A significant portion of infection control surveys conducted after the start of the COVID-19 pandemic found no deficiencies at New York City nursing homes — even those with substantial coronavirus death tolls, according to a new report.
Local news publication The City analyzed 35 inspection reports from surveys performed under the Centers for Medicare & Medicaid Services’ (CMS) new coronavirus-focused inspection strategy, instituted in March.
Only 10 had violations, with the remaining 25 — including facilities with more than 60 reported COVID-19 fatalities — were found to be in total compliance with infection control guidelines.
The 35 reports represent under half of the post-COVID inspections conducted by the state health department, according to the report.
The City’s analysis tracks with early results from research conducted by University of Chicago professor R. Tamara Konetzka, who last Friday testified before the U.S. Senate that she found no connection between a facility’s history of quality care and the likelihood of COVID-19 infections.
The racial makeup of a nursing home’s population, meanwhile, had a much larger influence on the chance of outbreaks, Konetzka found; facilities with the lowest proportion of white residents were more than twice as likely to have COVID-19 cases or deaths than those with the greatest proportion of white residents.
“Nursing homes are often a reflection of the neighborhoods in which they are located,” Konetzka said. “Consistent with the pandemic generally, nursing homes with traditionally underserved, non-white populations are bearing the worst outcomes.”
But in terms of a facility’s Nursing Home Compare ratings, non-profit or for-profit ownership structure, or proportion of Medicaid residents, there were no significant correlations.
“We conclude from this analysis that while some nursing homes undoubtedly had better infection control practices than others, the enormity of this pandemic, coupled with the inherent vulnerability of the nursing home setting, left even the highest-quality nursing homes largely unprepared,” Konetzka said.
CMS has not yet released detailed information about COVID-19 cases and deaths on the federal level, but administrator Seema Verma earlier this month praised the industry for doing “an amazing job” and cooperating with the coronavirus surveys.
That said, officials did find recurring problems in three primary areas during the first round of COVID-19 inspections: hand hygiene missteps, improper use of personal protective equipment (PPE), and issues with “cohorting” residents into positive and negative areas.
CMS in mid-April indicated that 36% of facilities were still not in compliance with hand-washing regulations, while 25% had problems with incorrect PPE use.
“Both of these are long-standing infection-control measures that all nursing homes are expected to follow per federal regulation,” CMS warned at the time. “CMS is continuing to conduct targeted infection control inspections to ensure nursing homes are prepared to confront COVID-19 and keep their residents safe.”
Those New York facilities that did receive citations mostly had problems with PPE usage and cohorting, in addition to staff members not maintaining appropriate distance from each other, according to The City.
A lawmaker and resident advocate interviewed by The City expressed concerns that the post-COVID inspections may not be thorough enough, given the need to perform partial or complete surveys over video to reduce the risk of introducing COVID-19 into facilities. New York health officials are also actively investigating 2,700 nursing home complaints, according to the publication.
“It’s very shocking that at the apex of this pandemic, our inspectors went in and reported that that there’s nothing out of the ordinary when it’s clear that the infection rate had spread,” state assemblyman Ron Kim told the outlet.