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Infection Control in Nursing Homes

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Adequate infection control measures are central to the safety and wellbeing of nursing home residents, some of the most vulnerable members of society and those most susceptible to illness. In an acceleration of trends away from strong regulation, it is now becoming harder in many states to enforce accountability by suing facilities for negligence.

Even with the unprecedented rise in infection, healthcare facilities in general have been shielded from liability, and nursing homes in particular from fault in COVID-19-related claims. Kentucky and Mississippi are two such states. Proponents of these measures have argued that exposure to liability impedes staff members’ effective decision-making, arguably false; that existing rules and regulations do enough to protect patients, also false; and that the involvement of family and friends of patients serve as a sufficient check on patient safety, which is now a less potent safeguard given necessary restrictions on in-person nursing home visits.

Worsening standards for infection control in nursing homes are nothing new. The problems go far beyond the current pandemic and reflect gaps in the system that have long existed. For years, eased regulatory standards have chipped away at protections for patients, creating under-resourced and understaffed nursing homes where proper safeguards are impossible. In June, a Pennsylvania nursing aide shared that during a typical shift, lasting as long as 16 hours at a time, he was fortunate if he could change a patient’s soiled diaper once in an eight-hour period. He further stated that low pay meant many staff members came to work sick, feeling they had no other choice.

In an analysis from the Centers for Medicare and Medicaid Services, 82% of nursing homes across the country were cited for infection control problems between 2013 and 2017, with half of them being repeat offenders. Lack of consistent handwashing and infrequent disinfection of common areas were chief culprits. Such failures allowed the seasonal flu to sweep across numerous facilities. Overstretched and overworked staff likely also contributed.

In-person visits had the benefit of creating soft accountability. Visitors were an additional pair of hands, eyes and ears amid stressed staff, but also did things like asking nurses if they had washed their hands before entering loved ones’ rooms. Amid restrictions, there is much we must do to fight for the improved standards our loved ones deserve. The current crisis can be an opportunity, if we take full advantage.

As many sources have noted, a bill to improve care standards for nursing home residents and staff was introduced to Congress in the spring. This would, among other things, mandate new standards for CMS inspections, increase infection control and prevention through the employment of full-time infection preventionists in facilities, and provide additional protection to nursing home workers through a minimum two weeks of paid sick leave. They provide a long-overdue start. But any measures to limit the legal liability of nursing homes for infection-related negligence must be robustly resisted through continued advocacy.

If you’re concerned about any of these issues, contact your local Adult Protective Services Agency or legal representative for support. It’s okay to report suspected mistreatment even if you don’t know for sure that it’s happening.