Coronavirus: How MA Nursing Homes Control Infections

BOSTON — At a time when authorities are struggling to slow the spread of the new coronavirus among vulnerable populations, including seniors, 54 percent of nursing homes in Massachusetts have been cited in recent years for problems with infection control.

According to a data analysis by Kaiser Health News and distributed by The Associated Press, 9,700 of the nation’s more than 15,000 nursing homes — about 63 percent — were cited by the federal government at least once during the last two inspection cycles, which ran from February 2016 to February 2020.

Nearly 3,500 nursing homes, or 23 percent, were cited more than once.

Even among those homes with the federal government’s top rating — five out of five stars — 40 percent have been cited at least once for infection problems. Such citations were issued to 80 percent of the worst-rated homes, with just a single star.

Check federal ratings for nursing homes in your area.

Infections are a persistent challenge for skilled nursing facilities. Kaiser noted that as many as 3.8 million occur in homes each year, killing nearly 388,000 residents.

The Kaiser analysis found that many infection citations concern basic sanitary practices now being stressed in the fight against coronavirus, including workers’ failure to wash hands as they move from patient to patient or to wear masks, gloves and gowns when dealing with contagious patients.

Some citations, however, involve matters less likely to factor into disease transmission -- allowing patients to develop bedsores, for example, or to catch infections through urinary catheters.

Federal inspectors classify violations in one of four levels of severity.

Most of these fall into the category of “potential harm.” Less severe violations might create “potential for minimal harm,” but more severe might threaten “actual harm” and the most severe put patients in “immediate jeopardy” and require prompt correction.

Violations are also classified in scope, as "isolated," "pattern" or "widespread," depending on the number of patients who could be affected.

In Massachusetts, 205 of the state's 337 nursing homes have been cited for infection problems in recent years, some more than once, Kaiser reported. Among 270 separate citations, the severity of most fell into the “potential for harm” category. Their scope was said to be widespread in 5.2 percent of cases, a pattern in 19.3 percent and isolated in 75.6 percent.

Michael Lauf, the president of Cape Cod Healthcare, said these problems are not unique to nursing homes, but affect hospitals and other facilities as well.

"At Cape Cod Healthcare, the safety of our patients, as well as our staff, physicians, and volunteers is our highest priority ..." Lauf said in a statement. "We anticipate the virus will continue to spread widely throughout our community."

Visitation has been canceled at all Cape Cod Healthcare facilities since March 15. All nursing homes listed with the Massachusetts Senior Care Association have barred visitors as well, urging residents to keep in touch with love ones via phone calls, video calls and social media.

Association President Tara Gregorio said the group is working closely with Gov. Charlie Baker's administration, the Massachusetts Department of Public Health and other state and federal agencies to get the support needed to slow the spread of COVID-19.

Gregorio said the association's most recent assessment survey showed that most nursing homes lack essential supplies like N-95 masks, gowns, gloves, face shields, thermometer covers and sanitizing gels.

"The Association is assisting nursing facilities across the Commonwealth to mobilize all resources necessary to implement every available measure in order to protect our vulnerable residents and dedicated staff from the spread of COVID-19," Gregorio said in a statement. "Their safety and well-being remain top priorities for our members.

Use this interactive map to see how often nursing homes in your area were cited for infection control problems.

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Source: A Kaiser Health News analysis of the Nursing Home Compare database from the Centers for Medicare and Medicaid Services as of February 2020, which details the “deficiencies” or citations that each nursing home received during inspections over the last two inspection cycles, which stretch back to February 2016. They include planned inspections, which occur once every 9 to 15 months, and inspections prompted by complaints or facility-self reporting of problems. The Kaiser data was distributed by the Associated Press.