AUSTIN (KXAN) — Long before COVID-19 began to threaten vulnerable nursing home residents, several Central Texas senior facilities had already failed to follow federal guidelines for infection control and prevention. 

KXAN Investigators dug through federal health inspection records to find nearly 30 Austin-area facilities had at least one deficiency related to preventing infection in the past 3 years. More than half of these facilities received multiple infection control deficiencies. 

The Centers for Medicare and Medicaid Services requires facilities to have outlined infection control procedures, including things like proper hand hygiene, a system of surveillance to identify possible communicable diseases, appropriate protective gear, and a plan for disinfecting equipment and the facility. 

“A lot of it is very basic: cleaning hands, clean environment,” said Connie Steed, president of the Association for Professionals in Infection Control and Epidemiology (APIC).  “If a patient does have an infection, that is treated properly, and they get placed in the right isolation, so that doesn’t get spread to another elderly resident.” 

Senior facilities have come under sharp focus since the rise of COVID-19, which is most dangerous for elderly people and those with preexisting medical conditions. Nursing homes and assisted living facilities have accounted for roughly 45% of the states 969 virus deaths, according to state data updated Wednesday.

KXAN independently confirmed cases of COVID-19 at 15 local nursing and assisted living facilities. The federal data cited in this report includes only nursing homes. You can read all of KXAN’s nursing home reporting here.

KXAN has confirmed at least four of the nursing homes with infection control deficiencies have now reported at least one case of COVID-19.

Steed said that doesn’t surprise her, as failures from the past can indicate current weaknesses in a facility’s ability to fight the spread of the virus. 

“If you’ve been cited for infection prevention, then I would suspect that would increase your risk,” she said. 

Meanwhile, several of the nursing homes that have reported cases of COVID-19 did notreceive infection prevention deficiencies from CMS. 

“Outbreaks can occur in any facility, even good facilities, because someone can bring it in. You can have a carrier, someone who is asymptomatic — they have no symptoms — they either see someone, take care of someone, or it could be a contract worker and they spread it, and no one knows,” Steed explained. 

Steed said a lack of personal protective equipment, commonly called PPE, has made it more difficult to properly control the virus, along with a lack of testing for staff and residents. 

“We want to know who’s infected and who’s not,” she said. Once a facility knows who’s sick, it can isolate them. 

Steed also emphasized the importance of an on-site Infection Preventionist (IP) to help get ahead of the spread. Someone “making sure those things get done,” she said. 

Feds consider rolling back infection prevention regulations

Rules from CMS published in 2016 required all federally supported skilled nursing facilities to have a trained IP on staff by November 2019. This could be a full-time or a part-time position, and the Centers For Disease Control and Prevention and CMS offer a free course to help current long-term care facilities (LTCF) get training.

However, Steed said she and other experts at APIC are concerned that in recent months CMS has been “backing off” on this requirement. 

CMS proposed a rule change last year, before the IP requirement went into effect, that would allow facilities to have an IP for a “sufficient-time,” as opposed to requiring them to work part-time. In other words, the facility would determine how much time an IP needed to spend in their homes. 

CMS said the goal of the proposed change would reduce the amount of regulations they have identified as “unnecessary, obsolete, or excessively burdensome.”

Steed’s organization wrote a letter to CMS officials, urging them not to proceed with the change. The letter reads, in part, “APIC respectfully requests that CMS reconsider its proposal to remove the requirement for a part-time individual designated as an IP in LTCFs. Facilities have not had the opportunity to fully implement this requirement, nor the time to demonstrate the effectiveness and cost efficiencies that can be experienced from this investment in prevention strategies. Residents of LTCFs deserve the benefit of onsite expertise.”

The letter also states, “interventions to improve the safety and well-being of residents should not be delayed or avoided because it is too difficult or costly.”

The proposed change also calls for biennial facility-wide assessments, instead of the current annual assessments. 

Steed said the coronavirus outbreak has shown more proactive emphasis on infection control could save lives, so her organization is concerned about less frequent facility assessments.

“I don’t think people are going to forget about this any time soon. This is not over, and this could come back. It could be seasonal for a while like influenza,” she said. “I think that’s what this has pointed out: that those simple things are extremely imperative, and we can’t take them for granted anymore.”

Dozens of deficiencies 

​CMS health inspection records detail more than just infection control deficiencies, but things like the safe storage and serving of food and a facility’s ability to prevent accidents.

KXAN Investigators found that over the last three inspection cycles since January 2017, 40 nursing facilities had multiple deficiencies in different categories. Some were cited with more than 20 different deficiencies over this time frame.

32 Central Texas nursing facilities received a deficiency stemming from a complaint. Every deficiency noted in the map was corrected by the facility. You can view the a map of the federal data below.