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Independent report issues 45 recommendations for state, long term care facilities in wake of COVID outbreak

Coronavirus

HARTFORD, Conn. (WTNH) — On Wednesday, Mathematica, an independent research company, finished its final report reviewing the response to COVID-19 in Connecticut nursing homes and assisted living facilities.

Governor Ned Lamont ordered the independent review on June 8. As of July 30, 72 percent of the state’s 4,432 deaths were long-term care residents.

The report evaluated the COVD-19 preparedness and response of both the state and the long term care (LTC) industry. In addition to the review, it also made specific recommendations for handling future outbreaks.

A preliminary report released on Aug. 18 indicated that the Connecticut Department of Public Health wasn’t properly prepared to deal with COVID-19 in those long-term care facilities.

While it found deficiencies in the state’s nursing home response, it also found that the state did a lot of things right, including acquiring personal protective equipment.

The final report focused on data collected and analyzed from July 13 to Sept. 15, which included publicly reported information, data and documentation provided by the state and interviews with key stakeholders.

Some of the key findings include:

  • Nursing homes with a greater incidence of COVID-19 in the surrounding community and those with more residents that received dialysis or cancer treatments – which tend to be delivered offsite – had more cases and deaths per licensed bed.
  • The prevalence of symptoms of depression increased by 15 percent and rates of unplanned weight loss nearly doubled right after the peak of the COVID-19 outbreak, suggesting that measuring COVID-19 cases and deaths alone does not capture the full impact of the pandemic on residents’ well-being.
  • After adjusting for facility characteristics such as size and proximity to Connecticut, Connecticut cases and deaths per licensed bed did not vary significantly across nearby states.

Mathematica’s report presented 45 recommendations in total: 23 short-term steps that the state and LTC industry can take to prepare for a second wave of coronavirus, and 22 long-term recommendations to prepare for future disease outbreaks in LTC facilities.

They were organized into 10 themes: person-centered care; surveillance and outbreak response; emergency response; screening and testing; infection control; LTC staffing and workforce availability; state agency roles, expertise, and skills; communication and coordination across state agencies, facilities, and support organizations; care transitions; and reimbursement mechanisms.

Some recommendations include:

  • Developing a framework to guide policies on the reopening of LTC facilities to visitors based on a set of criteria at the facility and community levels, rather than a one-size-fits-all statewide visitation policy. (DPH did announce loosening of visitation restrictions last week)
  • Considering legislation or regulations to (1) mandate a full-time infection preventionist in nursing homes and (2) increase the minimum required staffing levels in nursing homes.
  • Ensuring that all LTC facility staff have access to guaranteed paid sick leave under the state’s existing regulations.

State officials said they’re already started implementing more than one dozen of the short-term recommendations and stressed the report was essential for improvement.

“This report is important for our state, especially for both nursing home residents and their families, as it is a transparent look at how our state responded to COVID-19 within our long term care facilities,” Lamont said. “The novel coronavirus spread quickly and aggressively in Connecticut during the early stages of the pandemic, and we took the steps we believed were necessary at the time to control the spread and save lives. I am pleased by this independent validation of our decisions and actions, and that nearly all of the short term recommendations provided to the state have already been implemented. I look forward to future discussions with the legislature, the industry, staff and families on the additional longer term recommendations brought forward.”

Acting DPH Commissioner Gifford issued the following statement:

I want to thank Mathematica for their very thorough, fair and honest review of how COVID-19 impacted our long-term care facilities and most especially the residents and staff of nursing homes. This report provides us the reassurance that our intensive strategies to contain the COVID pandemic in long term care are on the right path, and that our preparations for a second wave are comprehensive and in line with national best practices. The report acknowledges that since June of this year, Connecticut has mandated and funded a testing strategy for nursing homes under which 72,196 COVID-19 tests have been conducted for nursing home residents, and 196,444 tests have been conducted for staff. Since beginning this program, our infection rates have plummeted, and remain low. I want to commend the efforts of the long term care industry, and in particular the staff caring for residents in our long term care facilities, for partnering with us in this achievement. I also want to commend the dedication and round-the-clock work of the staff of the Department of Public Health, both in monitoring and assisting the industry during this unprecedented event. DPH staff have conducted 2,406 focused infection control surveys, found more than 390 deficiencies and issued 21 citations with fines ranging between $720 and $10,000, provided countless hours of COVID-related training for facilities, and produced a library of guidance to help navigate a rapidly evolving and complex pandemic. DPH continues to plan actively for the future as well. Last week, for example, DPH issued an order requiring that nursing homes maintain a 30 day stockpile of personal protective equipment (PPE) as part of an effort to position the state’s nursing homes to meet a potential surge of COVID-19, and the state continues to stockpile its own reserve should facilities have trouble in the future sourcing their own PPE. These efforts are part of our on-going assessment and re-assessment of our COVID response, and the Mathematica report is an important resource informing our work. DPH appreciates that there are recommendations in this report that we have not yet implemented, and we will be working with the Office of Policy and Management, the Department of Social Services and our partners in the legislature and industry to review and consider those as well.

The full report can be seen below:

Copyright 2020 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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