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Georgia’s oversight of long-term care shaky as COVID-19 cases jump

By Carrie Teegardin, The Atlanta Journal-Constitution #atlanta-ga

State inspectors fanned out across Georgia this summer to conduct federally-required checks of infection-control protocols at every nursing home, reporting few problems.

But when August arrived, the numbers told a different story: It was the worst month yet for COVID-19 deaths and infections at Georgia’s facilities caring for vulnerable seniors.

In Laurens County, the local newspaper was packed with obituaries and residents were expressing grave concerns about conditions at the Dublinair Health and Rehab nursing home, Commission Chairwoman Brenda Chain said. At least 102 residents and 51 staff have tested positive and 24 residents have died —nearly all since early August. “With this being a small town and everything, just about everybody knows somebody that this has affected,” Chain said.

In Newton County, public officials got copies of an anonymous letter from a “relative” asking for an external investigation of the Riverside Health Care Center. Reports now show that an outbreak in the nursing home that began in early July has ballooned as of Tuesday to 102 residents testing positive and 32 residents dying.

In Atlanta, while Dunwoody Health and Rehabilitation Center had reported it was virtually COVID-free until mid-July, family members described cases of malnutrition, unexpected deaths, unanswered phone calls and callous demands to immediately send a funeral home to pick up their loved ones’ remains. Reports now show 118 residents and 63 staff have tested positive, and 28 residents have died.

“I don’t know how that facility is still in existence,” said Khalid Rashied, who pulled his mother out of the facility, fearing she wouldn’t survive.

Because of the risk of the coronavirus, for nearly six months families have been barred from making routine visits to check on loved ones in long-term care homes. Representatives of Georgia’s long-term care ombudsman’s office have been locked out, too.

Those tight limits mean that at one of the most dangerous times in history to live in a senior care facility, oversight has been left primarily up to a Georgia agency that has struggled for years to keep a close watch on nursing homes, assisted living facilities and personal care homes.

Georgia lags behind every state but one in completing standard inspections of nursing homes on time, the AJC found. While the reports are supposed to be done annually, federal records show that 42 percent of the state’s nursing homes — 152 facilities — have not undergone a comprehensive inspection for at least 18 months, and some for more than two years.

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Georgia also was called out in 2017 as among the nation’s worst at investigating complaints that patients may be at imminent risk of serious injury or death.

The lagging inspections could leave patients at risk in a state that has one of the nation’s highest shares of nursing homes with poor records. One in 4 Georgia nursing homes are rated as well below average, or 1-star, in the federal system.

Shortcomings are widespread as well in the state’s assisted living and personal care homes, the AJC found in an investigation last year.

The state Department of Community Health, the agency responsible for oversight, said delays in inspections are due to a shortage of inspectors and its suspension of routine inspections at the start of the pandemic, which created a backlog. Of the 57 “surveyor” positions Georgia has to inspect nursing homes, 24 are vacant.

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DCH also said it followed federal guidance in March to focus only on infection control checks and complaints where residents could be in immediate jeopardy. It did most of that work remotely through the spring.

DCH resumed on-site inspections after the federal government in June ordered states to do so by July 31 to look for infection control issues. Georgia was among the last states to inspect all homes, using outside vendors to help.

DCH said it is complying with a recent federal directive to conduct quick onsite visits at homes that report new outbreaks. DCH said it is also conducting complaint investigations now and coordinating with federal “strike force” teams inspecting nursing homes.

But so far, at least, the state has released to the public only a handful of reports citing homes for violations, even as deadly new outbreaks continue. Residents of long-term care facilities make up about 40 percent of the state’s overall COVID-19 deaths, and the August death count for senior care residents was higher than any month of the pandemic.

Some families say the state must be missing something.

Rashied said while his mother was at the Dunwoody Health nursing home for rehab after breaking a bone, he would call regularly to check on her. But the phone usually went unanswered. He said he was told she would be tested weekly for COVID-19 after being exposed to another resident who tested positive, but she apparently wasn’t, he said. A test done on the day she left was positive, but Rashied wasn’t told of the results for two days. He said his mother was so drugged up when he picked her up from the home she was unable to talk, eat or even sit up, and he contends she wasn’t given proper follow-up care for her broken bone.

“I don’t know if there is a worse place I could send my mother to,” Rashied said. “Hell is the only thing I can think of.”

But it turned out that his mother was one of the lucky ones. Unlike at least 28 other residents at the home, she survived.

Dunwoody Health is operated by Atlanta-based SavaSeniorCare, one of the nation’s largest senior care chains. The company attributed the outbreak to the facility’s location in a “highly populated urban area” where there is a heightened exposure to COVID-19. The company said it was working hard to control the outbreak, but said the pandemic is difficult to contain in a congregate setting.

”There have been residents who have tested negative for the virus and those who have been asymptomatic,” Sava said. “As a result of our efforts, 69 residents currently at the center have recovered (from COVID-19) in our care.”

With high rates of COVID-19 throughout Georgia, many long-term care operators say it’s almost impossible to block the virus completely since employees must come in and out. Even some of the state’s top-rated homes have had deadly outbreaks, especially early in the pandemic when needed amounts of personal protective equipment and tests were impossible to get. But Georgia’s history of lax oversight increased risks for residents in facilities that have records of infection control violations, inadequate staffing or care violations. Plus, with families locked out, residents of sub-par homes no longer had family members stop by to help and protect them.

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The Riverside Health Care Center in Newton County, about 35 miles east of Atlanta in Covington, had reported just one COVID-positive resident until early July, when the numbers started to explode. With cases and deaths rising, public officials say they got the anonymous letter asking for oversight, saying calls to the facility weren’t being answered.

The COVID-19 death toll at the 158-bed home is the second-highest among Georgia nursing homes. Local public health officials said they had provided infection-prevention training both virtually and on-site and that DCH was inspecting the home. But no reports on the inspections have been posted.

The U.S. Centers for Medicare and Medicaid Services, which regulates nearly all nursing homes, told the AJC Thursday that infection-control checks were done at the home in June, July and August in response to the increase but no public reports on the inspections were available yet. It’s unclear when — or even if – state or federal officials will release any details.

A standard survey of the home Feb. 13, before the pandemic hit, cited the home for five deficiencies, including failing to provide a safe, clean and comfortable homelike environment.

The nursing home did not respond to calls from the AJC, and its website doesn’t include the kind of COVID-19 update that many nursing homes provide online. Marcello Banes, the Newton County Commission chairman, said in a statement that he was “deeply saddened” by what was happening at the home. He called the situation at Riverside “unacceptable.”

The home has a 1-star federal quality rating, the lowest on the federal scale.

“I don’t know how that facility is still in existence.”

– Khalid Rashied, who pulled his mother out of Dunwoody Health and Rehabilitation Center, where 28 residents have died from COVID-19

At Dublinair Health and Rehab, about two hours south of Atlanta, the outbreak has been sudden and furious. Of the 24 COVID-19 deaths at the home, 23 were reported in August. Local officials said both public health officials and DCH inspectors had been on-site. But no reports had been released. Dublinair also has a 1-star rating.

The 149-bed home appears to have no website, and the administrator did not respond to calls from the AJC.

Bobby Pope, a pastor who officiated the funeral for his father-in-law, a Dublinair resident who died in July, said it’s been difficult to get information from the facility or to get an answer to calls. The family was allowed to enter wearing protective equipment when the death was imminent. He said they were told the cause of death was pneumonia. “Somebody needs to get in there and check to see what is going on,” said Pope, whose mother-in-law is also a resident there.

Chain, the Laurens County Commission chairwoman, said county health officials and DCH were working with the facility to try to contain the outbreak. CMS said inspections were conducted at the home in June and August, but no inspections reports were yet available.

The most recent standard inspection of Dublinair was in September 2018, when among the violations were infection prevention and control issues, government records show.

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