How New York’s Nursing Homes Control Infection

NEW YORK — At a time when authorities are struggling to slow the spread of coronavirus among vulnerable populations, including seniors, 52 percent of nursing homes in New York 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.

“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” Patricia Hunter of the Washington State Long-Term Care Ombudsman Program told Kaiser.

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.

Nancy Leveille, director, special projects and education development for New York State Health Facilities Association, said there many educational events and monitoring processes in place during the new coronavirus outbreak for infection prevention and control.

She said the Center for Medicare and Medicaid Services has directed the state Department of Health’s nursing home surveyors to specifically focus their attention on monitoring the infection control standards in skilled nursing facilities across the state.

Weekly educational sessions are provided on infection prevention topics related to COVID-19 from isolation precautions, use of personal protective equipment and supplies, testing procedures for COVID-19, assessment and treatment options, Leveille said.

Epidemiologists are available to the overall healthcare system and are working directly with the skilled nursing facilities to assess individual facility issues and problem solve solutions, she said.

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

Most of the violations 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.

Of 619 nursing homes in New York, the severity of most citations fell into the “potential for harm” category. Their scope was said to be widespread in 9 percent of cases, a pattern in 25 percent and isolated in 66 percent.

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 nine to 15 months, and inspections prompted by complaints or facility-self reporting of problems. The Kaiser data was distributed by the Associated Press.