State crackdown highlights issue of lax reporting by some nursing homes

The state Department of Public Health (DPH) is cracking down on long-term care facilities, including dozens of nursing homes, for failing to report the vaccination status of employees by Sept. 28 as mandated by executive order.

In making the announcement on Thursday, Oct. 28, DPH Commissioner Dr. Manisha Juthani issued a first round of civil penalties of up to $20,000 per day, citing health and safety concerns.

“Reporting timely and accurately to DPH helps the state ensure that the long-term care industry is meeting this goal and brings confidence to the community that our most vulnerable citizens are safe,” Juthani said.

Of the 643 long-term care facilities subject to the order, 226, or 35%, had failed to report to DPH by the Sept. 28 deadline, and 122 facilities have failed to report altogether through Oct. 21, according to the state. DPH is continuing its review and has begun to audit the information reported by the facilities.

What else isn’t being reported?

The state’s action also brings into question how nursing homes are reporting bi-weekly data on COVID-19 infections to the state. Most show up on data charts as having zero cases. Others, including Geer Village in North Canaan, report a high rate of infection among staff and residents, as well as COVID-related deaths.

None of the three nursing homes in the Northwest Corner, and the state itself, could explain why the majority of the 208 statewide nursing home facilities on the two most current bi-weekly reports (released by DPH on Oct. 12 and Oct. 26)reported not a single confirmed case of the virus, even at a time when the Delta variant is reported to be creating a surge among the most vulnerable populations.

A total of 37 cases of COVID-19 among residents, six deaths and 34 staff infections were reported statewide during the two-week period ending Oct. 26, out of a total nursing home population of 18,890.

The prior two-week reporting period, ending Oct. 12, revealed 71 resident infections statewide, three deaths and 34 staff infections, out of a total population of 18,849.

‘Very confusing to see all the zeroes’

The skilled nursing facility at Geer Nursing and Rehabilitation Center in North Canaan recently experienced a spike in new cases of COVID-19 among its fully vaccinated residents and staff. The assisted living facility at Geer Village remains unaffected.

“All I can say is that at the last Zoom call we had with DPH on Wednesday, Oct. 20, they indicated they had six new facilities reporting COVID outbreaks. It is very confusing to see all the zeroes on this week’s report,” said Geer CEO Kevin O’Connell on Friday, Oct. 29, a day after the bi-weekly data collection was released by the state.

O’Connell confirmed that 53 residents and 16 staff became infected with COVID-19 in recent weeks, and three residents with underlying health conditions died, with their deaths attributed to COVID-19.

Of the 53 residents infected, 25 have recovered; of the staff members infected, seven have recovered.

“After 18 months of battling to keep this virus out of our nursing home, we are sad to report an outbreak affecting 69 staff and residents. We are encouraged to see 37 individuals already recovered and coming off isolation. Sadly, we have lost three individuals with serious underlying health issues to COVID,” said O’Connell.

The Geer administrator said the infection was brought into the nursing home by a new patient who came in short term, had tested negative upon admission, and then tested positive a few days later. The infection was isolated to the nursing home, he said, and did not spread to the Lodge, assisted living facility or other campus locations.

“Once it gets into the building it is very difficult to control,” O’Connell said of the highly infectious Delta variant.

The Geer team, its CEO noted, is following guidance from the state DPH and the national Centers for Disease Control and Prevention(CDC), and continues to monitor the situation closely with ongoing testing occurring bi-weekly.

“Our remote location has previously been an advantage in keeping the virus out, but that is no longer the case, despite declining rates of infection across the state,” said O’Connell.

In a prior interview on Oct. 19, O’Connell said he had no idea whether other nursing homes are or are not reporting confirmed cases within 24 hours as required by the Centers for Medicare and Medicaid Services. But, he said at that time, the state DPH report, with all its zeroes, “does look odd.

“Whether we happen to have a unique case here, I don’t know. Do I think there are unreported cases out there? I understand the difficulties involved with testing and tracking cases. I would not be surprised if the numbers are higher when the new update comes out.”

As it turned out, the latest batch of numbers released in the state’s Oct. 28 bi-weekly data collection revealed the opposite, showing a decline in reported infections.

No current cases at Sharon Health Care Center

Non-compliance is one possible explanation for the low data collection, said Tim Brown, spokesman for Athena Health Care System, which operates Sharon Health Care Center. He did not rule out the possibility of statewide under-reporting.

“It is possible that there are more cases out there than are being reported,” said Brown in an interview on Oct. 20, during which he reported that there were no positive cases of COVID-19 at the Sharon nursing home.

At the start of the pandemic, before vaccines went into residents’ arms, the Sharon facility was a hot spot for COVID-19. Brown said he can relate to the fallout that facilities face when infections become public. “We have been reporting right from the beginning, when many others were not doing that.”

According to the most recent DPH report, three confirmed resident infections and four resident deaths at Sharon Health Care Center were recorded in the CDC’s National Healthcare Safety Network (NHSN) data for the period July 22, 2020 through Oct. 28, 2021; 14 staff infections were reported at the Sharon Nursing home after June 17, 2020.

Flaws in NHSN data

Bill Pond, administrator at Noble Horizons in Salisbury, maintains that there has never been a case of COVID-19 on campus, and the zeroes next to his facility in the most recent bi-weekly state reports, he said, are accurate.

Yet, a deeper dive into the DPH reports showing cumulative cases from 2020 reveals one reported resident case of COVID-19 and 12 reported staff infections at Noble.

Pond said the one reported case of a resident exposure was the result of a false-positive test from an individual who was being discharged shortly after the test was taken. “When we addressed that with DPH, they recorded it, took it into consideration and we had hoped it was going to be backed out,” but it never was, the Noble administrator explained.

“That’s a blemish on our record that has been brought to my attention before,” said Pond, who referred to the 2020 data collected by the National Healthcare Safety Network (NHSN) as “flawed. Many facilities early on had problems with that [portal].… Since then, it’s become more accurate.”

As for the reports of infected staff, Pond said not one of the workers who contracted the virus had physically been on campus, thanks to a strong, at-home and on-site outdoor screening process, established in March of 2020, prohibiting staff entry to the facility if symptoms of illness were present.

Pond said “100%” of the staff who tested positive contracted the disease from the community. “They were staff members scheduled to work a given day, and we paid them not to come in.”

The Noble administrator said he doubts that there is a severe undercount among nursing homes statewide and that the statistics are verifiable.

“If one case is not reported, and you don’t isolate that person and the virus spreads, then you have a real problem. It goes against the total grain of what we are all doing as a group” to stamp out the virus.

Geer’s O’Connell agreed. “We are all at a point where nobody is special or immune, and the only way out is to make sure you are reporting and that the state is tracking it.”

Facilities can face stiff penalties and fines for failing to report confirmed cases of COVID-19 within 24 hours through a special portal of the state DPH.

DPH has access to facility-reported data in the NHSN tracking system and pulls this data on a bi-weekly basis to produce the nursing home reports, according to spokesman Christopher Boyle.

“Any updates that facilities submit after Wednesday of each week are not reflected in the bi-weekly report,” Boyle explained. “If facilities notice a discrepancy in the report, they are advised to notify DPH.” He added that DPH is continuously updating and providing any revisions in subsequent reports.