We published a story this week about the nursing home industry resisting for years a federal mandate to plan for disasters including pandemics. About 43% of nursing homes nationally have been caught violating the requirement, including some with deadly COVID-19 outbreaks.
The story by New Mexico In Depth reporter Bryant Furlow and partners at ProPublica and the Raleigh, NC-based News & Observer newspaper features a COVID-19 outbreak and deaths at a nursing home in Albuquerque, Advanced Health Care.
As of yesterday, 102 of 335 New Mexicans who have died due to the COVID-19 pandemic were residents of nursing homes, and another 30 were residents of other long-term care facilities. We don’t know how many, if any, staff of nursing homes have died.
It’s important to know that AHC of Albuquerque earned a 5-Star rating — the highest level — from the Centers for Medicare and Medicaid Services. Also rated highly are two New Mexico facilities with deaths: Life Care in Farmington where 39 people have died, carries a four-star rating; and La Vida Llena in Albuquerque where 14 people have died, has a five-star rating.
That facilities with 4- and 5-star ratings have suffered outbreaks with so many deaths raises alarming questions about the strength of infection control requirements, the rigor of inspections and whether penalties for inspection violations are sufficiently large to incentivize adherence to regulations.
An emergency plan for pandemics is largely about controlling the spread of infectious and communicable diseases. The federal government requires that nursing homes include a plan for handling emerging infectious diseases in emergency preparedness plans.
In mid-March, as the first cases emerged in New Mexico, the state Health Department said it made the rounds of long-term care facilities to ensure they had proper emergency response plans in place. But it’s unclear whether they checked that nursing homes had the required section for how to handle emerging infectious diseases. New Mexico In Depth has not received a clear answer whether inspectors looked for that section, and the brief sentence in the March 16 inspection report for AHC simply states, “An Onsite Surveillance survey was conducted on 03/16/20 related to Covid 19 infection prevention and control.”
The administrator of AHC told Furlow there was no plan specifically for handling a pandemic. Nurses at AHC said there was no plan, or trainings conducted.
There are 71 nursing homes in New Mexico regulated by the federal government, which relies on inspections by state authorities to ensure regulations are being followed. There are 268 other long-term care or assisted living facilities that are regulated by the state. Reviewing state regulations for assisted living facilities, where 9% of New Mexico deaths have occurred, there are requirements for staff training related to infectious and communicable disease when it comes to food and laundry handling, but otherwise, there do not appear to be requirements for emergency response related to pandemics.
We’d also note that the Health Department state inspection portal where the public should be able to look up reports about facilities is outdated. AHC of Albuquerque reports are updated, probably because Furlow badgered state officials for them. But many are not up to date.
The large number of COVID-19 deaths at nursing homes in New Mexico spurs me to look beyond poorly rated facilities, to pandemic preparation at all facilities. It’s not enough to just examine poorly rated facilities or specific actions by administrators.
For instance, AHC of Albuquerque and the Life Care Center, owned by large national chains, are highly rated by CMS. It begs the question, what do these star ratings even mean?
There are so many questions — yes, about the strength of infection control requirements, how rigorous the inspections are and whether penalties are hefty enough — that deserve attention. More than enough for New Mexico authorities to take up.
This originally appeared in the New Mexico In Depth weekly newsletter. To receive the newsletter on Fridays, sign up here.