CT Nursing Home Coronavirus Response Had Gaps: Study

CONNECTICUT — A new state-commissioned consultant study found that there were some gaps in Connecticut’s early response to the coronavirus pandemic when it came to nursing home facilities.

The researchers also found that some nursing homes were hit extremely hard by the virus, but others had very few or no cases; in general better-rated facilities fared better than poorly-rated ones.

“Our preliminary assessment of the state’s response found that state officials made policy decisions and issued guidance based on the available knowledge at the time from national and state epidemiologists and public health experts, but that knowledge was undermined by gaps in the scientific understanding of the virus,” said Patricia Rowan, a researcher at Mathematica and the project’s director. “Connecticut took an important step in supporting this independent research, and we believe our recommendations will help ensure that the state and long-term care industry are better positioned to respond to a potential second wave of COVID-
19.”

Gov. Ned Lamont said in a statement that like other states Connecticut was hampered by low testing capacity and limited scientific knowledge about the coronavirus during the first couple months of the pandemic. The state commissioned the nearly $450,000 independent study in preparation of another possible wave of the virus in order to learn from what went right and what needed improvement, Lamont previously said.

The final report is due Sept. 30.

“I am grateful for the thorough work done by Mathematica to help us learn from our response thus far so we can make improvements as needed as we work to avoid another surge in COVID-19 cases,” Lamont said. “I look forward to reviewing the final report, and working with the long-term care industry to keep our residents and families safe from COVID-19.”

Mathematica found that the state’s emergency response and surveillance systems were insufficient to tackle the initial coronavirus outbreak.

“Connecticut’s [Department of Public Health] had a robust emergency response continuity of operations plan that outlined roles and responsibilities, the structure of the joint incident command, and communication expectations, but the plan focused exclusively on hospitals and did not explicitly address [Long-term care] facilities,” researchers stated.

The plan also assumed a sufficient supply of personal protective equipment and that only non-infected staff would work in healthcare facilities.

Data collection systems were paper or fax-based as the beginning of the outbreak in Connecticut. Daily electronic reporting didn’t begin until May 8.

As of January six out of nine positions in DPH’s office of public health preparedness and response were vacant; they were filled by July 2020, long after Connecticut’s first wave was over.

Long-term care facilities reported that the state’s guidance and communication became better with time and that the state’s mutual aid plan website became a central location for guidance. However, written guidance sometimes came weeks after calls with DPH; this led to some confusion on how to implement policies, according to the report.

Lamont issued his universal mask order for health care facility workers on April 4, one day after the national coronavirus task force recommended universal masking for the general public. New York implemented its health care mask order on March 13.

Nursing home surveys between March 4 and June 28 didn’t result in any citations for infection control.

Though some faults were found in the state’s response, there was also a lot the state got right, according to the report. The state began procuring personal protective equipment and distributing it weekly to long-term care facilities weekly in early April. The state’s stockpile was a small share of the total PPE used, but it allowed the state to act as a supplier of last resort for facilities.

Nursing homes

Connecticut’s outbreak in nursing homes peaked in mid-April with an average of 200 new daily cases and 50 deaths.

Many states in the northeast were hit hard by the coronavirus in long-term care facilities, but Connecticut had the highest death rate per population at 91 per 100,000 total population.

Total nursing home cases and deaths per licensed bed didn’t vary much between Connecticut and other nearby states, according to the report.

There were some stark contrasts on a home-by-home basis on how the coronavirus hit long-term care facilities. At least half of residents were infected with the virus in one out of every four nursing homes in Connecticut and at least 20 percent of residents died in one out of seven nursing homes. However, about 30 percent of nursing homes had very few or no cases or deaths.

Larger nursing homes tended to have more cases and deaths per licensed bed; nursing homes that were part of a chain had about 40 percent more cases or deaths than independently-owned homes, according to the report.

Higher-rated nursing homes typically had fewer coronavirus cases and deaths, as did nursing homes with higher staff ratings.

Homes with fewer health inspection deficiencies had fewer cases, but not fewer deaths.

Homes with a recent complaint in the last three years had 35 percent more cases and deaths than those without a recent complaint.

Assisted living facilities weren’t hit as hard as nursing homes; only 3 percent of assisted living facilities had more than 50 percent of residents contract the virus and only 3 percent had more than 20 percent of residents die. Around 37 percent of assisted living facilities in Connecticut had zero reported cases or deaths.

Adjusting for nursing home characteristics, deaths remain similar in nursing homes across nearby states.

Recommendations going forward

Mathematica suggested the state look to reduce duplicate resources and case reporting

The state should also revisit Medicaid reimbursement approaches as new coronavirus testing technology receives federal approval. For example the state should incentivize the use of a combined coronavirus/influenza test if it becomes available instead of incentivizing separate testing.

The state should also continue to act as a supplier of last resort for personal protective equipment if another wave of the virus hits in the fall or winter.

Nursing home facilities should adopt policies to limit exposure to the virus for staff and residents. Facilities should switch to 12-hour shifts instead of 8-hour shifts in order to limit entry and exit of staff. Facilities should also limit “moonlighting” among staff who work at multiple facilities.

Nursing homes should also better communicate with family members of residents through weekly written updates on the general situation in the facility. They should also assign points of contacts for family members to request updates on individual residents.

Connecticut should also plan to scale its COVID-19 recovery facility capacity for nursing home and assisted living residents.