AUSTIN (KXAN) — These days, Janie Luevano spends a lot of time outside. Inside, she doesn’t feel the usual holiday cheer. She chose to ditch the Christmas decorations this year — opting instead for a simple wreath on the front door.

“Maybe next year I’ll be in a better mood. This year, I’m not,” she said.

The year 2020, and more specifically the coronavirus, claimed two of her brothers’ lives. One of them, who she called “Jimmy,” died after contracting the virus in West Oaks Nursing and Rehabilitation.

“The hardest thing for me to accept is that I put him in the nursing home thinking he’d get better care and everything,” Luevano said. “I sometimes think if I hadn’t, he’d still be here.” 

Senior care advocate Brian Lee told KXAN he believes the care in these homes should have been better. He believes the problems started with poor infection control.

“I think this is what really snowballed this pandemic into the the avalanche that it is today,” he said.

Infection control complaints, citations

A KXAN review of HHSC infection control complaints from the past three years spotlights the challenge nursing homes and state regulators have faced leading up to and, ultimately, throughout the pandemic.

Infection control standards regulate practices like proper hand-washing, mask wearing and even protocols such as how frequently to change bed sheets and linens.

“They have this extensive list of emergency preparations that they have to be ready for — not only fires, hurricanes, floods, and wildfires — but included within the list of what they have to be ready for? Pandemics,” he said.

However, Lee said before the coronavirus outbreak, he believes infections and outbreaks of the flu or MRSA were considered “normal” among these vulnerable populations.

“I think that because of that — the “looking the other way” or “sticking your head in the sand” — whatever euphemism you want to use,” he said. “The nursing homes were unprepared, and the [state] inspectors didn’t help out with that preparation by making sure that they were held accountable through, you know, these preceding years before this pandemic.”

According to data obtained by KXAN investigators, in the two years prior to the pandemic, HHSC received an average of about 40 complaints per month alleging infection control violations. Of those complaints, HHSC would substantiate and cite facilities an average of three times per month.

“It feels like a dream, this virus. I still don’t understand it.”

Janie Luevano, Lost her brother to COVID-19

In March and April, the number of complaints — and citations — skyrocketed and has remained well above average.

In March, the number of infection control complaints jumped to 222. In April, the complaint count hit a high of 905, roughly 22 times higher than the previous two-year average. From March to October, HHSC was substantiating and citing nursing homes an average of 70 times per month — 23 times more than the average in 2018 and 2019, according to HHSC records.

The number of complaints substantiated with “no deficiency cited” rose similarly during the pandemic. HHSC said it takes the action of substantiating a complaint but not citing when it finds the allegation did occur, but the problem was corrected by the time of the investigation, according to an agency spokesperson.

On average, HHSC was substantiating allegations without citing facilities for infection control violations about two times per month in 2018 and 2019, but during the pandemic the agency has used that approach 10 times more often, agency data shows.

“We aggressively enforce our infection control and prevention rules through inspections, complaint investigations and assessment of penalties,” a spokesperson for the agency said.

They explained infection control was a “top priority,” noting their regulatory staff has been training facilities on the topic since “well prior to the pandemic.” The spokesperson said this training includes:

• Online trainings on the most commonly cited deficiencies
• Instructor-led training for new facility directors of nursing
• Instructor-led training for nurses who are transitioning from another practice setting (such as hospitals) to nursing facilities

They said their staff has also completed 6,079 on-site surveys of facilities’ infection control practices since late March and a total of 9,043 investigations covering all regulatory related complaints or incidents — the vast majority of these took place on-site in the homes as well. HHSC said their staff responded within 24 to most incidents.

“As long as COVID-19 remains in long-term care facilities, this effort will continue,” the spokesperson said.

HHSC also launched nearly 1,000 Special Infection Control Assessments before July, assisting facilities in complying with state and federal regulations.

“If something poses an immediate risk to resident health or safety or if a nursing facility resident has suffered harm, we issue a violation known as an Immediate Jeopardy,” the HHSC spokesperson explained.

These types of violations could result in a facility facing a monetary penalty or actions against their operating license.

According to HHSC data, from March 2017 to February 2018, only 5 Immediate Jeopardies were issued. From March 2018 to February 2019, the state issued one and then issued three from March 2019 to February 2020. However, the state has issued 100 of these types of serious violations since March 1.

Still, Lee disagreed, saying the numbers of infections and death indicate otherwise. His organization gives states regular “report cards,” reviewing the quality of care in long-term care facilities there. In their latest report, Texas was given a failing grade.

“Texas is not exactly a glowing state when it comes to nursing home quality and safety,” he said. “It’s a foul stench of death that is nursing homes right now. We have to do a better job keeping our loved ones safe and protecting those residents.”

Cases ballooning in nursing homes

Following a dip in late fall, the number of active cases in Texas nursing homes is again on the rise.

Congressman Lloyd Doggett (D-TX) emphasized the importance of getting infections under control as the vaccine begins to be distributed in these nursing homes.

“It is alarming. We need effective enforcement. We need to use fines. We need to not be sending extra federal money to nursing homes that have not been up to par,” he said.

He plans to introduce new legislation when the next Congress convenes, calling on a task force aimed at tracking and improving infection control protocols.

He said one of the biggest problems this year was a lack of accurate data, so he hopes to improve the level of infection control reporting.

“If we had had that during this pandemic, I’m convinced that lives would have been saved,” Doggett said.

Delia Satterwhite lost her brother in an Austin nursing home this year. She partnered with Congressman Doggett to tell her story, testifying in a Senate committee hearing on infection control this summer.

She told KXAN, even months later, it’s still hard for her to drive by the facility where he once lived.

“I wish they would have done something back then. Someone brought that virus in to him,” she said. “The nursing homes need to be held responsible.” 

Fortifying the workforce, first

Industry advocates at the Texas Health Care Association argued monetary fines will only hurt the residents and adversely affect care in these homes.

He said harsh enforcement was the main topic of conversation at a recent Health and Human Services committee hearing, but argued it was difficult for facilities to comply with ever-changing guidelines this year — accounting for “most” of the citations and violations.

“It’s disappointing to hear that type of response — that that’s the way to change behavior,” President Kevin Warren said. “We’ve got to figure out a way to make this an attractive profession. We’ve got to make sure that everybody in Texas understands the importance of the elderly in the state of Texas and the importance of the role these providers are in these communities.”

He also said they are frustrated with the guilt and blame being placed on hard-working staff.

“Each and every day, they’re wearing the mask eight, ten, twelve hours a day. They’re working extra shifts,” he said. ““It’s a 24-hour-a-day, 7-day-a-week issue in fighting COVID across the building. These buildings are doing a remarkable job in their efforts on infection control each and every day.”

Janie Luevano knows this firsthand. She worked in an Austin nursing home early on in her career.

“I know it’s a low paying job, and I know that’s the reason they don’t never have enough because they don’t pay enough,” she said. “They need to make sure they have plenty help.”

Lee agreed, saying “nursing home quality hinges on staffing.”

However, he doesn’t believe the industry is pushing hard enough for a more robust workforce or encouraging them with better pay. He said his group is pushing for increased state staffing standards — meaning more workers would be required in every home, depending on the number of residents living there.

“Here’s my phone,” Lee said, holding up his iPhone. “It still hasn’t rung from Texas — not one ring from any industry or any nursing home, saying they would work with us to get a better staffing standards and more money to pay for that staffing in the nursing homes.”

Kevin Warren said they’d be advocating for better pay for workers in the upcoming Texas legislative session, along with more resources to help these homes.

“We’ve got to figure out a way to make this an attractive profession. We’ve got to make sure that everybody….understands the importance of the elderly in the state of Texas, and the importance of the role of these providers in these communities,” he said.