Why Patient Care Protocols Are Critical During a Pandemic

You’ve heard the heartbreaking story of the LifeCare Center nursing home in Kirkland, Washington, which was an initial epicenter of the COVID-19 outbreak in that state. At least 35 residents and staff members of that long-term care community have died as a result of this highly contagious virus.

What went wrong

As I’ve written recently, senior living communities are typically well-prepared to confront a virulent illness like the flu, stomach viruses, or even COVID-19. They have strict protocols that they follow to keep residents healthy and prevent the spread of germs — processes that are redoubled when they learn of a nearby outbreak.

This fact made me wonder why the virus got so out of control at the nursing facility in Washington State. I looked up their Centers for Medicare and Medicaid Services (CMS) rating, and they have the highest rating possible, which made this outbreak even more surprising. Had there perhaps been a breakdown in LifeCare’s disease prevention protocols?

CMS released their initial findings on the events that led up to the outbreak in Kirkland. According to their March 23 report, inspectors at LifeCare Center found three “Immediate Jeopardy” situations — conditions that put a patient’s safety in imminent danger. The investigation found that, in the early stages of their COVID-19 outbreak, LifeCare failed to:

Rapidly identify and manage ill residents
Notify the Washington Department of Health about the growing rate of respiratory infection among their residents
Possess a sufficient backup plan during the absence of the facility’s primary clinician, who also had fallen ill.

How could all of these protocol breakdowns happen in a facility that had gotten 5 stars, CMS’s highest rating? In LifeCare’s defense, I think it is worth noting that this is a unique virus that is spread even before symptoms appear, and that makes it especially challenging to remediate. On top of this, according to virologists, a person can be infected with COVID-19 and remain asymptomatic, but still highly contagious, for up to two weeks.

So, yes, there were things LifeCare Center could have done better, but in terms of the virus taking hold initially, it’s really tough when symptoms are not yet evident. This is a complex situation few could have imagined.

The value of a CMS rating

At medicare.gov/nursinghomecompare, you can see an easy-to-understand five-star scale rating provided by CMS based on its periodic inspections and reporting on skilled nursing facilities. The ratings take into account a nursing home’s health inspections, staffing, and quality measures.

If you are researching continuing care retirement communities (CCRCs or life plan communities), it’s important to know that these CMS ratings only apply to skilled nursing facilities and not to the entire community in the case of a CCRC. It’s also worth noting that CMS only rates care providers that are Medicare- and/or Medicaid-certified. A private pay facility would not have a CMS rating.

CMS ratings are an indicator of how well a skilled nursing provider to adhering to government and industry standards. A 5-star facility is obviously better than a 1-star facility. But as the tragic Kirkland case study shows, despite high CMS ratings, things can still happen that lead to problems or even catastrophes.

Following protocol

When proper patient care and safety protocols are followed and the community is properly staffed, nursing facilities are typically quite safe. Among the common procedures that nursing homes use to ensure their residents remain healthy and well-cared for are:

Early detection of an outbreak (two or more cases of the same illness)
Reporting to local health agencies
Isolating affected residents and identifying those with whom they have been in contact (contact tracing)
Deep-cleaning the entire location
Reducing entry points
Conducting visitor screening (including suppliers) and keeping tracking logs
Limiting or temporarily halting visitors
Effective signage with protocol reminders

As the initial CMS report noted, the LifeCare Center in Kirkland had several breakdowns in their protocols around detection, reporting, and contingency planning.

What’s next

According to Centers for Disease Control and Prevention (CDC) data shared with CMS, as of last week, 147 nursing homes across 27 states had at least one resident with COVID-19. While this is a small fraction of the nation’s 15,000 nursing homes, it is still concerning. Older people and those with pre-existing conditions are disproportionately becoming critically ill and dying of complications from COVID-19.

As a result of this pandemic, CMS has already begun to revise some of their methodologies with the goal of making nursing homes safer than ever going forward. For example, CMS and the CDC are aggressively monitoring nursing homes with active COVID-19 cases. CMS is using this data to identify geographic areas the virus is likely to hit next so they can focus their “targeted infection control inspection” efforts accordingly.

These efforts at the federal level are an important step toward stemming the spread of COVID-19 in our country. But no matter what, if a senior living community doesn’t take pride in always following proper protocols and putting their residents first, sadly, these nationwide efforts won’t make a dent in the spread of this deadly virus.

FREE Detailed Profile Reports on CCRCs/Life Plan Communities
Search Communities