Report: In early stages of COVID-19, nursing homes overlooked as state focused on hospitals
Health experts around the world recognized early in the COVID-19 pandemic that older people were most at risk of becoming seriously ill and dying from the new coronavirus.
But despite those early findings, thousands of Connecticut residents in long-term care facilities have died.
A final state-commissioned report released Thursday concluded that many early efforts focusing on coordination and resources for hospitals “hampered Connecticut’s preparedness and response to the COVID-19 outbreak in long-term care facilities.”
“Long-term care facilities were not recognized as critical health care assets in the state’s emergency preparedness plans, nor were long-term care facilities representatives at the table at the beginning of the outbreak,” wrote the authors of the 157-page analysis.
Mathematica, a third-party policy research consulting company, was commissioned by Gov. Ned Lamont’s administration for $450,000 to provide an assessment of the state’s pandemic response and improvement strategies, especially when it comes to protecting older residents.
About 72% of the state’s 4,432 total deaths from COVID-19 as of July 30 were people in nursing homes and assisted living facilities.
Mathematica delivered an interim report in August with some preliminary findings and recommendations.
During a daily media briefing Thursday, Lamont said that the final report contained “nothing that surprising” and noted that Connecticut’s COVID-19 infection and fatality rates were similar to those of neighboring states New York, Massachusetts and Rhode Island.
Lamont said the pandemic’s spread in places like Italy earlier this year informed the decision to ramp up hospital capacity.
“But I don’t think that was at the expense of the nursing homes. I mean, very early on we were one of the first to say no visitations, just given the nature of the spread,” he said. “We were one of the very first to have COVID-only facilities. First wings, and then facilities themselves just to make sure those with infections were segregated from the rest of the community.”
Deidre Gifford, acting commissioner for the state Department of Public Health, said the state was learning a lot at the beginning of the pandemic.
“And so we took steps as we learned that they needed to be taken,” she said. “As we learned about the nature of the infectivity and the spread and where it was happening, we took those steps.”
Report authors also concluded that long-term care facilities, with a lack of knowledge about how the virus spread, “did not take prompt and immediate action to limit entry to their buildings, enforce staff screening measures, and implement universal mask wearing” early on.
Facilities also lacked personal protective equipment, or PPE, some failed to make equipment accessible to staff, and family members reported problems with getting information about their loved ones.
The state granted long-term care providers immunity from liability during the pandemic, which “removed a critical mechanism for holding facilities accountable for negligence,” authors wrote.
Nursing homes in communities with widespread COVID-19 transmission among the general population had more cases and deaths, according to the report. Facilities with residents who left the building for medical care like dialysis or cancer treatment also had more cases and deaths.
One key finding of the report was that restrictions on visitors at nursing homes and assisted living facilities had adverse effects on residents. As of mid-April, about 53% of residents reported symptoms of depression, which only began to decline in May when the state allowed outdoor visits to take place.
Rates of unplanned weight loss among older residents nearly doubled after the peak of the COVID-19 outbreak, according to the report.
Mairead Painter, the state’s long-term care ombudsman, said the report highlights the concerns for the well-being of elderly residents.
“We know that COVID-19 has increased risks associated with long-term care settings where residents were required to be isolated from loved ones and peers,” she said. “For months, advocates have been saying that this isolation has had unintended consequences beyond the risk of infection, and we need to better understand the full picture.”
Gifford and DPH recently relaxed visitor restrictions at nursing homes and assisted living facilities to again allow in-person, indoor visits as long as certain conditions are met.
Painter hopes that issues of weight loss and depression are monitored more closely going forward.
“We know that many precautions will remain in place for months to come. Due to these necessary precautions, individual nursing homes need to have appropriate staffing levels to meet the residents’ individualized needs, including social, emotional,” she said.
The report includes short- and long-term recommendations both for the state and for the long-term care industry. They include:
- The state should make infection control training mandatory for the designated on-call nurses at assisted living service agencies.
- The state should continue its planning efforts to scale up COVID-19 recovery facility capacity as needed and deploy it quickly in response to the scope and severity of a second wave.
- The state should explore creating a mechanism to redeploy furloughed licensed health care personnel from other settings to long-term care facilities during future outbreaks.
- Connecticut should broaden qualifications for an infection prevention specialist and expand the role to full-time in all nursing homes.
- State distribution plans of any COVID-19 vaccines should designate long-term care residents and staff as having priority to receive them.
- The state should maintain a stockpile of PPE that is available to long-term care facilities in case of future increases in COVID-19 or other infectious diseases.
Gifford said the state has already completed or is in the process of completing nearly all of the recommended actions outlined in the report. A new DPH order will require nursing homes to have a 30-day supply of PPE on hand by Oct. 16, and Gifford said state inspectors will check.
Matt Barrett, president and CEO the Connecticut Association of Health Care Facilities/Connecticut Center for Assisted Living, and Mag Morelli, president of LeadingAge Connecticut, said in a joint statement that the Mathematica report is well-timed given that facilities are adopting new visitation guidance and enhancing prevention actions.
“Connecticut nursing homes are already implementing internal reviews, conducting surveillance testing of staff, magnifying efforts to double down on infection prevention and control practices, and participating in new training modules provided by the federal government,” they wrote.
The organization leaders warned that until a vaccine is approved and distributed, the pandemic will continue to affect communities and long-term care facilities.
That became evident recently when a third nursing home in Greater Norwich reported an outbreak involving more than half its population, with 56 new cases among residents and staff.
The Connecticut Mirror reports that the outbreak at Harrington Court Nursing Home in Colchester comes on the heels of recent outbreaks at managed care facilities in Groton and Norwich — all within the past two months.
Connecticut Public’s Patrick Skahill contributed to this report.
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