Nursing Home Reforms Launched in Mass. To Protect Residents From COVID-19

As the coronavirus pandemic continues to impact long term care facilities throughout the United States, state officials in Massachusetts have announced a series of reforms aimed at reducing the risk of patient-to-patient transmission of COVID-19 at nursing homes, which will take on increased importance as the flu and winter season approach.

Massachusetts Governor Charlie Baker announced the Accountability and Supports Package 2.0 this week, which includes approximately $140 million in monetary support to help improve nursing home infection control standards and resident quality of life throughout the state.

While many healthcare facilities were caught off guard by the rapid spread of the novel coronavirus earlier this year, with nursing homes generally accounting for about a quarter of all COVID deaths in the early months of the pandemic, as residents are elderly and have weakened immune systems that make them most susceptible to the virus.

According to the press release, Massachusetts nursing homes will be required to strengthen staffing and the direct care workforce to improve the standard of care for its residents. In additional to the increased workforce, Baker has announced all nursing home facilities will be required to have a two-patient maximum per room to ensure adequate spacing in congregate rooms.

Although understaffing is often seen as a form of nursing home neglect, it has been a major risk factor during the COVID-19 pandemic, with many of the hardest hit facilities also having worse track records for resident-to-staff ratios.

Under the new Massachusetts reforms, nursing home facilities will also be required to establish effective isolation spaces for COVID-19 positive residents being discharged from hospitals. Under the guidelines, the care facilities will be required to maintain specific levels of personal protective equipment (PPE) and have no deficiencies on infection control procedures, which will be under surveillance by state regulators, according to Baker.

Of the total $140 million initial investment, $82 million will be allocated for restructured Medicaid rates, which are intended to incentivize Medicaid facilities to maintain high-quality, high-occupancy, and care for high-acuity special populations, including residents with substance use disorder and mental health diagnoses.

The state order will also include requirements for nursing home workers to receive flu vaccinations, eliminating a current option for staff to opt-out of getting a flu vaccine. Exemptions will only be considered for medical or religious purposes.

With more than 1.3 million residents in over 15,000 Medicare and Medicaid-certified nursing homes throughout the United States, significant attention has been placed on COVID-19’s progress through nursing homes, which have been hard hit. Many experts have claimed nursing homes were hit the hardest due to low levels of staffing, a lack of preparation, and the elderly’s increased vulnerability to the effects of the virus.

In August, the U.S Centers for Medicare and Medicaid Services (CMS) released a report indicating nursing home and long term health care facilities had reported 216,219 confirmed cases of COVID-19, with another 129,338 suspected cases. Of the confirmed cases, a total of 53,196 COVID-19 related deaths were reported.

The U.S. Centers for Disease Control and Prevention (CDC) published a study late last month highlighting a link between COVID-19 and nursing home quality of care, indicating facilities which scored better in federal ratings have been less likely to experience severe outbreaks at their facilities.

In general, researchers found the better the nursing home scored had a direct correlation to whether the facility was able to prevent or control COVID-19 outbreaks during the on-going pandemic.

Federal investigators are exploring the possibility of nursing home neglect playing a role in the COVID-19 outbreak, which was first detected in a nursing home in Washington State that became the epicenter for the U.S. pandemic. Investigators say the nursing home failed to respond to the outbreak adequately, placing residents in jeopardy of illness and death.