Input from SDFMC Impacts National Coronavirus Commission for Safety and Quality in Nursing Home Final Report

Part 1: Drawing from Experience Leads to Many Recommendations

In preparation for serving as the Midwest representative on the National Coronavirus Commission for Safety and Quality in Nursing Homes, Mark Burket, chief executive officer of Platte Health Center, set out to gather the thoughts and perspectives of his colleagues on the daily and compounded pandemic-related issues nursing homes face. One phone call he made was to South Dakota Foundation for Medical Care’s (SDFMC’s) Lori Hintz, RN, who serves as a quality improvement advisor for nursing homes in South Dakota.

Based on her deep-seeded relationships and years of experience working with nursing homes, the Centers for Medicare & Medicaid Services (CMS), and health departments, Lori was able to offer Mark an arsenal of suggestions. Being a nursing home administrator, Mark also has daily interactions with nursing home staff and residents and plays a significant advocacy role statewide. With Mark’s participation on the Commission, he shared these recommendations nationally and a few made it to the final report!

Lori recommended multiple quick implementation strategies and actions as well as long-term strategies on behalf of South Dakota nursing homes:  

SDFMC Strategy Recommendations

Quick Implementation Strategies/Actions

  • Expand COVID assessment to more than just temperature checks – such as assessing for loss of taste and smell via using “sniff test”
  • Decrease the amount of duplicative survey visits, facility assessments and reporting, which takes away valuable resident care time and staff education time where efforts should be focused
  • Use survey visits as an educational opportunity rather than punitive 
  • Lessen punitive actions (CMPs) as this decreases fiscal capacity of the facility
  • Provide funding for higher pay for staff to help maintain workforce stability
  • Provide funding to support full-time infection prevention employee
  • Provide funding/reimbursement for the purchase of appropriate PPE and ensure nursing homes are priority in receiving adequate PPE 
  • Reimbursement for staff and resident testing
  • Bonus reimbursement per day for nursing homes that are COVID-negative
  • Engage larger community in prevention efforts
    • Actions and strategies may not be a one size fits all approach – decreasing COVID in nursing homes relates to what is happening in the community and adjacent communities of the facility.  If there is community surge, tighter restrictions, and tighter controls.  Nursing homes must be aware of and part of their local community strategic mitigation plan. 
  • CMS to include QIOs early on in directives and provide education as needed so that QIOs can assist nursing homes from the onset of new directives 
    • QIOs could be utilized in the planning and implementation stages for new directives to help achieve a smoother and more efficient, less frustrating time for nursing homes. 
  • Develop statewide strike teams to assist, assess and provide education
  • Provide funding and training to increase the number of certified infection prevention professionals

Long-Term Strategies/Actions

  • Resources and mandates:      
    • Private rooms and bathrooms
    • Updated ventilation systems
    • Necessary structural upgrades
  • Place nursing home residents and staff as a priority to receive the COVID-19 vaccination when available

Nursing homes today have residents with much higher needs than they did 30-40 years ago when many nursing homes were originally built and are not equipped or set up to take care of these needs.  

The purpose of the National Coronavirus Commission for Safety and Quality in Nursing Homes was to convene experts to address safety and quality issues facing the nation’s nursing homes during this pandemic, and to put forth recommendations and best practices on infection prevention, safety procedures and quality of life for residents in nursing homes. Due to the fact that the nursing home population has been disproportionately affected by coronavirus with a death rate greater than 40% according to multiple sources, the urgency was noted, and the National Coronavirus Commission was developed.

As one can imagine, there was a plethora of recommendations the group put forward.  What finally emerged were 27 recommendations and associated action steps that nursing homes, leadership, staff, residents, and others can take to help mitigate the spread. These recommendations were organized into 10 themes:

  1. Testing and Screening
  2. Equipment and PPE
  3. Cohorting
  4. Visitation
  5. Communication
  6. Workforce Ecosystem: Stopgaps for Resident Safety
  7. Workforce System: Strategic Reinforcement
  8. Technical Assistance and Quality Improvement
  9. Facilities
  10. Nursing Home Data

There were two recommendations that made the final list from SDFMC lead Lori Hintz, including the strike teams and the physical environment. Both are respectively located under 8A and 9A-C in the report.  

Commission members were given the option to approve or object to each of the ten recommendations. The biggest objection that Mark had was related to the requirement that all nursing homes across the nation have an infection control staff member. He said this was virtually impossible for nursing homes in South Dakota. In doing his homework, Mark was informed that there are only 20 certified infection control individuals in the state of South Dakota, and with a total 103 nursing homes it would be impossible to meet this requirement. His thought process on objecting to this recommendation was not to paint nursing homes into a corner and to hold them accountable for something that may not be possible for them to achieve. 

Part of the long-term goals discussed the infrastructure of many nursing home buildings that were constructed well over 30-40 years ago and are not capable of meeting today’s infection control standards.  With superbugs such as MRSA and CRE, communal living is not ideal in today’s world.

To view the full independent Coronavirus Commission for Safety and Quality in Nursing Homes report, visit here:  cms.gov/files/document/covid-final-nh-commission-report.pdf

To view the Trump Administration Response to Commission findings, visit here: cms.gov/files/document/covid-independent-nursing-home-covid-19-federal-response.pdf