she said. “The safety of residents was only as good as the weakest strategy for prevention of viral spread.”
Once the pandemic ends, nursing home leaders will be “looking at all the deficiencies that have been brought to light and starting to address them,” Hill said. Staff will be better trained in infection control, facilities will examine their ability to isolate residents, and protocols will be scrutinized, he predicted.
“There’s going to be so many things that get another look after COVID in the long-term care facility industry; it’s going to need an overhaul,” Hill said. “There will be some silver linings through all the challenges. There will be some positives.”
As the lessons from this pandemic—and the resiliency of the long-term care industry in general—unfold, nursing homes will look for ways to become more nimble when coping with a crisis, Feifer said.
“It really does become, in some ways, a resource issue. How well resourced is this industry?” he said. “This virus is unlike the world has ever seen before, and the next one, whenever that may be, will be different from this one too.”
Below is the state-issued list of nursing homes with cases of COVID-19 and deaths released on April 17. The nursing homes in red were cited for at least one infection-control violation between 2017-2019.
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Meeting in Hartford on Wednesday, June 15, the board revoked the license of Leslie Matejek, a registered nurse from Derby, after she tested positive for cocaine three times in 2015, the board’s memorandum of decision said.
The memo shows that in 2010 Matejek’s license was placed on probation for four years after she admitted falsifying a prescription for Oxycontin. According to the memo, she tested positive for oxycodone three times in 2010 and morphine twice in 2011. Her probation was later extended to February of this year, with weekly random drug tests.
The board also revoked the license of Jennifer Reinhard, a licensed practical nurse from Torrington, because it found that she had violated the terms of an earlier two-year probation. Reinhard did not supply reports to show she was seeing a therapist or proof that she had passed weekly drug tests, the memorandum of decision said.
The board also revoked the RN license of John Sherman of Watertown, New York, who was working at Silver Hill Hospital in New Canaan. The board found that in 2014 Sherman stole anti-anxiety drugs for his own use and used alcohol or drugs to excess, the memorandum of decision said.
The license of Holly Cocchiola, an LPN from Bethlehem, was also revoked. State records show that she tested positive for heroin after a car accident on Feb. 14. She was arrested and charged with possession of a controlled substance, evading responsibility and driving under the influence of drugs or alcohol, records show.
On Wednesday, the board suspended the license of Dorsey Saunders, an LPN from Bridgeport, because she posed “a clear and immediate danger” to the public, state Department of Public Health (DPH) records show.
On March 23 the board placed her license on probation for four years for stealing drugs, including oxycodone and fentanyl, while on duty at Fairview of Fairfield, a nursing home in the Southport section of Fairfield.
Officials from the state Department of Public Health repeatedly tried to contact her and were unsuccessful so it concluded she had failed to comply with the terms of her probation, records show.
The board also suspended the license of Dawn Noyce, an RN from Canterbury. State records show that in April 2015, she pleaded guilty to driving under the influence of drugs or alcohol and was placed on probation for 18 months. Her probation officer, Julie Valliere, told DPH that Noyce had been fired from two nursing jobs in the past year and has struggled with drug and alcohol abuse, records show.
The board imposed a four-year probation on Jamie Libertini, an RN from New Milford, who admitted abusing Percocet, Dilaudid and Xanax to excess between August 2012 and August 2013, according to a consent order.
Libertini also admitted stealing Dilaudid from the patient stock in August 2013 while working as a nurse at Danbury Hospital. She also took blank prescription forms from the hospital and forged 12 prescription orders to obtain Ambien and Xanax, the order said.
On March 30, 2015, Libertini tested positive for an anti-anxiety drug for which she did not have a prescription, and on April 29, 2015, her license was temporarily suspended, state records show. DPH records show the hospital fired Libertini.
On Sept. 9, 2015, Danbury police charged Libertini with multiple counts of obtaining controlled drugs with forged prescriptions, fraud, forgery, larceny and identity theft, DPH records show. She received accelerated rehabilitation, a special form of probation, in connection with the charges, records show.
The board also:
• Imposed a four-year probation on Lori Karen Salupen, an RN from Bristol, after she admitted at a hearing that she had stolen and abused Percocet in September 2015 while working at Cook Willow Health Center in Plymouth, the board’s memorandum of decision states.
• Imposed a four-year probation on Shelly Volpe, an LPN from Groton under a consent order with the board. The order said that she took oxycodone and other drugs from the Norwich Rehabilitation and Care Center, where she was working, and falsified one or more drug reports.
• Placed the license of Lindsay M. Wayman, an RN from Naugatuck, on probation for two years, a consent order said. The order said that while working as a nurse at Waterbury Hospital in 2008, Wayman abused alcohol, marijuana and/or opiates to excess and was unable to perform her duties as a nurse.
• Imposed a one-year probation on Allyssa Graham, an advanced practice registered nurse from Old Lyme, who will not be able to prescribe medication for herself or relatives during that year, under a consent order. Between July 2014 and July 2015, Graham prescribed multiple controlled substances for her husband and did not maintain medical records to support the prescriptions for painkillers and anti-anxiety drugs, state records show.
• Placed the license of Melody L. Williams-Destra, an RN from Bloomfield, on probation for one year after it found that in 2015 she created two false state Department of Education health assessment forms for a friend’s grandchildren and forged a co-worker’s name to the forms, records show.
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