New Directives Are Needed to Keep Residents Safe
No California population is more at imminent risk of death or severe illness from COVID-19 than nursing home residents. There is an immediate need for public officials to implement stronger measures to help keep them safe. Although well intended, the actions taken to-date are not nearly sufficient to keep residents safe and some of the measures are counterproductive.
To minimize exposure to COVID-19, nursing homes in California and nationally have been ordered to bar almost all visitors. This includes family members, friends, church groups, volunteers, other visitors, ombudsmen and advocates. It also includes many family caregivers who provide daily life sustaining care to loved ones in understaffed nursing homes.
Now state nursing home surveyors, the last line of third-party protection for nursing home residents, have been sidelined. Most of them have been redirected to providing remote technical assistance to nursing homes on infection control, a role that could and should be led and staffed by the nursing home industry. The California Department of Public Health (CDPH) has several hundred highly trained registered nurses who inspect nursing homes and are experts on federal and state infection control standards. They should be out in force in California nursing homes during this crisis, not in their offices.
Cutting off California nursing home residents from any meaningful oversight increases their risk of exposure to both COVID-19 and deadly neglect. Who will detect life-threatening infection control problems, which are rampant in nursing homes? Who will detect dangerous levels of understaffing – a notorious problem in nursing homes in the best of times – when staff are unavailable because of illness, childcare, quarantine or fear? Who will ensure that nursing homes do not admit new residents being pushed out of hospitals when they do not have the staff to serve those who are already there?
There is no one left to sound the alarm in nursing homes if residents are neglected during this crisis. California can and must do better.
The following actions should be taken immediately by CDPH to improve resident safety and diminish their isolation.
- Reassign its nurse evaluators to monitor nursing homes onsite throughout the state until the crisis passes. Give inspectors the authority to require immediate correction of serious problems, to respond to urgent complaints and to give guidance to facilities as needed.
- Closely monitor nursing home staffing levels on a daily basis. Require nursing homes to report their direct care staffing levels and resident census every day to CDPH and to post these reports on their websites. Impose a ban on admitting new residents in any facility that does not have sufficient staff to meet the needs of the residents.
- Issue a moratorium on involuntary transfers and discharges of residents. They deserve the same protections from unsafe evictions as the rest of the public in this dangerous time.
- Ensure nursing homes provide meaningful, frequent and safe opportunities for residents to maintain contact with loved ones remotely until visitation is restored. Assign a CDPH training coordinator to model best practices, present webinars and lead this initiative.
All Californians are filled with dread and uncertainty about COVID-19, none more so than nursing home residents and their loved ones. The directives by our governments meant to slow the transmission of the virus in nursing homes have dramatically increased residents’ exposure to isolation and neglect, problems that have long infected nursing homes and proven deadly.
Our state nurse evaluators are absent from nursing homes at a time when they have never been more essential.