Lane County’s nursing homes are the second worst in the state for health inspection deficiencies. Yet because of COVID-19, it’s not clear how they are doing during this pandemic — the Centers for Medicare and Medicaid Services have put those inspections on hold.
Local nursing homes have a history of being inadequate, having been cited in the past for elder abuse, mixing up medications and ignoring basic health and sanitation protocols. And the issues haven’t really gotten better, with the pandemic leaving some of these problematic places without accountability and causing concern for local advocates and for those who have spent time with residents in the past.
In other parts of Oregon, nursing homes have been epicenters for outbreaks of the virus, even forcing one Portland facility to move residents out of the building after 28 people died. Lane County has not yet had a known case in its nursing homes — though we have had one in a long-term care facility — but if a case does come up, these homes may not be prepared due to short staffing and the rigorous need for sanitation to prevent the spread of the virus.
“I think we are going to have more possibility of having another outbreak. Without proper testing and still not enough PPE available, we are not prepared,” says former local ombudsman Lee Bliven. As ombudsman he managed complaints about area nursing homes.
As the pandemic spreads, the Oregon Department of Human Services has continually updated rules on restricted visitation, which it started in February 2020. In March, DHS launched an in-person review of a facility’s infection control procedures to learn how prepared they are in potentially handling a COVID-19 outbreak.
According to a DHS press release, 670 sites were visited and reviewed for their emergency preparedness. But some nursing home residents and workers still caught the virus. As of May 19, 18 long-term care facilities in the Willamette Valley have confirmed cases for both residents and workers.
Now as counties enter Phase 1 of reopening with Gov. Kate Brown’s approval, restrictions on visiting nursing homes are loosening, meaning the facilities must take extra precautions. With these precautions in mind, it’s difficult for someone who checks in on the home, such as a local ombudsman, to visit and ensure residents are taken care of.
The state’s current long-term care ombudsman, Fred Steele, says 10 deputy ombudsmen and many volunteers check in on long-term care home complaints, including nursing facilities. Some of these long-term care facilities are owned by larger companies and corporations, while others are independently owned. Oregon has 550 residential care homes, including 220 memory care buildings and 130 skilled nursing facilities. Separately, the state has 1,300 adult foster care homes.
As the head of the independent state agency, Steele oversees all the deputy ombudsmen. Usually, he says, they are allowed to go into a facility to meet with a resident without calling ahead and following the check-in procedure, to ensure confidentiality.
Now, only 11 people in the department have the authority to go into a building, but they have to first get authorization from the care facility and sign in to visit the resident, alerting the management that an ombudsman is investigating a complaint.
“It’s a potential concern,” Steele says. “It hasn’t been a problem in the last few months, but it could start interfering with confidentiality.”
After speaking to workers, Bliven says many are scared to speak up.
“What I am hearing is, whatever anyone says, it will come back in some form of retaliation against everyone,” Bliven says. “There has been enough bad press and the owners are very nervous.” Bliven was an ombudsman for the last five years, until December 2019.
With the staff hesitant to report issues, limited accountability on complaints and once-a-year health visits, it is unknown how prepared Lane County nursing homes are for a potential outbreak.
A nursing home can be inspected by various agencies, depending on the type of facility. Health inspections take place once a year, but other issues will be investigated if a complaint is registered. Bliven says a complaint needs to be started within 48 hours of an incident, but within eight hours for a serious incident. Regardless of how a complaint starts, they all end up at DHS, he says.
Bad marks in health inspections are called deficiencies, which range in scope (how many people it affects) and severity (how badly it affects them). The seriousness of a deficiency is designated by a letter with the most severe issues categorized as “immediate jeopardy to resident health and safety” in which J is an isolated issue, K is a pattern and L is widespread.
According to data from Medicare.Gov, made available by the Accountability Project and analyzed by Eugene Weekly, Lane County nursing homes rank second for the most health deficiencies, holding 11 percent of the state’s total from January 2018 to January 2020.
When it comes to the most serious deficiencies, the J,K,L letters, Lane County ranks second again, sweeping in 16 percent of the state’s total.
This is second to only Multnomah County, whose nursing facilities hold 22 percent of state deficiencies, but which is also the most populous county.
EW sent a list of questions to the DHS office of Aging and People with Disabilities. Due to COVID-19 shelter-in-place work conditions, DHS said it had no one available for a phone interview. The office says several employees collaborated to answer the questions over email. The routine health inspections are also put on hold due to COVID-19, and nursing facilities are instead supposed to focus on infection control.
The department says that a facility’s past isn’t necessarily an indication of how well it is following the pandemic protocols.
“A facility’s history of complying with regulations is always a consideration, but it’s not necessarily reflective of current operations or management. Here’s why: Facilities are required to make corrections as a result of deficiency findings,” the email says.
Bliven says that although facilities are required to address the deficiencies, they still may get away without making corrections, or the issue comes back, and fines are not a deterrent. “They don’t care, they get away with it. Let’s say they get a big fine. Well, they can pay it off. They write a letter about their deficiencies and set up a plan to correct it. It’s what they consider the price of doing business,” Bliven says.
Darsell Barton spent several years spending time with her mother in a rehabilitation center, and says when it comes to inspections, many of them may not be completely accurate.
“There is nothing faker than a facility when a survey unit is in,” she says. “And as soon as they visit it is like a telephone chain and they start calling other homes in the area and prepare for the inspection.”
From 2016 to summer 2018, Barton says her mother lived in Avamere Park Rehabilitation Center in Eugene, and she visited her every day until she passed. Barton says she could speak forever on all the incidents she witnessed while visiting her mom, and has a flash drive filled with photos of the worst she had seen. Although Barton says she has reported multiple issues, she says the state couldn’t always investigate it.
“They say, ‘If we don’t see it happen, then we can’t prove it happened,’” she says.
Bliven says this issue comes from the fact that many long-term care facilities in Oregon are owned by bigger for-profit corporations.
“It costs money,” Bliven says. “If you spend money on protection and care for residents, then you have to pay more for the staffing and your profits go way down. And that’s the biggest problem right now.”
In Eugene, Avamere River Park facility and Avamere Rehabilitation Center are owned by a company that also manages facilities all over Oregon and Washington. Avamere River Park has the second most deficiencies in the county, and its last recorded health inspection was in May 2019. That health inspection led to 36 marked deficiencies alone, including water pitchers and cups not being properly sanitized, residents being left on bedpans and certified nursing assistants complaining about always being short staffed.
Just south of Eugene, Creswell Health & Rehabilitation Center currently holds the second most fines and deficiencies in the whole state; it was fined a total of $154,370 in the last three years. This facility was cited for 40 health deficiencies in 2018, and 20 in 2019. Bliven argues that though the deficiencies are supposed to be reconciled, it doesn’t necessarily mean that they are being addressed or that anything is changing.
According to the Centers for Disease Control and Prevention, not only are people 65 and older considered high risk for the virus, so are those who are immunocompromised. Dr. John Townes is a professor of medicine with Oregon Health and Science University who specializes in infectious diseases. He says proper sanitization is crucial in preventing cross contamination of the virus, especially in a health care setting. “Before and after they come in contact with a resident, they would be sanitizing their hands,” Townes says of protocol, adding that the environment has to be clean because of how important hygiene is in mitigating the spread of the virus.
Sanitation Stops the Spread
With the virus being easily transmitted by respiratory particles, experts say it is imperative to continually sanitize surfaces — such as the above-mentioned pitchers and cups — and that medical workers must dress wearing personal protective equipment to prevent the spread.
When asked who ensures nursing facilities are following COVID-19 sanitation rules, DHS writes in its response that the facilities are always required to follow the CDC’s protocols.
Barton says when her mother lived at Avamere Park Rehabilitation Center, she would often go into the laundry room to grab a towel or something, and see miscellaneous red biohazard bags piled in the closet. She also has photos of biohazard bags in the dumpster, spilling out of the top and some had even been ripped open.
There were several times, she adds, that her mom would have to be admitted to the emergency room, only to return home to a urine soaked bed that hadn’t been cleaned in a week, until the paramedics brought her back and changed it.
“Every time I spoke up, they took it out on me,” Barton alleges. “The place was filthy.”
When she visited her mom, Barton says she also noticed the air conditioner and heat was clogged with dust and often got stuck at certain temperatures.
Dr. Townes of OHSU says that inadequate ventilation and crowded living areas make way for transmitting the virus noting that, for example, an old HVAC system may not have good air circulation. Although he is not an expert in nursing home conditions, he says they should also be sanitizing surfaces frequently and also wearing PPE.
Chunhuei Chi is a researcher at Oregon State University and is an expert in comparative health care and health policy. Since COVID-19 started gaining traction in January, Chi has been following the virus. He says that in order for nursing homes to properly mitigate the potential spread of the virus, they need to figure out how to implement social distancing for their residents.
He says that he has seen Timber Hill, a nursing home in Corvallis, reduce the number of residents in a dining room at a time, also taking extra time to disinfect tables. If residents are allowed to walk around, they should be wearing masks. Other events at this nursing home, he says, were canceled.
“Nursing homes are one of the highest risk situations across the country,” Chi says. He explains that this has to do with the big communal areas, and the lack of training nurses and workers have in preventing the spread of a virus like COVID-19.
“Even before the pandemic, I observed how unprepared they are,” he says.
But all of these extra precautions may be difficult to take into account when the staff is already overworked.
“Staff are underpaid and overworked,” Bliven says. “I’ve been working on stricter guidelines to not have stretched staff.” He says that since the pandemic, many residents are confined to their rooms and have to wait for a staff member to check on them.
He adds that there is still a major shortage of PPE. Hospital workers are still struggling to get enough gear, which means that nursing home workers have the same problem. He says workers are supposed to report if they have a case, but that it can be difficult to track and quickly get out of hand. At the Portland Veteran Affairs Medical Center, 29 staff and patients tested positive for the coronavirus. And DHS recently shut down a southeast Portland nursing facility after 117 people were infected, resulting in 28 deaths.
A worker in a local group care home who asked to remain anonymous due to union negotiations says this pandemic has been hard for care workers because their concerns are minimized, and they are overstretched and targeted if they do bring up concerns.
“A lot of heartfelt and qualified staff are rendered less so because they are trying to protect their livelihood,” he tells EW.
At the beginning of the pandemic in late February, he says, each home got surgical masks, and they stayed stocked up on gloves. But because of shortages he has been wearing the same mask for a month and a half.
The worker argues that instead of clamping down on visitors and keeping the doors closed so that employees are the only ones registering complaints, the managers of the homes should exercise “mindful caution,” so that they can have access to accountability for workers and residents.
“Advocates are not allowed to come in. It’s something that is intended to be helpful, but there is a potential dark side that comes to that too.”
Originally, he explains, staff wasn’t even allowed to go outside and get some fresh air. Now that restriction has become more flexible and employees can go outside and take a break from wearing their masks.
As of press time, about 83 of Oregon’s 140 coronavirus deaths are associated with care homes. In other facilities, like Healthcare at Foster Creek in Portland, the virus spread through nursing facilities like wildfire, hitting both staff and residents. The staff then goes home to potentially spread the virus to their families.
Lane County has no confirmed cases of COVID-19 in a nursing or rehab facility, but no one is out of the woods yet. These homes are trying to manage during the pandemic while being short staffed, and a lack of visitors and transparency when it comes to inspections.
Family members find it’s difficult to visit a relative living in a nursing facility during the pandemic. If their loved ones do get the coronavirus, they may not get to say goodbye.
Bliven says changes are coming. Recently, Oregon passed a law that requires facilities to have someone who specializes in communicable diseases, he explains. But it won’t go into effect for another several years.
“It was the one thing I worked on to get passed,” he says. He also pushed for change that will require assisted living caregivers to have a license and a background in psychology. Bliven started pushing for these changes after his wife experienced neglect at Avamere Rehabilitation Center.
“We have improvements started, but it’s a slow process,” he says.
As things begin to open up, Steele, the current state ombudsman, says they are looking towards a different approach, focusing on prevention.
If you have concerns about a nursing facility, call 1-877-280-4555.To submit concerns about a residential care or assisted living facility, call 1-844-503-4773 or email firstname.lastname@example.org. If you witness a situation that is abusive to an older adult or a person with disabilities, call the state’s safeline at 1-855-503-7233.