Expert: Nursing home location has the greatest impact on the number of COVID cases

Almost a year after the coronavirus epidemic, experts have shown that the spread of COVID-19 within the community hosting nursing homes is more deadly to caregivers than traditional quality assessments and inspection reports. It states that it could be a better indicator of how it affects the virus.

Nursing homes were hit hard by thousands of cases and deaths early in the pandemic. In Connecticut, nursing home deaths account for 57% of the state’s total deaths.

“The strongest predictor of whether we see the case [a particular setting] David Grabowski, a professor of health policy at Harvard Medical School and co-author of a recent treatise on the epidemic of COVID in nursing homes, said.

“Cases of COVID-19 in nursing homes are related to facility location and size, not traditional quality indicators such as star ratings or previous infection control citations,” Grabowski said. I am.

A Hurst Connecticut media survey of infection control violations in nursing homes found little correlation between defects found by federal inspectors and the number of residents who died after being infected with the coronavirus. ..

For example, East Hartford’s Riverside Health and Rehabilitation Center has not been breached of infection control since 2017, federal inspection records show. Still, a 4-star facility lost 76 patients at COVID last year — the most common in Connecticut.

In contrast, the Monsignor Boynows Nursing Home in New Britain, a five-star facility with no COVID deaths as of January 12, was cited last year for violating infection procedures during a pandemic. It was.

According to test records, seven of the ten nursing homes with the highest COVID deaths have been cited at least once in the last few years due to inadequate infection control procedures, and four have more than one in 2020. I was violated.

A review of 10 of 18 nursing homes where no one died from COVID showed that 9 of these facilities had at least one infection control breach in the last few years and 4 were cited in 2020. it was done.

To date, 3,728 residents of 213 nursing homes in the state have died from complications associated with COVID-19. As of January 12, 6,553 residents of Connecticut have died of COVID.

Matt Barrett, chairman of the Connecticut Healthcare Facility Association, said community expansion is the most relevant factor in how seriously COVID affected long-term care facilities.

“In areas where COVID-19 is abundant, facility staff are infected with the virus and bring it to the facility for asymptomatic spread,” Barrett said.

Due to the expansion of the pandemic, all nursing homes have been closed. In other words, only employees were able to enter. The family couldn’t visit their loved ones.

Lots of violations

According to Hurst’s review, a federal inspector at the Abbott Terrace Health Center in Waterbury cited the facility four times in 2020 and once in 2019 and 2017 due to improper infection procedures.

Violations in April 2020 include failure to verify that residents were wearing masks and failure to maintain social distance.

Current On January 12, 52 patients died of COVID at a 2-star facility.

However, a similar infection protocol violation was found at the Chesthem Health & Rehabilitation Center in East Hampton. This is a 5-star facility that has never lost a patient with COVID.

Inspectors in May 2020 did not separate COVID and non-COVID patients and cited Chestrum for improper use of personal protective equipment.

Dr. Vivian Leung, Head of Infection Program at the Department of State’s Public Health Service, acknowledged the impact of community expansion.

“Our epidemiologists, such as national epidemiologists and CDC epidemiologists, have found that community incidence is a major factor in nursing home cases,” says Leung. “You can’t effectively protect the most vulnerable people without controlling the spread of the community.”

Leung said: “These outbreaks are multifactorial, but the link to community incidence in controlling other factors is clear. Immunization is not 100%, so vaccination alone cannot prevent these outbreaks. . “

COVID expansion

A recent study by Harvard University, supported by the National Institute on Aging and the National Institutes of Health, investigated the outbreak of COVID-19 in New York, Detroit, and Cleveland.

The study found that the severity of COVID-19 outbreaks in nursing homes reflected the proportion of spread among the general population near the facility.

Other researchers provided similar ratings.

“Patients in the building are more likely to have a COVID if they are in an environment with a lot of people with a COVID in the community,” said Vincent Mor, a professor of health services and policy at the School of Public. I will. Brown University Health.

R. Tamara Konetzka, a professor of health services research at the University of Chicago, said that traditional methods of assessing nursing homes do not work with COVID-19. “The first reported death was due to a five-star nursing home in Washington State,” Konetska said.

Tim Brown, a spokesman for Athena Health Care Systems, which owns the Shady Knoll Health Center in Seymour, Connecticut, agreed that community expansion is a major cause of COVID outbreaks in nursing homes.

“Some of the first cases we saw required treatment from people who visited our building before the state mandated strict restrictions, or offsite such as dialysis clinics, and ours. “Building,” Brown said.

Mark Parkinson, president of the American Health Care Association, said wearing masks and social distances is the only way to reduce the spread to the community and thus to nursing homes.

“If everyone wears masks and social distances to reduce the level of COVID in the community, care facilities could dramatically reduce these infection rates,” Parkinson said.