10 deaths, 60 cases of coronavirus in Washington state …
Trump Administration Is Relaxing Oversight of Nursing Homes
NBC News & NY Times: By Jesse Drucker and
A proposal would loosen federal rules meant to control infections, just as the coronavirus rips through nursing homes.
“These are frail, medically compromised people,” said an attorney at the nonprofit Center for Medicare Advocacy, who opposes the change.
The Trump administration last year moved to roll back regulations aimed at preventing infections from spreading in nursing homes, a decision that is facing renewed criticism for endangering the elderly amid the coronavirus outbreak.
With older, vulnerable residents living in close quarters, nursing homes face a heightened risk from the coronavirus — a majority of the nine deaths reported in the U.S. so far from the virus were residents of a long-term care center in Washington state. But over the last three years, the Trump administration has advanced — with the support of the nursing home industry — an effort to ease regulations on long-term care facilities and has taken significant steps to reduce fines for violations.
Of particular concern in nursing homes is what experts call “infection control” to halt or prevent the spread of disease within health care facilities. Last July, the Trump administration proposed rolling back regulations requiring all nursing homes and other long-term care facilities to employ infection prevention specialists at least part time, citing “excessively burdensome requirements” on the industry. Under the proposal, which is still working its way through federal rule-making, nursing homes would be allowed to use consultants for infection prevention rather than hiring staff.
“These are frail, medically compromised people, and they need to have someone focused on infection,” said Toby Edelman, a senior policy attorney at the nonprofit Center for Medicare Advocacy who opposes the proposed change.
The Trump administration defended its oversight of nursing homes and its infection control and prevention efforts. “The health, safety and welfare of America’s patients — including nursing home residents — and our provider workforce in the face of [coronavirus] is our highest priority,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services, which oversees regulation of long-term care facilities, said in a statement.
“The agency works daily with states and other partners to make sure nursing homes meet rigorous safety and quality standards as a condition of their participation in Medicare and Medicaid,” Verma said. “These longstanding federal regulations require facilities to prevent the spread of any infectious agent or organism.”
The requirement for infection prevention specialists was part of an Obama administration effort, finalized in 2016, requiring all long-term care facilities to develop infection control and prevention plans to detect, report and contain communicable diseases. Nursing homes manage from 1.6 million to 3.8 million infections each year, according to the Centers for Medicare and Medicaid Services.
The 2016 provision also requires that infection preventionists receive specialized training and that all long-term care facilities employ a specialist at least part time. The specialists are responsible for ensuring that nursing home staff properly clean their hands, disinfect surfaces and follow other protocols, helping to prevent both residents and health care providers from becoming infected.
The provision took effect in November despite the Trump administration’s objections, but the administration has continued working to reverse it.
In a plan unveiled last July, the administration proposed eliminating the requirement that nursing homes employ infection specialists at least part time, citing the “excessive administrative burden” on long-term care facilities, as well as potential confusion about the definition of “part-time.” Instead, the administration proposed requiring only that infection preventionists spend “sufficient time at the facility.”
Life Care Center of Kirkland — the skilled nursing and rehabilitation facility linked to at least five coronavirus deaths in Washington — declined to specify whether it had an infection prevention specialist on staff. A spokeswoman for Life Care Center referred NBC News to a statement released Monday that said the facility was “following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns and gloves when caring for any symptomatic patients.”
Life Care Center of Kirkland has a five-star rating from the federal government’s Nursing Home Compare website, making it a top-rated facility. However, CMS cited the nursing home last year for failing “to consistently implement an effective infection control program,” according to an April 2019 inspection report.
“The facility failed to ensure staff consistently performed hand hygeine [sic] and change gloves as needed while washing dishes,” the report said. “These failures placed resident’s at risk for harm and transmitting/acquiring infections.” CMS said that Life Care of Kirkland had corrected the problem by May 2019.
Last year, the Centers for Medicare and Medicaid Services also proposed reducing the frequency of facility-wide assessments that nursing homes are required to conduct to determine the resources they need for emergencies, as well as day-to-day operations. Nursing homes would only be required to conduct them every two years, instead of annually.
Industry groups have defended the proposed changes, which are in the process of being finalized through federal rule-making. “This gives greater flexibility to hire and find an infection preventionist and share between facilities, if needed,” said Cristina Crawford, a spokeswoman for the American Health Care Association, a trade group for nursing facilities.
From Washington state news agency 5 News:
A majority of cases stemmed from an outbreak at Life Care Center nursing home in Kirkland.
- A man in his 60s is hospitalized at Valley Medical Center in Renton. This man has underlying health conditions. He is in critical but stable condition.
- A man in his 60s is hospitalized at Virginia Mason Medical Center in Seattle. This man has underlying health conditions and is in critical condition.
- A woman in her 50s who was infected after visiting South Korea between Feb. 7-23. She works at a Federal Way United States Postal Office but did not come in contact with the public, according to Dr. Jeff Duchin, health officer of Public Health Seattle & King County. The woman’s husband, who did not travel to South Korea but has been in the same house as her, is under quarantine.
- A woman in her 40s who is employed by Life Care Center in Kirkland. The CDC is responding to a possible outbreak at the nursing facility.
- A woman in her 90s is hospitalized at EvergreenHealth in Kirkland. She had underlying health conditions and is in critical condition.
- A man in his 70s was hospitalized at Evergreen Health in Kirkland. He had underlying health conditions and is in critical condition.
- A man in his 50s is hospitalized at Highline Hospital in stable but critical condition. He had no known exposures and no underlying health conditions.
- A woman in her 80s who is a resident of Life Care was hospitalized at EvergreenHealth. She is in critical condition.
- A woman in her 40s who is employed by Life Care Center was never hospitalized and recovering at home.
- A female in her 60s who was never hospitalized. The woman is a family member of a confirmed case of COVID-19.
- A man in his 70s who is a “frequent visitor” of Life Care. His hospitalization status is unknown.
- A man in his 20s is hospitalized at Swedish Issaquah with unknown exposure.
- A man in his 20s is hospitalized at Swedish Issaquah with unknown exposure.
- A woman in her 60s, resident of Life Care Center, hospitalized at Evergreen Health.
- A man in his 50s associated with Life Care Center, not hospitalized.
- A man in his 60s, resident of Life Care Center, hospitalized at Evergreen Health.
- A woman in her 70s, resident of Life Care Center, hospitalized at Evergreen Health.
- A man in his 60s, resident of Life Care Center, hospitalized at Evergreen Health.
- A woman in her 70s, resident of Life Care Center, hospitalized at Evergreen Health.
- A man in his 30s, no known exposure, not hospitalized.
- A girl in her teens, associated with Life Care Center, not hospitalized.
- A man in his 80s, resident of Life Care Center, hospitalized at Evergreen Health.
- A woman in her 40s is being hospitalized. She has underlying health conditions.
- A man in his 40s who worked at Life Care Center in Kirkland is isolated at home.
- A woman in her 60s hospitalized with underlying conditions.
- A woman in her 50s who worked at Life Care in Kirkland was hospitalized with underlying health conditions.
- A woman in her 50s who worked at Life Care in Kirkland was isolated at home.