Oregon Report Finds Fatal Shortcomings In Handling Of COVID-19 In Long-term Care Facilities

adult care home Linda looking out window Sharri Anderson.jpeg

Oregon’s long-term care facilities and the agencies that regulate them can do more to curb infections and deaths amid the COVID-19 pandemic, a state report released Wednesday said. 

The long-term care industry’s handling of COVID-19 and shortcomings in the state’s regulatory system are laid bare in the 44-page report the Oregon Secretary of State’s office released. Auditors compiled the advisory report, which scrutinizes infection control practices, and highlights gaps in Oregon laws and procedures for handling widespread viral infections. 

Auditors recommended the state make improvements, including additional monitoring to improve facilities’ compliance with infection control protocols and more state monitoring and public disclosure of vaccination rates of staff and patients within facilities. 

Auditors also raised concern that complaint investigations and routine licensing inspections had slowed down or even stopped amid the agencies’ COVID-19 response.

Oregon has minimal state regulations for staffing, infection control, emergency preparedness and staff and resident vaccination reporting for assisted living and residential care facilities, the report said.

“COVID-19 has stressed every system in our nation and laid bare challenges and inequities that existed long before the pandemic,” Secretary of State Shemia Fagan said in a statement. “This is a moment for all of us to take stock and ensure we are improving the vital systems and services that Oregonians count on to provide care and support. The goal of this advisory report is to offer concrete steps to improve the safety of these facilities, for the residents and the workers providing their care.”

Auditors completed the report as a research project rather than a formal audit, so the information could be given to state agencies sooner. However, the office said it vigorously vetted the report and worked with agencies prior to its release.

Oregon’s long-term care system shelters nearly 32,000 residents in almost 700 facilities that include nursing homes, assisted living facilities and residential care facilities. The review did not include adult foster care homes, which are small and have five or fewer residents apiece. The long-term-care system’s population is one of the state’s most vulnerable: nearly 1,200 residents have died of COVID-19 through Feb. 25, which is 54% of all deaths from the virus statewide.

The report found the Oregon Health Authority, the state’s public health agency, and the Oregon Department of Human Services, which regulates long-term care facilities, “had not planned basic elements for a joint response to emergencies prior to COVID-19, delaying actions that may have prevented early cases and deaths of COVID-19 in long-term care.” The report urged the agencies to collaborate and put procedures in place to prepare for future emergencies and to investigate more common outbreaks of flu and norovirus.

While regulators conducted hundreds of infection control surveys at long-term care facilities in connection with the COVID-19 pandemic, they sharply cut their licensing recertification surveys, which are much more thorough, the report found. Those stopped in March 2020, as inspectors focused on infection control work. By November, 54% of Oregon’s nursing homes had not had a survey in the last 18 months. In comparison, the national average was 22%, a similar level to California and Washington state.

The Oregon Department of Human Services is also behind on responding to complaints, and only responds if a complaint involves an “immediate jeopardy” level of problem, the report said.

“Issues such as quality of life for residents, food and nutrition services, wound care, and lesser allegations of abuse or neglect that fall short of immediate jeopardy are not being addressed,” auditors wrote.

Auditors recommended more inspector visits to facilities and more financial penalties for facilities that are repeat offenders. The report also recommended the state explore putting more staff in place to respond to complaints.

“People we interviewed said that while most facilities are doing a good job, a few are not,” auditors wrote. “They have observed the improper use of masks and have been told by facility personnel that personal protective equipment is not necessary.”

Prior Warnings On Inspection Staff Shortages

The report is not the first alarm to ring about the state’s oversight of long-term care facilities during the pandemic. In November 2020, Oregon’s long-term care ombudsman wrote to Gov. Kate Brown with several suggestions, including more staff so the state could inspect all long-term care facilities, not just those with COVID-19 cases. The ombudsman’s office doesn’t conduct inspections but advocates on behalf of residents and hears concerns from them and their families and works to resolve them. 

The ombudsman’s office also urged the Oregon Department of Human Services to scrutinize facilities with histories of abuse, neglect and infection control problems, saying the “current regulatory structure caters too much to facilities at the expense of residents,” state auditors noted. The ombudsman also called for state fines on facilities with egregious conduct tied to infection control, pointing out in November that the Department of Human Services had not issued penalties even though it had the authority to do so.

“However, ODHS officials note that executive orders, which are placed on facilities after an outbreak, shut down admissions,” auditors wrote. “Restricting admissions has financial consequences for facilities.”

Early on, state officials took weeks to shut down Healthcare at Foster Creek, a long-term care facility in Portland. The May 5 order came nearly three weeks after the facility was cited for immediate jeopardy due to substandard infection control practices. By then, more than two dozen people died of COVID-19 there. That delay reflected a lack of preparation for the pandemic and a “hesitancy to take proactive actions in a crucial case,” auditors wrote, adding it helped inform the agencies’ response to future outbreaks.

Gaps In Training and Data 

The report found gaps in state rules. For example, state law and administrative rules do not clarify if unlicensed front-line workers in long-term care facilities need to take infection control training, the report found. State law says employees must take the training. But Oregon Health Authority administrative rules cite federal guidance that refers only to licensed healthcare workers taking training, the report said, calling this a “significant gap.”

Auditors were concerned about the lack of information about vaccinations of staff at long-term care facilities. They suggested the state consider obtaining and publishing vaccination rates of staff at individual facilities, as a tool for consumers and as a way to boost participation in vaccines. They suggested modeling this based off of a 2015 law that requires public schools and child care centers to post vaccination rates for students and children.

Agencies Say They Are Addressing The Issues

The Oregon Health Authority and Oregon Department of Human Services replied to the report in a letter. They defended their handling of the pandemic, noting that COVID-19 deaths and cases Oregon’s long-term care facilities rank better than the national average: 10th lowest in long-term care facilities and fifth lowest in nursing homes.

“Responding to the COVID-19 pandemic required gut-wrenching tradeoffs between community safety and each individual residents’ quality of life in large congregate living settings,” wrote authority Director Patrick Allen and human services Director Fariborz Pakseresht. 

They plan to start collecting vaccination rates of staff and residents at long-term care facilities at the end of this month, the letter said.

They said they have resumed survey inspections at community-based facilities and still have a backlog, due to the workload of responding to COVID-19. They’ll work with lawmakers to determine the necessary staffing and look for new funding opportunities offered by the federal American Rescue Plan, they wrote.

The letter sidestepped a full endorsement of the recommendation to consider using financial penalties on facilities not in compliance with infection control protocols.

“ODHS and OHA use appropriate escalation of regulatory tools when needed, but our first approach is to educate, collaborate and focus on continuous improvement, prevention and learning,” they wrote, adding they have issued civil penalties of about $500,000 for infection control violations over the past year. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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