The employee handbook at the Amberwood Court Rehabilitation and Care Community in Denver was clear about the best way to keep germs from spreading through the 88-bed facility.
“Handwashing is the single most important step we can take to prevent the transfer of infection,” the policy stated. “Each of us has the responsibility to the residents, ourselves, and to our families, to reduce the spread of infection by using good infection control techniques.”
But, in September, a federal inspector watched as a nurse’s aide went from one room to another, pushing a cart of medical equipment that she used to take residents’ vital signs. She did not clean the equipment between uses. In putting on and removing gloves, she washed her hands only twice — and each time for only 9 seconds, less than the 15 to 20 seconds the employee policy required.
That was one of several lapses in infection control that inspectors observed during their visit last year, prompting the U.S. Department of Health and Human Services to cite the facility.
“Based on observations, record review and staff interviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections facility wide,” inspectors wrote in their report.
Now, at least two residents of Amberwood have died from COVID-19, the disease caused by the highly infectious new coronavirus.
The deaths highlight the difficulties nursing homes have in controlling infections within their facilities. There are now 44 outbreaks of COVID-19 in residential and non-hospital facilities in Colorado, according to the state Health Department. That list includes nursing homes and also assisted-living facilities, which collectively have emerged as the state’s hotspot for coronavirus deaths. As of Friday, nearly one-third of COVID-19 deaths in the state were linked to a nursing home or assisted-living center.
At least five nursing homes where residents have died from COVID-19 were cited within the past three years by federal authorities for inspection-control violations, according to a Colorado Sun review of federal records. Workers at the facilities were observed failing to properly sanitize medical equipment and failing to follow recommended hand-washing practices.
The Laurel Manor Care Center in Colorado Springs, where at least three residents have died from COVID-19, was cited last summer for not properly isolating a resident diagnosed with an infectious disease. The North Shore Health & Rehab Facility in Loveland, which has also seen at least three COVID-19 deaths, was cited last spring after inspectors saw housekeeping staff not following required disinfectant procedures. And the Center at Lowry, in Denver, was hit last year with a rare level-4 violation — the most serious kind — for not sanitizing blood-glucose monitors that were used to test multiple residents.
The facilities all quickly corrected the violations, usually within a month’s time, according to federal records. And none appears to have been punished with a fine related to infection-control problems.
Both locally and nationally, nursing home leaders say they are working hard to block the coronavirus from entering their facilities and to stop its spread once it creeps in.
“The story is what the communities are doing to protect the residents,” Jay Moskowitz, the CEO of Vivage, a Denver-based senior care company that owns Amberwood and several other facilities, told The Sun last week.
“The threat of coronavirus to those that we serve — older adults and those with underlying health conditions — is alarming, with dire consequences,” Mark Parkinson, the president and CEO at the American Health Care Association and National Center for Assisted Living, two trade groups for long-term care facilities, said in a statement. “We must do everything we can to prevent the further spread into our buildings.”
Violations are common
Kaiser Health News reported last month that, of the nation’s nearly 9,700 nursing homes, 63% were cited for one or more infection-control violations going back to 2016.
Deaths from COVID-19 aren’t limited to facilities that have had past problems with infection control, however.
As of Tuesday afternoon, there had been at least nine deaths at Centennial Health Care Center in Greeley, the head of the county’s public health department said. The facility has a clean infection-control record in federal inspections dating back to at least 2017. At least three other nursing homes where there have been deaths from COVID-19 in Colorado also have not been cited for infection-control problems in that period.
New rules to stop spread of COVID-19
To prevent the spread of coronavirus to nursing homes, Colorado and federal authorities have increasingly clamped down.
Visitors aren’t allowed. Communal dining and other activities are suspended. Workers have their temperature taken at the start of their shift. And residents who begin to show signs of a coronavirus infection are quickly isolated, though most nursing homes do not have the sophisticated isolation rooms that hospitals do.
As a result of the new rules, some of the typical onsite state inspections of nursing homes have been reduced by the Colorado Department of Public Health and Environment, according to the department. But Dr. Eric France, CDPHE’s chief medical officer, said inspectors have stepped up their scrutiny of nursing homes’ infection-control practices. Facilities that have had prior infection-control violations have received extra attention, France said.
“A lot of the work is using our surveyors to see what can we help, how can we help, how can we show up as a partner and technical advisor for the nursing homes themselves so that these outbreaks don’t happen,” France said.
Dr. Mark Wallace, executive director of the Weld County Department of Public Health and Environment, said there are plenty of ways the virus could have been introduced into the facilities. Perhaps through workers who didn’t realize they’d been infected. Perhaps through visitors before the restrictions were put in place. Perhaps through residents being admitted after they’d been infected but before they showed symptoms.
That’s why the lockdown measures are needed, Wallace said, to “deprive the virus of another person to hop across to somebody else.”
And, as the number of COVID-19 deaths tied to nursing homes continues to grow, there’s hope that these tighter rules and closer oversight are beginning to curtail the outbreaks. Wallace, whose county has seen outbreaks in three facilities, said Tuesday that new cases do not appear to be emerging in nursing homes or assisted-living facilities there.
“We’re keeping our fingers crossed that we can keep that moving forward,” he said.
Staff writer Jesse Paul contributed to this report.
Resources for families
Information about disciplinary actions against a nursing home is posted online, but finding it can be tricky. There are two main places to look:
To find information about discipline from the state government, look up the nursing home by name at www.healthfacilities.info. Once on the nursing home’s page, click on all the various inspection reports to read more about what state inspectors found.
Information on federal discipline can be found on Medicare’s Nursing Home Compare site, where users can search by location and name.
Kaiser Health News has searchable, zoomable maps of nursing home infection-control violations, for quick reference.
Families who are concerned about the safety or treatment of their loved ones in nursing homes can also contact a long-term care ombudsman. There are several located throughout the state. To find yours, start on CDPHE’s ombudsman page. The organization Disability Law Colorado also has more information about the ombudsman program.