Articles Posted in Infections in Nursing Homes

In light of the emergence of the new Omicron variant of Covid-19, Maryland nursing homes should take steps to prevent and reduce the likelihood of transmission amongst staff and residents. While people hoped that nursing homes and assisted living facilities have honed their strategies to keep the spread in check, the reality is that many of these facilities fail to engage in a flexible and adaptive approach to virus prevention. Some approach Maryland nursing homes can take include:

  • Encourage vaccination;
  • Consider local transmission rates in decision-making processes;

From the beginning of the COVID-19 pandemic, many states passed legislation or issued executive orders shielding nursing homes and long-term care institutions from liability for COVID-19 harms that residents may have suffered. Maryland is one of several states that have introduced legislation allowing for this type of immunity. While not every COVID-19 case in a Maryland nursing home is due to another’s negligence, the fact of the matter is that the harrowing number of cases reflects the persistent low standard of treatment and care many of these facilities provide. Despite guidance from federal and state agencies, many nursing homes provide subpar care to their residents.

In light of these complicated and unclear immunities, many people are left wondering what recourse they have if their family members suffer injuries because of the neglect of a Maryland nursing home. The Maryland Nursing Home Bill of Rights provides that residents have the right to receive quality care, and facilities must treat residents with respect. Generally, nursing homes that fail to meet this standard will be held liable for the damages that their negligence causes. This duty does not mean that nursing facilities have an obligation to prevent their residents or patients from all viruses and infections. However, they must maintain policies to prevent and control infections.

The Centers for Disease Control (CDC) provides Maryland nursing homes with guidelines on preventing the spread of disease within their facilities. These include:

Although vaccine mandates may provide relief for some nursing home residents, some nursing homes worry that they may lead to understaffing in Maryland nursing homes and throughout the U.S. A federal vaccine mandate is going in effect, meaning that in many nursing homes, workers will be required to get vaccinated against COVID-19. Currently, 27% of nursing home staff have not been vaccinated, causing some to worry that those staff members will look for another job instead of getting vaccinated. Administrators said that some other healthcare providers who also receive federal funding, such as some hospitals, home health agencies, and community health clinics, do not yet require the vaccine and may provide alternative employment options for those workers.

Maryland’s governor recently announced that all employees at Maryland nursing homes and hospitals must be vaccinated or undergo ongoing screening and testing. Maryland nursing home staff must receive their first dose of a COVID-19 vaccine by September 1st. If a nursing home fails to comply or to report vaccination compliance, it will be subject to fines, penalties, and enforcement action. About 79% of staff members at Maryland nursing homes have been vaccinated so far.

A Maryland nursing home resident who contracts a communicable disease because of the nursing home’s failure to adequately protect its residents may be able to file a claim against the facility. State and federal regulations require nursing homes to adequately care for and protect residents. Nursing homes must continue to take precautions to help protect residents from contracting COVID-19. Even nursing homes residents who are vaccinated continue to need protection, as many are immunocompromised and may not be fully protected even with vaccines. This means that a nursing home may be liable for failing to take adequate protections to protect a resident from COVID-19. Facilities are still expected to take measures to protect residents, such as routine cleaning, investigating potential cases, isolating COVID-19 positive or suspected positive residents, and screening staff. The facility is also required to record infections and report them to health officials.

Health officials are beginning to worry about outbreaks of COVID-19 in long-term care facilities again as the delta variant causes an increase in cases in the country. With the rollout of the COVID-19 vaccine and 81 percent of nursing home residents being vaccinated, deaths in long-term care facilities have decreased dramatically. However, the delta variant and the rate of vaccination among nursing home staff have caused some experts to worry. In some states, vaccinations rates among nursing home staff are less than 50 percent. The increase in cases with the rise of the variant is worrisome for Maryland nursing home residents.

The Centers for Disease Control and Prevention has said that although breakthrough infections (infections among those who are vaccinated) are rare but may be as transmissible, and warn that the delta variant is “highly contagious” and likely more severe. Health officials in some states have confirmed that unvaccinated staff members are spreading COVID-19 among nursing homes. An official in Mississippi said recently that there were over 100 outbreaks in the state’s long-term care facilities, 72 of them being in nursing homes. Seven residents died recently at a facility in Indiana where less than 50 percent of the staff was vaccinated. Some advocates have called for vaccine mandates for workers in long-term care facilities. Others worry that it will create more workforce shortages. In Maryland, over 10,000 residents have contracted COVID-19 and over 2,300 residents have died. 82% of residents have been vaccinated and 71% of staff.

What Are a Maryland Nursing Home's Duties to Residents?

Maryland nursing homes that accept Medicare and Medicaid patients are required to follow state and federal regulations. Federal regulations require nursing homes to provide adequate medical care to residents, which includes taking steps to investigate and control diseases within the facility, maintain a record of infections, isolate patients who become infected, and report diseases to local health officials. Maryland long-term care facilities that do not take adequate measures to prevent the spread of disease among residents or care for patients who contract a disease may be liable for injuries to residents. In a Maryland negligence claim, a plaintiff must show that the nursing home failed to meet its duty of care to adequately care for a resident in one or more ways. Maryland nursing home residents and their families may be able to file a claim against a long-term care facility for negligence, wrongful death, or another cause of action.

Instances of nursing home abuse and neglect have been widespread since before 2020 and the advent of the Covid-19 pandemic. The arrival of the novel virus presented many challenges to elder care that have reduced the quality of life of many nursing home residents. Instances of abuse and neglect have also sharply increased since the beginning of 2020. A recent trade publication describes some of the factors and issues related to the Covid-19 pandemic that has put a strain on the nursing home industry and contributed to increased instances of abuse and neglect.

The rise of Covid-19 put a strain on the staffing of nursing homes, assisted living centers, and long-term care facilities. Illness, lockdowns, and travel restrictions made it more difficult for nursing homes to find qualified staff to offer care to their residents. Understaffed nursing homes resulted in residents being neglected as there were simply not enough skilled workers to offer care that met a reasonable standard. In some cases, the needs of residents increased as a result of the lessened social interaction and restrictions on family contact caused by covid-19 restrictions.

Although reduced staff and increased need help explain the uptick in abuse and neglect instances, these explanations do not make a valid justification for substandard care. Nursing home residents who have been victims of abuse or neglect, and their families, are entitled to recourse. Nursing homes often carry malpractice and liability insurance to cover their financial responsibilities in the event of abuse or neglect. The nursing home and long-term care industries contribute billions of dollars in profits to owners and executives, funded by both private payers and the federal government through Medicare and Medicaid. Victims need not shy away from seeking compensation simply because the pandemic made administering nursing homes more difficult for the owners and executives.

Over a year into the COVID-19 pandemic, some states are proposing—and passing—reforms to address the issues prevalent in Maryland nursing homes and those across the country. New York state recently passed a law set to be signed into law that would require for-profit nursing homes to spend at least 70% of revenue on direct patient care. In addition, any profits over 5% would be given to the state. The law would direct 40% of a nursing home’s budget to be spent on staff who work directly with residents. A law professor commented that a state immunity law that was recently repealed had allowed homes to engage in practices that created “unreasonable risk to residents.” One family member whose husband, a Navy veteran, was a resident in a nursing home said that he had not been given a shower in weeks.

Maryland lawmakers have considered a reform bill that would impose additional requirements on out-of-state nursing home purchasers, along with other reform bills. The bill would require state inspections after owners from outside of Maryland purchase nursing homes in the state. The bill would require unannounced inspections three and six months after the purchases are made.

Nursing home residents in Maryland continue to be at risk for abuse and neglect by staff members, medical providers, and other residents. Abuse may be physical, sexual, emotional, or financial. Signs of abuse can vary but could include unsanitary living conditions, broken bones, unexplained injuries, a history of repeated injuries, fear of certain people, bedsores, missing property, and missing funds. Neglect can be more difficult to detect in some cases, but it could include a lack of mobility, poor personal hygiene, and psychological distress.

New York state recently passed a law that revokes the immunity of nursing homes from liability for decisions concerning the COVID-19 pandemic, according to a recent article. Over 15,000 residents and staff died in nursing homes, assisted living facilities, and other long-term care facilities in that state. New York had originally passed a bill granting immunity to nursing homes during the pandemic, preventing residents and their families from suing nursing homes in court for an injury or death based on negligence. Meanwhile, Maryland has considered increasing immunity for COVID-related injuries.

In January of this year, the state Senate introduced a bill that would expand immunity from claims based on COVID-19. As introduced, it would protect anyone who acts in compliance with certain regulations, statutes, and orders (including Maryland nursing homes and long-term care facilities). However, the bill would not protect people who act with gross negligence or intentional wrongdoing. The Senate bill remains pending, and a similar bill was introduced in the House. Proponents’ of New York’s law argued that the immunity protected nursing homes that made decisions even in bad faith.

Are Nursing Home Immune from COVID-19 Claims?

Under Md. Code Ann. Pub. Safety section 14-3A-06, a healthcare provider is shielded from liability if the healthcare provider acts in good faith while there is a “catastrophic health emergency” proclamation. This law was in place before the COVID-19 pandemic. Even if Maryland’s proposed bill becomes law, facilities must follow state and federal guidelines to receive immunity. As of March 1, 2021, under a Maryland directive, licensed nursing homes must comply with the guidance on COVID-19 issued by the U.S. Centers for Disease Control and Prevention, U.S. Centers for Medicare and Medicaid Services, and the Maryland Department of Health. If a resident or staff member tests positive for COVID-19, all residents who have not tested positive for COVID-19 within the previous 90 days must be tested. Maryland has had more than 30,000 COVID-19 cases in nursing homes and over 3,500 deaths in nursing homes, group homes, and assisted living facilities.

Maryland residents who have loved ones in nursing homes have likely been particularly worried about their loved ones’ health, as well as nursing home abuse and neglect, during the COVID-19 pandemic. Due to the large numbers of people living in one area and the relative vulnerability of those living in nursing homes, it is perhaps not a surprise that the facilities have been hit particularly hard by COVID-19. Outbreaks have spread through nursing homes at alarming rates, and there are concerns that they have potentially been fueled by negligent staffing, medical neglect, and lack of proper sanitation procedures. Additionally, there have been high death rates of individuals living in nursing homes, with recent news revealing that those rates may have been undercounted.

Last month, New York State Attorney General Letitia James released a new report based on an investigation into nursing home policies that caused abuse and neglect and threatened the lives of residents and staff alike. One of the key findings in this report was that the number of nursing home deaths tied to COVID-19 has been undercounted by Governor Andrew Cuomo’s administration by as much as fifty percent.

Why Are Nursing Home COVID Deaths Underreported?

Part of the problem that seems related to the fact that the state only counted residents who died on nursing home property, rather than including those who were transferred to a hospital. But the new report indicates that many deaths occurred in hospitals once residents caught COVID-19 in their nursing homes and were then transferred. For example, one facility reported five confirmed and six presumed COVID-19 deaths to the state’s Department of Health. But the same facility reported a total of 27 COVID-19 deaths at the facility itself and another 13 deaths in hospitals. Discrepancies like this were found in multiple nursing homes.

After the COVID-19 pandemic hit, many families were prevented from visiting their loved ones living in Maryland nursing homes. Visits often serve as a time when families can spend time with their loved ones, and also observe their loved one’s condition in-person. Some advocates claim that there has been a surge in reports of neglect among nursing home residents. Federal data reflects that almost 30 percent of nursing homes report staff shortages now across the United States. Nineteen percent of nursing homes in Maryland report a shortage of nurses and/or aides.

Federal regulations established through the creation of Medicare and Medicaid allow federal oversight of many nursing homes. Even before the pandemic, in surveys conducted from January 2019 through March 2020, 39% of facilities had incidents with suspected or alleged reports of abuse, neglect, or misappropriation of property. Yet, the Centers for Medicare & Medicaid Services (CMS) actually suspended survey activities last March except in some circumstances. More recent guidance allows for survey activities to resume if the state has progressed in its reopening plan or at the state’s discretion. Nursing homes have a responsibility to care for their residents, keep residents safe from harm, and prevent abuse and neglect. Claims can be filed against facilities in cases where nursing homes or staff members have abused or neglected a resident.

Local Group Calls for Reform of Nursing Homes

The Centers for Disease Control (CDC) recently revised its COVID-19 guidelines to state that the coronavirus can be spread through aerosols, raising questions about the practices of Maryland nursing homes. It was previously known that the virus could be spread through respiratory droplets, such as when an infected person coughs, talks, and breathes. But experts now say that the virus is also spread through aerosols, which can remain in the air for hours and travel more than six feet. Experts still believe that the virus is mainly spread through respiratory droplets, but believe that airborne transmission does occur. Dr. Anthony Fauci stated that he was pretty confident that there was some airborne transmission of COVID-19.

Aerosols are microscopic droplets or particles and remain suspended in the air for some time, as opposed to respiratory droplets, which drop to the ground. Aerosols can accumulate in a confined space like a poorly ventilated room. Air purifiers and open windows can help to mitigate aerosol transmission by increasing ventilation within a confined space.

Some researchers have raised this issue in regards to nursing homes. Some research reported on one case of a COVID-19 outbreak in a nursing home with inadequate ventilation. One ward in a nursing home had a rate of 81% positive COVID-19 cases among residents, as opposed to no cases among the other six wards in the nursing home. Based on the low rate of the virus in the community, fast rate of transmission within the ward, the documented poor ventilation, and despite the use of surgical masks, the data suggested that the outbreak was caused by aerosol transmission due to inadequate ventilation.

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