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More than 80% of Texas nursing homes cited recently for infection control problems

Austin American-Statesman logo Austin American-Statesman 3/14/2020 Julie Chang
a person standing in front of a building: Retirement and Nursing Center Austin in Central Austin has been cited three times for infection control problems in the last three years, according to federal data. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN] © Ricardo Brazziell Retirement and Nursing Center Austin in Central Austin has been cited three times for infection control problems in the last three years, according to federal data. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN]

More than 80% of Texas nursing homes were cited in the last three years by the federal government for not following proper protocol to prevent infections, raising concerns about the safety of such facilities amid the new coronavirus outbreak.

Government watchdogs cited 74% of the 57 nursing homes in Travis, Williamson, Hays and Bastrop counties between 2017 and 2019, according to latest available federal data collected by the USA Today Network, of which the American-Statesman is a member. Nationally, the rate is 75%. The most common violations found at Central Texas nursing homes involved caregivers not properly washing or sanitizing their hands. Other violations at local facilities included not properly quarantining a patient who had diarrhea and allowing a catheter tube to drag across a dirty floor.

"Staff can be stretched very thinly and be assigned to care for 15, 20 or more residents on a shift. When that is the case, not properly performing a task — washing hands, or taking other precautions — may shave a few seconds of time for the staff person to move on to help the next resident," said Patty Ducayet, the state's long-term care ombudsman at the Texas Health and Human Services. In her role, Ducayet advocates for the voices of nursing home residents.

Details on Central Texas nursing home violators

a car parked on the side of a building: A person is escorted into Pflugerville Care Center on Friday. The nursing facility is restricting visitors to prevent the introduction of the new coronavirus, COVID-19, to its residents. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN] © Ricardo Brazziell A person is escorted into Pflugerville Care Center on Friday. The nursing facility is restricting visitors to prevent the introduction of the new coronavirus, COVID-19, to its residents. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN]

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a person standing in front of a brick building: A man enters the Retirement and Nursing Center Austin in Central Austin after taking a smoke break on Thursday. The federal government has cited the facility three times for infection control problems in the last three years. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN] © Ricardo Brazziell A man enters the Retirement and Nursing Center Austin in Central Austin after taking a smoke break on Thursday. The federal government has cited the facility three times for infection control problems in the last three years. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN]

Nursing home residents are particularly vulnerable to infections because they also live in close proximity to each other and many have reduced immunity and multiple chronic health conditions. A large study of the new coronavirus disease, COVID-19, in China found that 15% of patients in their 80s or older died from the disease while 1.3% of patients in their 50s died.

Infection control violations are among the most persistent problems for nursing homes nationwide. That holds true in Texas, where Health and Human Services Commission conducts annual inspections of nursing homes and feeds the results to the federal government. The state has consistently named infection control the most common violation among its nursing homes.

In some cases, violations can lead to fines, but they often do not. The average fine nationally was about $15,000. A nursing home that accumulates several violations —particularly egregious ones — could lose critical federal funding.

Sandy Senn, whose 99-year-old mother lives at Georgetown's Estrella Oaks Rehabilitation and Care Center, said she has some concerns about the cleanliness of her facility. A few months ago, her mother became sick with a daylong stomach bug that she said other staff and residents had also contracted.

"For the price these people are paying, they need to do a lot of upgrading of employees and cleaning procedures," Senn said.

The facility was purchased by another company in December, and officials told the American-Statesman they were not familiar with a recent stomach virus outbreak. The last time the facility received an infection control citation was in 2017. Inspectors said staff members did not follow proper hand hygiene protocols while providing incontinence care to a resident and did not properly note on a door that a resident inside was in isolation because of an infection.

The vulnerability of nursing homes

Infection control policies at nursing homes have come under scrutiny after the COVID-19 outbreak that spread through Life Care Center of Kirkland, a nursing home outside of Seattle. More than a dozen deaths have been associated with the facility.

The USA Today investigation found that Life Care Center had one violation in the last three years that involved a family reporting a resident's open heel wound touching the ground.

Inspection officials assign points for violations depending on the severity. Of the 988 Texas nursing facilities cited, 221 of them had violations at least as severe as Life Care Center's; four were in Central Texas. Nine Central Texas facilities were cited three or more times in the last three years.

Cypress Healthcare and Rehabilitation Center in San Marcos received four, the most of a single facility during that period. Inspectors said some staff members did not clean their hands properly and said a resident wasn't properly isolated despite testing positive for a bacterial infection that causes diarrhea.

Molly Lawrence, office manager at Cypress Healthcare, which came under new ownership in 2019, told the Statesman that problems were quickly corrected.

"It doesn't take much to get tagged from the state sometimes, but everything that has been found was resolved within 30 days," Lawrence said.

Facility officials and their advocates say they follow rigorous infection control procedures and a violation found during a single inspection doesn't mean safety protocols aren't followed the rest of the year.

"You assume universal precautions, which means that you act and work as if everybody could be infectious," said Amy Chidester, the administrator at Southwest Austin's Brush Country Nursing and Rehabilitation, about typical infection control procedures her staff follows.

Brush Country received three infection control citations in the last three years. Inspectors said a staff member did not change gloves after cleaning a resident and before placing the resident in clean underwear. Inspectors also said a staff member did not properly wash her hands after changing used bed linens in a hallway where there was an outbreak of residents with the flu.

High employee turnover and poor staff training can contribute to the number of infection control violations that a facility accumulates, said George Linial, president of Leading Age Texas, which represents nonprofits that provide services to the elderly.

The average turnover rate of certified nurse aides who work in Texas long-term living facilities, like nursing homes, was 85%, according to a 2017 report from the Texas Department of State Health Services.

One possible cause of high turnover is increased workload, according to the report.

"We've got a huge workforce issue in long term care, particularly in the frontline staff. It takes people a while to gain that sort of focus on infection control over time. I do think that turnover is a big issue. ... If you have a new person every day, it makes that standard of care more difficult," Linial said.

Limiting visitors as prevention

Last week, Central Texas nursing homes were closely monitoring ever-changing recommendations and guidance from local and federal officials about how to prevent the virus from hitting their facilities.

By Friday, nearly a dozen facilities contacted by the Statesman were restricting visitors, including limiting or barring family members, friends and volunteers. Families were being asked to pick up residents' laundry at the front door and to video conference call their loved ones.

Complete coverage: Texas prepares for coronavirus

Any essential visitors, including employees, were being questioned about having any symptoms of respiratory infections or whether they had traveled internationally.

Visitors and staff were also having their temperatures taken regularly.

Sue Schnars, whose daughter has a disability and cannot speak, fears that being barred from visiting her at Pflugerville Care Center would mean her daughter's quality of care could diminish. Schnars visits her daughter every day for at least 45 minutes.

The facility had one violation in recent years that involved a staff member not properly sanitizing her hands in between undressing and redressing a resident's wound.

Steven Hamman, whose longtime friend and godfather to his child is also in the Pflugerville Care Center, said the facility appears clean. Hamman is more concerned that residents who have dementia like his friend still feel connected to the outside world amid the suspension of visitors.

Many facilities have suspended activities that involve contact with outside visitors.

"What's really critical for those with this condition is having that connectivity with familiar people," Hamman said. "With people who are a part of them."

a man riding on the back of a truck: A woman is escorts a man into Pflugerville Nursing and Rehabilitation Center on Friday afternoon. The nursing facility has been cited once for infection control problems in the last three years, according to federal data. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN] © Ricardo Brazziell A woman is escorts a man into Pflugerville Nursing and Rehabilitation Center on Friday afternoon. The nursing facility has been cited once for infection control problems in the last three years, according to federal data. [RICARDO B. BRAZZIELL/AMERICAN-STATESMAN]
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