As COVID-19 outbreaks increase, health officials wrestle with how to enforce new guidelines at nursing homes

Monday, April 13, 2020
As COVID-19 outbreaks increase, health officials wrestle with how to enforce new guidelines at nursing homes
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Nursing homes' primary mission is to make life easier for many families, but now their vulnerability is making the quarantine harder for those at home.

RALEIGH, N.C. (WTVD) -- The primary mission for many nursing homes is to make life easier for many families, but now their vulnerability is making the quarantine harder for those at home.

"I absolutely worry," said Ray Kouzel, whose mother lives in a Wake County nursing home. "The stress level is through the roof."

Health departments in several counties on Monday confirmed dozens of new positive cases of COVID-19 at nursing homes and acute care facilities, including Chatham, Durham, Franklin, Orange, Wake, and Wayne, among others.

In total, the North Carolina Department of Human Services is reporting outbreaks at 42 congregate living settings, include 29 nursing homes and skilled nursing facilities in 21 counties.

"This virus poses exceptional challenges--not just for nursing homes, but for everyone who is working to stop the spread of infection," said Robert Brown, a spokesman for the North Carolina Healthcare Facilities Association. "The fact that it can be transmitted by people who are displaying no symptoms whatsoever makes it incredibly challenging to control for all of our facilities."

Indeed, facilities like nursing homes and acute care centers have long been subject to inspections and reviews, even before the crisis caused by the new coronavirus.

An ABC11 I-Team Investigation into the pre-COVID data finds some struggles: as many as 150 facilities (35 percent) were cited for infection control deficiencies between January 2016 and January 2020.

That includes Signature HealthCare in Chapel Hill, where officials reported an outbreak of 31 cases.

Even for those without citations, several facilities that are currently hot spots had previously earned low ratings from the U.S. Center for Medicare and Medicaid Services; the ratings are based on staffing levels, inspections and other quality control measures.

Last week, Governor Roy Cooper instituted new mandates in an Executive Order, requiring nursing homes and applicable facilities to improve communications with staff, require universal use of masks, institute temperature and cough checks, cancel community dining and increase patient monitoring, among other provisions.

"If an outbreak occurs, quick and aggressive action must happen," said Amy Ellis, a spokeswoman for the NC Department of Health and Human Services. "If a person has a concern about the care being provided to their family member or friend, he/she may file a complaint with the Division of Health Services Regulation."

As for testing, PruittHealth and The Laurels were able to secure COVID-19 testing for all staff and patients at its respective and affected facilities, but Ellis said that might not be possible at other establishments.

"Depending on testing capacity, clinical scenario, circumstances of the facility, the health department will advise whether testing of all residents or a group of residents is required," she said.

Health officials and facility administrators agree there are ample ways for families of loved ones to get involved in insuring the proper care and attention for residents.

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"We are encouraging our facilities to stay in close contact with families during this situation and provide updates on the steps being taken to keep facilities safe," Robert Brown, with the North Carolina Healthcare Facilities Association, explained. "Some questions that family members may wish to ask a facility administrator include: What procedures are being used to screen residents for signs or symptoms? If there are positive cases in the facility, what steps are you taking to prevent the spread to additional residents? What steps will you take if my loved one develops symptoms and/or tests positive? Can you help facilitate virtual communications with my family member?"

PruittHealth's communications department, meanwhile, writes in a statement that they receive more than 400 calls every day from family members, the majority of which are to schedule a video chat.

Besides filing a complaint with NC DHHS, there's also the option of contacting the regional Ombudsman, or a group of advocates, which serves as an independent liaison and review entity for long term care patients.

Ray Kouzel said those chats are critical to stay calm during this difficult time. It's also his way of making sure his mother knows she's not alone.

"A phone call can emotionally help a patient who thinks they're in prison in the first place," Kouzel says. "This is even worse."