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Nursing Homes and Long-Term Care Facilities and COVID 19

Nursing Homes at Higher Risk For Coronavirus

As the novel coronavirus (COVID 19) pandemic continues – shown to be particularly hard on older people and people of all ages with serious underlying conditions – it is of utmost importance that nursing and assisted living (also known as long-term care) facilities who care for patients within this population are vigilant in preventing and protecting against the spread. Unfortunately, based on the numerous examples of tragic outbreaks already occurring within these facilities across the State of California and United States, not all have prepared, trained, or become properly equipped to do so. If you or a loved one in one of these facilities has not been properly cared for or has passed away due to COVID 19, you are encouraged to contact a coronavirus attorney at the Gomez Trial Attorneys who have specific experience in nursing home abuse and neglect.

San Diego Coronavirus Lawyer

Why are nursing homes and long-term care facilities at such high risk for outbreaks of COVID 19?

Over the last few weeks, the United States, along with the rest of the world, has suffered tremendously as a result of the outbreak of COVID 19. Because this virus is novel, very little research exists and much about it is unknown. However, amidst all of the unknowns, changing information, orders, and public recommendations, one aspect of the virus has remained constant: “Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk from severe illness for COVID-19.” (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html.) The death rate is between 10% and 17% for people 85 and older, and 3% to 11% for people age 65 to 84.

Sometimes called “skilled nursing facilities” (SNFs), “nursing homes,” “rehabilitation centers” “convalescent hospitals,” “assisted living facilities,” or “long-term care facilities,” these facilities provide a variety of medical and personal care to chronically ill persons, older people and people who are unable to manage independently in the community. Over 4 million Americans each year are admitted to these facilities and over one million persons reside in them. In other words, these facilities care for a vast number of Americans who fit the precise demographic most vulnerable to severe illness from COVID 19. “Given their congregate nature and residents served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19.”

However, the serious risk of outbreak in these facilities goes beyond the patient demographics alone. Other factors include:

  • The nature of the interactions between patients and staff – frequent, intimate interaction including help using the restroom, feeding, getting in and out of bed, etc.
  • High numbers of patients and staff living and working in close quarters, congregating in dining halls and activity rooms
  • Visitors who come to see patients in the facilities who may not have been properly screened
  • Physicians, nurses, and staff who provide care at multiple facilities
  • Chronic understaffing and staffing turnover
  • Staff caring for and moving from resident to resident without adequate protective equipment
  • Patients with dementia who are unable to accurately report symptoms, understand or abide by isolation/distancing guidelines, etc.
  • Physical infrastructure of dated facilities, which pose challenges to disinfecting, distancing, isolating, and quarantining residents

While several of the above-listed factors may have changed in recent weeks, some are simply impossible to avoid, and unfortunately, the damage has been done.

Have there been major outbreaks at these facilities already?

Yes. Indeed, one of the first major US clusters of COVID 19 cases came from within a long-term residential care facility in Kirkland, Washington, where 81 residents, 34 staff members, and 14 visitors contracted COVID 19. Tragically, twenty-three people died as a result. Since then, the instances of outbreak in these environments has rapidly increased.

According to the Centers for Disease Control (CDC), as of March 30, more than 400 of 15,000 US nursing facilities had a reported outbreak of COVID 19 among staff, residents, or both. In Los Angeles alone, County health officials are investigating cases of COVID 19 at 67 different institutions, which include nursing homes and assisted living facilities, among other types of institutions. Statewide, California has seen massive and deadly outbreaks at nursing homes. Examples include:

  • Cedar Mountain Post-Acute Rehabilitation in San Bernardino – 51 residents and 6 staff members tested positive, and 2 patients have died from COVID 19 at this nursing home
  • Extended Care Hospital of Riverside – 30 patients and staff members tested positive at this 90-bed nursing home
  • Stellar Care in San Diego – 4 residents and 2 employees tested positive at this memory-care center, a four-story senior living facility near the San Diego State University campus
  • Orinda Care Center in the Bay Area – 24 residents and 3 staff members tested positive at this care facility

As numerous statistical models and scientific reports indicate that we have not yet reached the peak of this pandemic in California, the number of impacted facilities is only expected to rise.

What should nursing homes and long-term facilities do to prevent and contain the spread of the virus among their patients and staff?

Infection is always a threat to nursing homes – whether sepsis, influenza, staph, the list goes on and on. Thus, nursing and long-term care facilities should already have a plan in place to prevent infection – it should not be triggered by this pandemic alone. Thus, these facilities should follow their own already-existing infection policies, procedures, as well as general anti-infection protocols recommended by the government.

However, with COVID 19, there are adjustments that need to be made due to the level of contagion and severity of the virus. Thus, nursing and long-term care facilities should stay up-to-date with and follow all local, state, and federal administrative guidelines to prevent and contain the spread of COVID 19.

After the long-term care facility outbreak in Washington, the CDC prepared a report reflecting on what happened, why it happened, and what the implications are for public health in long-term care facilities. Three key takeaways were:

  1. Once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors.
  2. Limitations in effective infection control and prevention and staff working in multiple facilities contributed to intra-and interfacility spread.
  3. Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members, restricting visitation except in compassionate care situations, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures.

Accordingly, the CDC recommended nursing facilities take the following proactive steps, including but not limited to:

  • Restricting all visitation except for certain compassionate care situations, such as end of life situations
  • Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)
  • Cancel all group activities and communal dining
  • Implement active screening of residents and HCP for fever and respiratory symptoms
  • Educating and training HCP, consultant personnel, residents, and their families about COVID-19, infection prevention and actions they can take to protect themselves and their communities
  • Providing hand hygiene supplies to residents and staff, and personal protective equipment (PPE) to staff
  • Vigorous environmental cleaning and disinfection
  • Utilizing the “Preparedness Checklist for Nursing Homes and other Long-Term Care Settings” to develop a comprehensive COVID-19 response plan

Likewise, the Centers for Medicare & Medicaid Services (CMS) have issued recommendations for nursing and long-term care facilities. While the complete list can be found here, the basic recommendations include:

  1. Immediately ensuring compliance with all CMS and CDC guidance related to infection control (e.g. hand hygiene, self-assessment checklist, CDC’s guidance to long-term care facilities, use of personal protective equipment, etc.)
  2. Implement symptom screening for every individual entering long-term care facility, including residents, staff, visitors, outside health workers, vendors, etc.)
  3. Ensure staff are using appropriate personal protective equipment
  4. Use separate staff for COVID 19 positive patients, separating them from COVID 19 negative (or unknown status) patients

Due to the evolving nature of the data, science and knowledge about this virus, continuing to stay informed of CMS, CDC and other public health guidelines is critical to the safe administration of nursing homes and

Attorney John Gomez

Coronavirus attorney, John Gomez

long-term care facilities. Accordingly, these facilities should be constantly checking to make sure they are in compliance with the most updated standard of care recommendations.

If I have or my loved one has been impacted by a nursing or long-term care facility‘s failure to take proper precautions against COVID 19, what should I do?

Unfortunately, many of the most common problems seen in these facilities all the time – understaffing, staffing turnover, inadequate training and supplies – pose an even greater threat to residents in the wake of COVID 19, as they become agents of the infection. When a nursing home negligently fails to implement appropriate policies, procedures, training and other measures to prevent the spread of COVID 19, it can result in serious illness and even death for patients, staff, and visitors.

If you or a loved one in one of these facilities has not been properly cared for or has passed away due to COVID 19, you are encouraged to contact an attorney who has specific experience in nursing home abuse and neglect.


Gomez Trial Attorneys
655 West Broadway, Suite 1700
San Diego, CA 92101
Phone: (619)-237-3490

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