RI Coronavirus: How Well Nursing Homes Control Infection

PROVIDENCE, RI — At a time when authorities are struggling to slow the spread of coronavirus among vulnerable populations, including seniors, 31 percent of nursing homes in Rhode Island have been cited in recent years for problems with infection control.

But the state's leading nursing home association said such problem are quickly remedied, and that additional measures have been taken to help prevent the spread of the coronavirus among the vulnerable elderly population.

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.

Federal inspectors classify infection 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 Rhode Island, 30 citations for infection problems were issued to 25 of the state's 81 nursing homes during the two recent inspection cycles. All fell into the "potential for harm" category in terms of severity and most were listed as "isolated" in terms of scope. Just three citations were for a "pattern" in and seven for "widespread" scope.

The Rhode Island Health Care Association represents 64 of the 81 nursing homes. Scott Fraser, its president and CEO, said any deficiencies identified must and are fixed within a certain period of time.

"When there is a deficiency, serious or not, it must be remedied right away," Fraser said. "Our member homes work quickly to fix any issues."

Rhode Island is frequently among the top states in the nation when it comes to addressing deficiencies, Fraser said. In 2019, America's Health Rankings listed Rhode Island second in the nation when it comes to nursing home care.

"We are very proud that the state is frequently ranked in the top 10 or five," he said.

With infection control at such a high priority during the coronavirus pandemic, even more steps have been taken to keep both patients and health care workers safe, Fraser said.

Many nursing homes ended visitation before Gov. Gina Raimondo issued an order requiring the move, he said. Also, staff and residents are frequently monitored for symptoms and nursing homes are working to make sure there is a sufficient supply of masks, gloves and other necessary personal protection equipment.

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

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.