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Improving nursing home safety requires all the facts

Nursing homes exist to care for people who cannot be kept safe at home; who, for reasons of physical or cognitive health or both, need trustworthy and competent support more than their cherished independence. The sick and elderly move in to nursing homes to stay alive and safe.

Instead, that has made them prime targets for the insidiously lethal COVID-19 epidemic. Far from being safer, nursing home patients have sickened and died from the coronavirus in high numbers all over the world. In the U.S., the governmental response in March was to order inspections of nursing homes with high fatality and infection rates; in Connecticut, Gov. Ned Lamont went a step further and in April ordered inspections of all 213 nursing homes in the state.

Lamont deserves credit for that decision which, it now turns out, may have been more prescient than the governor himself realized. Two studies cited by the Associated Press show that the virus has run rampant among patients and staff even in some of the highest-rated nursing homes. Deciding factors for which facilities experience the most infections seem to be location and population density. The reports indicate that the most vulnerable are nursing homes that are comparatively large and located in urban areas or counties with high infection numbers. 

The studies — one by the National Institute on Aging and another based at Harvard Medical School — covered 26 and 20 states, respectively. According to the AP, researchers found no correlation between the number of infections and previous quality ratings or prior infection violations.

That is a sobering thought, because it might appear there is little than can be done to prevent the high number of infections; about 60 percent of Connecticut's COVID-related fatalities have been nursing home residents. But the public is still awaiting the results of most of the inspections, which were expedited with the help of the Connecticut National Guard. We do not yet have the whole picture because the state Department of Public Health has been unaccountably slow in releasing them. The second batch came out last week, bringing the total to 26 reports on nursing homes, accounting for 313 deaths and more than 1,100 residents infected. That's just over 10 percent of the facilities.

The inspection reports released thus far include detailed observations by inspectors and each facility's response about corrective action. Bayview in Waterford, which is listed as having 127 beds, 40 reported infections and seven deaths at the time of the inspection, "failed to ensure infection prevention strategies were consistently implemented." The report notes failures in social distancing and handling and use of PPE equipment that could potentially affect "any resident."

The challenges in caring for people who may be physically or cognitively unequipped to cooperate for their own safety are admittedly great, as an administrator for Bayview owner Athena Health Care Systems told the Connecticut Mirror. But the inspectors are reporting staff behavior, not that of patients. And it is owners and staff who must prove they can improve safety.

They face an elusive enemy virus. However, the shortages of masks and other protective gear in the early days of the pandemic have eased. We have also learned since then that the virus can be spread by people without symptoms; increased testing and temperature-taking should help with that. And it appears that the loathed quarantining of patients from visitors may have helped, given the finding that the nursing home infection rates are high in the same communities where the numbers are high. That will most likely have to continue.

The lack of gear, testing and experience with this particular virus generated a perfect storm that descended on vulnerable people. As researchers learn more about how the virus behaves in individuals and in groups, the response should improve, but that also requires the information the governor set out to get. The reports need to be released quickly; this is a matter of life and death.

The Day editorial board meets regularly with political, business and community leaders and convenes weekly to formulate editorial viewpoints. It is composed of President and Publisher Tim Dwyer, Editorial Page Editor Paul Choiniere, Managing Editor Tim Cotter, Staff Writer Julia Bergman and retired deputy managing editor Lisa McGinley. However, only the publisher and editorial page editor are responsible for developing the editorial opinions. The board operates independently from the Day newsroom.


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