How Florida's long-term care facilities are managing the COVID-19 virus
Infection Control: As with pay and staffing, infection control was a challenge pre-COVID. More than 600 of 699 nursing homes surveyed between 2013 and 2017 in Florida were found to have infection prevention and control deficiencies, according to a May 2020 report from the U.S. Government Accountability Office. Many were repeat offenders: 144 were cited in multiple non-consecutive years and 283 were cited in multiple consecutive years. Problems range from a failure to wash hands to not isolating sick residents or wearing proper protective equipment.
But shortages of equipment, testing delays and confusion over how the new virus spreads — up to 40% of cases are asymptomatic — have created a nightmarish scenario for facilities that were never intended to operate like hospitals in the first place. Emergency orders and inspections conducted by AHCA during the pandemic reveal some facilities in disarray — failing to follow social distancing guidelines or protect their residences and staff from infection.
Thus far, the state has halted admissions to five long-term care facilities — including the Fair Havens Center in Miami and Lakeland’s Grace Manor at Lake Morton — and suspended the licenses of three South Florida assisted living facilities after inspections indicated improper operations during the COVID outbreak.
Salmos 23V, which operates a 67-bed facility in Hialeah, was one of the facilities that had its license suspended. AHCA inspected the facility in late May after 47 residents were hospitalized with suspected COVID-19 infections. The agency found a staff member who’d tested positive for the virus at the entrance of the facility taking temperatures and screening staff. That employee wasn’t wearing a mask, nor were other staff or residents, according to the emergency order. The facility had reported two resident deaths to the state as of July.
Heritage Park Rehabilitation and Healthcare, a 120-bed provider in Fort Myers, has had trouble with PPE shortages. In May, the 1199 SEIU United Healthcare Workers East union, which represents workers at 75 nursing homes in Florida, filed complaints with the Occupational Safety and Health Administration and AHCA after nursing assistants at Heritage Park Rehabilitation and Healthcare alleged that management was concealing cases of COVID-19 and not providing them with protective equipment.
A subsequent, unannounced state inspection of the facility cited multiple deficiencies, including a failure to supply adequate PPE. The state surveyor noted that the doors of at least seven isolation rooms were open when they should have been closed and none of the seven rooms had isolation gowns or masks readily available for staff to use.
Multiple CNAs and nurses at the facility told the inspector they’d had to procure masks on their own from friends and had been wearing the same ones for days and even weeks. At one point, a group of CNAs became so upset that they gathered around the time clock and announced they were walking out. A regional nurse at the facility convinced them to stay and returned a couple hours later with N95 masks, according to the report.
Another nurse at the facility told the inspector that she and other aides had cared for a feverish resident who was transferred to the hospital after his condition worsened. The resident ended up testing positive for COVID, but staff were not told about his diagnosis for a week. By then, a CNA who’d taken care of him had also fallen ill, and another resident had tested positive. “The management again did not do investigation into who was around him,” the nurse said.
According to state data, seven residents of Heritage Park Rehabilitation and Healthcare have died of COVID-19; as of mid-July, eight COVID-positive patients had been transferred to other facilities, and 20 staffers had tested positive for the disease. The facility was on the Nursing Home Watch List with a conditional license as of the end of July and has a two-star, or “below-average,” rating from CMS.
Jennifer Trapp, a spokeswoman for Consulate Health Care, which operates Heritage Park, did not respond to the specific allegations but says the company has “worked tirelessly” to protect its staff and residents. Trapp says the company has followed all CDC and CMS guidelines “to the letter,” worked with state and local health agencies to secure adequate PPE and testing and provided “constant staff education on effective infection control protocols, proper use of PPE, best practices for staying safe at home, and much more.” She says the chain has fared better than much of the industry when it comes to COVID.
Avante’s Biegasiewicz says the need for N95 masks caught everyone in the industry by surprise. It’s not something skilled nursing facilities usually need or stock, and by the time it was apparent, there was a worldwide shortage.
“Everything else we had on hand — we had isolation gowns and caps and goggles and all the things we needed for isolation, but, of course, not to the magnitude of supply we’d need in preparation for a pandemic,” Biegasiewicz says. “None of us were prepared for the amount of PPE we would need — not necessarily that we needed it right away — but as a back supply if we did have any outbreak.”