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COVID-19 outbreaks at nursing homes follow years of infection control problems

The Centers for Medicare and Medicaid Services have responded by giving residents and their families more ways to get information from nursing homes.

ST CHARLES, Mo. — In these strange times, Annette Jansen recognizes that being a good daughter means she looks like a burglar.

“I might get the police saying there's a peeping Tom out there,” she said during a recent visit to Frontier Health and Rehabilitation in St. Charles County.

For two months, Jansen has been visiting Frontier to look in the windows. She’s trying to get a glimpse of her mother, Leona Behrens, a Frontier resident who recently tested positive for COVID-19.

“I don't know from the outside where she's at,” said Jansen. “If she's alert enough, I can use a dry erase board.”

Lifting her mother’s mood is just part of the reason she makes these trips. Jansen said she is concerned that she can’t verify how the staff are caring for her.

“I'm not sure that they really did contain it right off the bat," said Jansen. “My mom had a roommate that was positive and they kept her in there with just a curtain."

Credit: Annette Jansen
Leona Behrens posed with her grandchildren, Paige and Grant, outside of her window last week

Frontier Health and Rehabilitation has reported that 20 of its residents died from COVID-19 since the first diagnosed case on March 23. It’s one of the 76 nursing homes and group living facilities that have seen an outbreak of COVID-19 in the St. Louis area, according to the state's health department.

Kay Van Wey, a medical malpractice attorney, said the risks to nursing home residents are nationwide.

“The nursing home industry has been a very troubled industry for many years. We should be ashamed in the United States at how poorly they care for our loved ones,” said Van Wey.

RELATED: Woman in her 50s is latest St. Charles nursing home resident to die from COVID-19

Nursing home histories show COVID-19 risks

The evidence of that, she adds, can be seen in a facility’s inspection record.

“If they had a history of poor compliance and poor safety practices before COVID, a lot of times that has continued. And that's where we're seeing a large cluster of these cases,” said Van Wey.

The I-Team looked at the inspection history for three facilities with the highest published numbers of resident deaths to COVID-19 in the St. Louis region.

Out of St. Louis area facilities in Missouri that have shared their case numbers with the public, Frontier Health and Rehabilitation has had the most deaths. In at least one Centers for Medicare & Medicaid Services (CMS) inspection every year since 2015, Frontier’s documented deficiencies included infection control issues, often related to staff hand-washing.

In a statement from Frontier on May 13, a representative wrote, “None of the deficiencies cited in our past surveys has ever resulted in any patient harm.  All deficiencies cited in the most recent survey (November 2019) were corrected through additional staff training to the satisfaction of the inspectors by early January 2020, well before the first positive coronavirus case occurred at Frontier on March 23.”

Edwardsville Care Center in Madison County, Ill., has seen 17 residents die of COVID-19. The facility has also had an infection control deficiency in its inspection records every year since 2016. Those records from the Centers for Medicare & Medicaid Services mention outbreaks of urinary tract infections in 2017 and a contagious fungal infection in 2018.

Grandview Healthcare in Franklin County, Mo., has had at least 11 residents die of COVID-19. CMS cited the nursing home for infection control deficiencies every year since 2015.

5 On Your Side asked for a statement on these inspections from Edwardsville Care Center and Grandview Healthcare for this story. Neither facility has provided one.

A new national focus on nursing homes

In a wave of surveys completed by Centers for Medicare & Medicaid Services in the last week of March, 36% of nursing homes were not following handwashing guidelines and 25% were not using personal protective equipment the right way.

“My hope is that the pandemic will shine a light on the poor care and the really poor job that many nursing homes do taking care of residents and that someone will call for national reform,” said Van Wey.

CMS suspended routine inspections on March 20 in order to focus on high-risk facilities and look exclusively at nursing home infection control. The agency issued guidance to nursing homes on how to manage protective equipment and prevent infection. One step the organization recommendeds was for facilities to start assessing themselves and have documentation to show the CMS surveyors when they arrive.

CMS Administrator Seema Verma recently told reporters, “Nursing home residents and their families who want to be sure a nursing home is safe should not hesitate to ask staff directly: What are the results of your CMS self-assessment?”

When asked whether they have been conducting these self-assessment surveys, Frontier and Edwardsville say they have but would not share them with 5 On Your Side. Grandview Healthcare did not return a call asking for the same.

RELATED: 2 more people die at Franklin County nursing home

CMS also announced that it would now require nursing homes to tell residents and their families more information about the number of cases of COVID-19 in their facilities.

Jansen’s mother is one of the cases in recovery, although Jansen is planning to relocate her.

“With her preexisting conditions and her age, I didn't think she'd be strong enough to fight it,” said Jansen. “I was a child and we would go see my grandmother in a nursing home, and I watched my own mom who is now in a nursing home, fighting for her. That was an example for me. I'm not going to let her just exist. That's not the right life.”

How to find out about your relative’s nursing home

Health departments in Missouri and Illinois have taken different approaches to keeping the public informed about cases of COVID-19 at nursing homes. The Illinois Department of Public Health is publishing information about numbers of cases and deaths at every nursing home in the state on their website.

The Missouri Department of Health and Senior Services is publishing only the number of congregate living facilities in each county that has an outbreak of COVID-19. A representative for DHSS told 5 On Your Side that the department is not tracking the number of nursing home residents who die of COVID-19 or the number of cases at each facility.

Nursing homes with Medicare or Medicaid residents have inspection results published in the CMS Nursing Home Compare tool. Previous deficiencies are visible under the “Health Inspections” tab on a nursing home’s profile.

Van Wey also recommends that families ask nursing homes directly about their self-assessments and numbers of cases and deaths within a facility. If they don’t respond with clear answers, she added, it may be time to reach out to the state nursing home oversight agency. In Missouri, DHSS has an ombudsman program for long-term care. The Department of Aging in Illinois operates its long-term care ombudsman program.

5 On Your Side has not received statements for the purpose of this story from Edwardsville Care Center or Grandview Healthcare. This is the full statement from a representative of Frontier Health and Rehabilitation:

"None of the deficiencies cited in our past surveys has ever resulted in any patient harm. All deficiencies cited in the most recent survey (November 2019) were corrected through additional staff training to the satisfaction of the inspectors by early January 2020, well before the first positive coronavirus case occurred at Frontier on March 23. In addition to our monthly in-service staff training on infection control, on March 8 our Director of Nursing began conducting additional training sessions to educate and re-educate staff each time we receive new infection control guidance from the CDC. These additional steps include screening residents and staff for symptoms beyond the flu, use of new temperature screening tools, proper use of PPE, proper handwashing techniques and consistent assignment so that only certain staff members interact with each resident. We are doing everything we can to stop the spread of this virus and follow proper infection control procedures, while making sure our residents still receive the daily care they require.

"These improvements in our infection controls are making a measurable difference in the health and safety of our residents. 65 of our residents have recovered from being COVID-19 positive and 14 of those have successfully been discharged and returned to live at home. Two additional residents from this category are scheduled to be discharged later this week. In addition, 40 of our residents that have been with us since March 23 have tested negative and remain asymptomatic.

"These recovery numbers have impressed area hospitals too. Since April 25, Frontier has admitted 9 new COVID-19 positive residents being discharged from area hospitals as far away as Belleville, Illinois, thanks to their respect for our COVID unit’s performance and cleanliness."

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