Iowa nursing homes with dozens of infections were cleared by inspectors weeks before
In response to a formal open-records complaint, the Iowa Department of Public Health is continuing to withhold data regarding COVID-19 outbreaks in Iowa nursing homes. (Photo by Clark Kauffman/Iowa Capital Dispatch)
Of the 20 Iowa nursing homes with the biggest, active COVID-19 outbreaks, 14 were cleared by state inspectors of any infection-control violations earlier this year.
In some cases, facilities with as many as seven dozen confirmed COVID-19 infections have undergone two, three or even four infection-control inspections since the pandemic began and been cleared by state inspectors each time.
At the Hiawatha Care Center in Linn County, for example, state officials performed an infection-control inspection on June 18 and found zero violations. Responding to a complaint, inspectors returned and did another infection-control review on July 29 and again found no violations. On Sept. 24, inspectors returned in response to a second complaint and again found no violations. On Oct. 14, inspectors responded to a third complaint and, for the fourth time, found no infection-control issues.
On Nov. 1, two weeks after that last state inspection, the Hiawatha Care Center is the site of an outbreak that has so far infected 94 residents and staffers. The facility houses just 71 residents.
Even in cases where residents have died at homes where violations of infection-control standards were confirmed by the state, no fines or penalties have been imposed.
For example, inspectors visited the Perry Lutheran Home in early October and found that workers there were screening themselves for COVID-19 and taking their own temperature. In some cases, the workers cleared themselves for work shortly before testing positive for the virus. By the time inspectors investigated, three of the home’s 71 residents had died of COVID-19.
DIA imposed no fines for allowing workers to screen themselves and now the home is the site of an active outbreak that has resulted in 42 people being infected.
DIA officials have long pointed out that inspections represent only a “snapshot” of the conditions at a care facility, and are not a predictor of how well a home will fare during a future inspection. Industry officials and federal regulators note that not all outbreaks are the result of regulatory violations.
John Hale, a consultant and advocate for Iowa’s long-term care residents, said the Legislature’s government oversight committees should examine the state’s handling of COVID-19 outbreaks in Iowa nursing homes.
“I’m greatly concerned about the continuing shortages of personal protective equipment, spottiness in the testing of residents and staff, growing frustrations about limited family visitation, and residents saying that there is not nearly enough well-trained staff on duty to meet their needs,” he said. “Simply put, we need to get much more aggressive in fighting this battle.”
All told, the 20 Iowa nursing homes with the biggest, current outbreaks account for a total 1,304 infections, according to the Iowa Department of Public Health. DIA inspectors have conducted a total of 39 infection-control inspections at those 20 facilities during the pandemic and found violations at six of them. No state fines were imposed against any of the facilities for infection-control violations.
Among the cases:
- Ravenwood Specialty Care in Waterloo has been inspected three times by the state during the pandemic and cleared of any infection-control violations each time. The facility has had at least 66 infections.
- The Colonial Manor home in Amana has been inspected twice for infection-control violations and cleared both times. It is currently the site of an outbreak tied to 61 infections.
- At the Good Samaritan Home in Ottumwa, an active outbreak is now tied to 128 infections. Inspectors have conducted three infection-control reviews at the home. The home has been cited for violations related to personal protective equipment and the failure to properly quarantine residents, but no fines or penalties have been imposed.
- The Rose Vista home in Woodbine is now the site of active outbreak associated with 95 infections. The home has twice been inspected for infection-control issues. It was cleared of any violations once and cited for handwashing violations the second time. No fines or penalties were imposed.
- The Alverno home in Clinton has been inspected three times by the state during the pandemic and cleared of any infection-control violations each time. The facility has had at least 42 infections.
Hale says the state of Iowa should create and make public “a clear plan of attack” to address the growth of COVID-19 in nursing homes; invite input from residents, family members and front-line caregivers in addition to industry lobbyists; disclose how new federal and state virus-relief money is being spent; and make the support of Iowa’s direct-care workforce a high priority.
Iowa’s infection-control inspections are the result of a directive from the Centers for Medicare and Medicaid Services, which in March ordered all state inspection agencies to conduct infection-focused reviews at all of the nation’s 15,400 Medicare-certified nursing homes.
According to a new Washington Post analysis of that initiative, these inspections found zero infection-control violations in almost 8 out of 10 nursing homes nationwide.
According to the Post, the homes that received a clean bill of health from inspectors have experienced 290,000 coronavirus infections, accompanied by 43,000 deaths of residents and staff.
The Post reported that nationally, inspectors rarely imposed fines against the relatively few care facilities that were cited for violations.
A CMS spokesman told the Post the inspection process is not meant to be punitive in nature, noting that nursing homes have been given instructions on how to comply with regulations before the inspections take place.
CMS administrator Seema Verma told the Post some nursing home workers are on their best behavior once state inspectors are on site.
“We go in, we think everything is okay, and then the next day they’re not washing their hands after they’re interacting with patients,” Verma said.
One Iowa home that is not the site of a current, active outbreak could be facing significant federal penalties imposed by CMS for infection-control violations this summer.
In August, Pottawattamie County Public Health officials asked DIA to investigate the Oakland Manor nursing home in Oakland, which had been the site of at least 51 COVID-19 infections and seven resident deaths. In late June, DIA’s inspectors had visited Oakland Manor and reported it was entirely in compliance with federal COVID-19 prevention guidelines.
After county officials complained, DIA officials returned to Oakland Manor and spent five weeks investigating the facility. The inspectors determined residents of the home were in “immediate jeopardy,” triggering immediate corrective action, and then cited the home for 11 regulatory violations related to infection control, resident abuse and inadequate medical care.
The state proposed a $20,500 fine against the facility but has held that fine in suspension in case CMS wants to impose a federal penalty against the home for the same violations.
The most recent federal fine imposed at Oakland Manor was in 2017, according to CMS.
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