In South Carolina, the first death related to COVID-19, also known as coronavirus, was an elderly person residing at a nursing home in Lexington. In early March, the resident was transferred from the nursing home facility to Lexington Medical Center and was placed in isolation. A test for coronavirus was administered and returned a positive result. Tragically, the patient died in the hospital the following week due to complications from COVID-19.
To contain the spread of COVID-19, in March, many businesses and activities were required to shut down across the nation, as well as the globe. However, there remained a growing concern for those at the highest risk of contracting the virus. Individuals who are 65 years of age or older and live in nursing facilities are at particularly high risk for experiencing complications with COVID-19. Nursing facilities owe many responsibilities to the residents they serve, including the responsibility to prevent the spread of infectious diseases.
Read on for more information about the dangers that infectious diseases, such as COVID-19, pose to older Americans, and how nursing homes are required to respond.
Why Nursing Homes Are common Places for Infectious Diseases to Occur
According to the Centers for Disease Control, those at the highest risk of contracting COVID-19 are older Americans and those living in nursing home facilities. In fact, 80 percent of the COVID-19 deaths in the United States have involved older individuals. Up to 59 percent of the people between the ages of 65 and 84 who have contracted the virus required hospitalization. Up to 70 percent of individuals over the age of 84 who have contracted COVID-19 required hospitalization.
Of those hospitalized, nearly 30 percent aged 85 years or older and up to 31 percent between the ages of 65 and 84 will be admitted to the intensive care unit. In the U.S., the death rate for COVID-19 patients 85 and older is up to 27 percent. For patients ages 65 to 84, up to 11 percent will die from complications caused by the virus.
As we age, our bodies undergo numerous changes that adversely affect the responsiveness of our immune systems. Our bodies become more susceptible to illness and less able to fight the illness. By nature, nursing home facilities house individuals with fragile immune systems and a lessened ability to fight illnesses in close proximity to one another.
Nursing homes are designed to provide residents with the ability to maintain relationships with family and friends. Frequent visits from friends and family can potentially pass illnesses to their loved ones and among other residents. Staff members may also infect patients with illnesses that they are suffering from when they come to work. These are the main reasons why nursing home residents are so susceptible to the spread of highly contagious diseases like COVID-19.
What Facilities Are Required to Do to Address Infectious Diseases
Nursing homes are regulated by state and federal laws. One requirement of these regulations involves the implementation of an infection prevention and control program. Infection and control programs in nursing facilities are integrated, responsive processes that apply to all the programs, services, and settings provided by a facility.
The main goals of this type of program include:
- Minimizing the risk of infection in individual residents, whenever possible.
- Reducing the risk of the transmission of infectious illnesses between residents and facility staff.
- Reducing the risk of infections in residents who require devices and procedures, e.g., catheters, as a part of their daily care.
A nursing home facility’s infection prevention and control program may include:
- Providing vaccinations against common illnesses such as influenza and pneumonia, if vaccines are available.
- Surveillance of the conditions present in the nursing home and signs of potential outbreaks.
- Ongoing analysis of data collected during surveillance.
- Providing training for staff on how to detect infections in individual residents and the resident population, as well as proper infection control procedures.
- Monitoring of infection control procedures by all departments and all members of the staff.
- Designating an infection control coordinator and providing them with the administrative support and authority to carry out the facility’s plan.
Infection Prevention and Control Precautions
Common infection prevention and control precautions that are used by nursing home staff include:
- Standard precautions such as wearing gloves when exposure to bodily fluids is highly likely; hand hygiene even when gloves are worn; masks, eye protection, and gowns when patient care may expose the staff to bodily fluids; care to avoid injuries from sharp objects used in patient care.
- Contact precautions, including preventing staff or other residents from coming in direct or indirect contact with infectious agents resulting from wound infections and infectious drainage, colonization with MRSA, RSV infections, or skin infections, infectious diarrhea, and fecal incontinence.
- Direct precautions including requiring staff to wear masks when entering the room or coming in contact with someone who is infectious and providing residents with masks if he or she is leaving his or her room.
Limitations to Nursing Home Infection Control Programs
While infection control programs help prevent the spread of infection in nursing home facilities, they are not the sole solution to infection prevention.
Nursing home staff regularly experience limitations in implementing their infection control program for several reasons, including:
- Employees responsible for upholding infection control procedures and policies may have other job tasks that limit available time to devote to infection control.
- Before hiring, most employees do not receive adequate training on infection control. Typically, the task is one that is mostly learned “on-the-job.”
- While infection control is mandated by federal and state regulations, the resources available for developing an effective program are usually quite limited.
- The risk of infection among the facility’s population may be varied. Short-term care patients and those who permanently live at the facility have vastly different needs in terms of infection control. Mobile residents are in frequent contact with other residents who may lack proper hand hygiene or have incontinence issues that are hard to control.
- The risk variations between independent residents and those who are functionally impaired, requiring a high level of assistance by staff, have not been properly quantified.
- There are no benchmarks on a national level regarding the incidence of infection in long-term care facilities.
- Infection control policies and procedures for nursing homes are often modified from hospital policies. However, those policies are not always practical in a nursing home setting. There are few clinical trials regarding the effectiveness of infection prevention and control policies in nursing home settings.
- Nursing home staff is responsible for determining whether a policy that is good for the resident population is also good for individual residents and vice versa. The needs of single residents versus the needs of the resident population are often vastly different.
COVID-19 and the high risk of spreading the virus among nursing home residents, visitors, and staff resulted in additional infection control procedures, including:
- Restrictions on all visitation, except that provided in compassionate care situations such as end-of-life.
- Restrictions on all volunteers and non-essential personnel at the facility, such as hair stylists.
- The cancellation of all planned group activities.
- The cancellation of gatherings in dining rooms and other communal areas.
- Screening of all residents and staff who are exhibiting potential symptoms of the virus, including fever or coughing.
Common Nursing Home Infectious Diseases
COVID-19 is not the only infectious disease that nursing home staff must recognize, prevent, and control. Other common infections occurring in nursing homes include:
- Diarrheal diseases, such as bacterial or viral gastroenteritis. Older adults often do not produce enough stomach acid to prevent infectious gastroenteritis on their own. Diarrhea can increase the risk of death to residents, generally due to the increased dehydration associated with this type of illness.
- Urinary tract infections (UTIs). This is the most common type of infection in nursing homes, and is also the most over-diagnosed infection in such facilities. UTIs in nursing home residents are frequently the result of indwelling catheters. The infections typically impact about half of the resident population at one point or another.
- Pneumonia and other respiratory tract infections. Pneumonia is the leading cause of death among nursing home residents and one of the main contributors to resident hospitalizations. Of all people hospitalized for pneumonia, 10-18 percent are nursing home residents. The residents who are at the highest risk for contracting a respiratory infection are those who require a feeding tube. Another issue that increases the risk of pneumonia is poor dental hygiene, as dental plaque is a bacteria known to result in pneumonia. Studies indicate that more than half of all nursing home residents have extensive dental needs that may not only cause discomfort but can also lead to other illnesses.
- Chronic wound infections, including pressure ulcers, vascular ulcers, and diabetic wound infections. Pressure ulcers—also known as bedsores—are a very common infection in nursing home facilities. Factors that place a resident at a high risk for bedsores include loss of mobility, mental impairment, incontinence, improper nutrition, and other underlying health conditions.
- Seasonal influenza. The flu is another common infection experienced by residents and staff at nursing homes. In spite of making influenza vaccines readily available for the resident population, many residents lack adequate preventative care to fight the flu.
Protecting Your Loved One Through Distance
Placing a cherished parent or sibling in a nursing home is an act that, for some people, results in a tremendous amount of guilt. The family members of nursing home residents often find themselves explaining their inability to care for an aging family member at home. They vow to visit often, and many do just that.
Unfortunately, with the first case of COVID-19 in the nation and the state both occurring within the nursing home population, nursing homes immediately had to begin limiting visitation to reduce the spread of the illness. The sheer prevalence of COVID-19 and the infected individuals who have no symptoms made restrictions on visitation in facilities necessary.
COVID-19 cases continue to increase across the nation and the spread is becoming harder to contain. Many relatives of nursing home residents express fear that it may be a long time before they’re permitted to see their loved one again. At the same time, advocates for the elderly note that, while infection control procedures are important, preventing seniors from having visitors and enjoying communal activities with other residents is depriving them of much-needed support.
Family members provide love, attention, and a friendly face for their aging loved ones. Additionally, frequent visitation protects your loved ones because you can monitor the quality of resident care.
Family members who cannot visit their loved ones at the nursing home are urged to keep in contact remotely through the following methods:
- Email and video chat options such as those provided by FaceTime or Skype.
- Frequent phone calls.
- Close communication with the facility staff and administration. During the implementation of the COVID-19 prevention and control procedures, facilities were encouraged to provide a point of contact for family members. Staff was advised to provide families with regular status updates regarding the facility’s procedures and the presence of COVID-19 positive residents at the facility.
Some other tips for family members who are concerned about their elderly loved ones during this time include:
- Avoid panicking and removing the nursing home resident from the facility. Residents may face an even greater risk of infection outside of the quarantined halls of the nursing home.
- If you’re wondering what the staff at your loved one’s facility is doing to reduce the rate of COVID-19 infections, read the guidelines produced by the CDC. If you are worried that the staff is not following those guidelines, you can contact South Carolina’s Long Term Care Ombudsman Program here.
Call the Hughey Law Firm’s Nursing Home Lawyers Today.
Since 2007, the Hughey Law Firm has fought against nursing homes to seek justice for the abuse and neglect of their patients, including for the failure to establish and follow proper health and safety procedures.
We cannot guarantee results in any case. Case outcomes depend on the individual facts specific to each one, and they may differ significantly. That said, we work hard on every case we take, and have obtained more than $140 million for our clients, including victims of negligent nursing homes.
If your loved one was injured or has contracted an infection (including COVID-19) due to nursing home abuse or neglect, contact the experienced nursing home lawyers at The Hughey Law Firm for answers to your questions and to learn your legal options. Even during a shelter in place order, we can still meet with you and offer a free virtual consultation by phone at (843) 881-8644, through our contact form, or through video conferencing software.
Hughey Law Firm LLC
1311 Chuck Dawley Blvd. | Suite 201
Mt. Pleasant, SC 29464