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Levine explains facility efforts

Infection-control enforcement to ramp up on nursing homes

On the day the federal Centers for Medicare and Medicaid Services announced plans to ramp up infection-control enforcement on nursing homes, Pennsylvania’s health secretary outlined efforts to prevent and contain outbreaks of the coronavirus in long-term care facilities.

Long-term care residents comprise two-thirds of Pennsylvania’s 5,667 deaths from COVID-19, according to the state Department of Health. A May 11 New York Times article listed Pennsylvania as fourth in the number of long-term facility deaths.

“The very nature of the long-term care facilities setting” makes them more susceptible to outbreaks, because of occupants’ age, the frequency of their chronic medical conditions and their living in close proximity, Health Secretary Dr. Rachel Levine said.

To contain the spread of COVID-19, the state limited visitation early on, provided infection control advice, shipped personal protective equipment, assisted through the Patient Safety Authority and involved the National Guard for serious staffing shortages, Levine said.

Some facilities turned down help, apparently afraid they’d be cited for failure to follow procedures — although citations were not the intent, Levine said.

The main avenue for introduction of the virus into facilities was asymptomatic or presymptomatic staffers. “We know that individuals can be asymptomatic and that they can be very contagious,” Levine said. “They unknowingly spread (the virus).”

Recently the state began a program to test all staffers and residents of long-term facilities, largely to ferret out asymptomatic carriers.

The testing will continue regularly, depending on how prevalent the virus is in each facility, she said.

Many infected long-term care residents went to hospitals and then returned to the facilities, which has led to criticism. But Levine defended the practice.

Almost invariably, the infected residents caught the virus in their facilities, then, after treatment, simply went back “home,” Levine said.

“They did not bring new cases in,” she said. “The virus was already there.”

At the time, “there were not that many other options,” she said. There was concern about overwhelming hospitals.

Still, the department has been talking about different strategies for the future.

To press nursing homes on infection control, CMS will step up “civil money penalties” for persistent violators, while “imposing enforcement actions on lower level infection control deficiencies to ensure they are addressed,” according to a CMS news release.

CMS will also use its power to direct $80 million in Coronavirus Aid, Relief, and Economic Security Act funding for survey and certification to incentivize states to inspect nursing homes for infection control compliance.

“States that have not completed 100 percent of focused infection control surveys of their nursing home by July 31, 2020, will be required to submit a corrective action plan,” the news release states. “If, after the 30-day period, states have still not performed surveys in 100 percent of nursing homes, their CARES Act fiscal year 2021 allocation may be reduced by 10 percent.”

Subsequent 30-day extensions could lead to further reductions of 5 percent, with the held-back money going to compliant states.

Inspections work better when they’re in person, rather than virtual, indicated agency Administrator Seema Verma Monday on a conference call.

“There’s no substitute for boots on the ground,” she said.

Among issues that inspectors will likely encounter are those related to handwashing, “which continues to be a challenge,” and lack of preparation for “adequate cohorting,” Verma said.

Mirror Staff Writer William Kibler is at 949-7038.

By the numbers

New/total county cases: Blair 0/50 (1 death); Bedford 1/40 (2 deaths); Cambria 1/58 (2 deaths); Centre 1/154

(7 deaths); Clearfield 1/40; Huntingdon 1/231 (includes SCI Huntingdon); area new/total cases: 5/573

New/total cases statewide: 356/72,282

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