Jackson County nursing home has history of infection control violations
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CHARLESTON -- A Jackson County nursing home at the center of an outbreak of the coronavirus has a history of being cited for lack of infectious disease control policies.
Eldercare Health and Rehabilitation, a 120-bed nursing home in Ripley, had 59 residents who have tested positive for COVID-19, a respiratory virus that causes fever, cough and shortness of breath. As of Sunday evening, there are now 100 coronavirus cases in Jackson County, according to the Department of Health and Human Resources.
The facility has 84 patients and 63 staff members who have all been tested. Of the staff tested last week, three have tested positive, though test results for additional staff members were still pending as of Sunday night. DHHR reported Saturday night the deaths of two nursing home residents in Jackson County: an 83-year-old man and an 88-year-old woman. In a statement Sunday, Eldercare confirmed that the two deaths were residents of their facility.
"We are continually working with the Jackson County Health Department and West Virginia Department of Health and Human Resources Cabinet Secretary Bill Crouch," according to a statement released by Eldercare Sunday. "We will follow Secretary Crouch's guidelines and recommendation as we continue through this process."
According to an inspection report by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) dated Aug. 21, 2019, Eldercare was cited 17 times for health violations -- five more violations than the average number of citations for West Virginia nursing homes and 8.8 more than the U.S. average.
In the 2019 health inspection report, Eldercare was specifically cited for its lack of any infection prevention and control program. The facility failed to notify the Jackson County Health Department about an outbreak of an illness causing respiratory symptoms, and laundry staff were cited for not properly handling patients' laundry.
"Based on observation and staff interview, the facility failed to establish and maintain an effective infection control policy," the report stated. "This deficient practice has the potential to affect all residents residing in the facility."
According to the report, an unknown respiratory illness resembling the flu was discovered through infection control tracking on Aug. 12 and observed between Aug. 19 and Aug. 21. Eldercare was required to report the outbreak to the local health department. The report was only made after the surveyor asked the director and assistant director of nursing at Eldercare whether the outbreak had been reported.
"During this interview it was determined the facility had not notified the local health department until after our entrance on 08/19/19," the report stated.
According to the report, Eldercare submitted a plan of correction for the citation on Oct. 1, 2019. But it's not the first time the Ripley facility has been cited for issues involving infectious diseases. In a health inspection report dated July 19, 2017, Eldercare was cited for failing "to ensure an effective infection control program designed to prevent the development and/or transmission of disease and infection to the extent possible."
The facility was cited when surveyors observed a nurse sticking her ungloved fingers in an over-the-counter aspirin bottle and putting the pills in a cup. The same nurse was also observed pouring medication into her bare hand and into a cup. Gloves are required when dispensing medication. After being confronted in an interview, the nurse threw away the medications.
Vanguard Healthcare Services, the parent company of Eldercare, settled a federal False Claims Act lawsuit brought by the Department of Justice and State of Tennessee in 2019. Vanguard agreed to pay $18 million after billing CMS for "grossly substandard nursing home services." A request for comment by Vanguard was not returned.
"Seniors rely on the Medicare and Medicaid programs to provide them with quality care and to ensure that they are treated with dignity and respect," said Jody Hunt, assistant attorney general of the Department of Justice's Civil Division. "The Department will not tolerate nursing home operators that put their own economic gain ahead of the needs of their residents, and will continue to aggressively pursue those operators who bill Medicare and Medicaid for substandard nursing services."
It was the outbreak of the coronavirus at Eldercare that was the catalyst for Gov. Jim Justice issuing an executive order calling for all residents and staff of the state's 123 nursing homes to be tested for the coronavirus, as well as re-testing nursing homes that have already been tested. Justice also ordered DHHR and the West Virginia National Guard to post positive test results for nursing home residents and staff as part of the DHHR coronavirus dashboard.
"I was not very happy," Justice said. "The primary reason I was not very happy all centered around one nursing home ... in Jackson County. Just to tell it like it is ... if my people find anything that has been done wrong, believe that we'll absolutely react, and we'll react in an extremely strong way. We're still investigating that situation, but the entire situation with our nursing homes is not as good as it needs to be."
Todd Kimble, the administrator for Eldercare, said in an email Sunday that the 2019 citation was quickly remedied. He pointed to two statements released over the weekend detailing how Eldercare was handling the outbreak. Kimble said the source of the outbreak was a staff member who tested positive on April 6 and that the county and state were both notified.
"As additional positive cases were identified, each time the appropriate State and County agencies were notified," Kimble said. "Neither entity was giving an order to test every patient or the staff. Patients testing positive were quarantined within the facility as per CDC guidelines and staff testing positive were quarantined to home and monitored daily by the Health Department. Eldercare has not let any employee work if they were ill or pending test results."
Kimble said that Eldercare staff tested their residents on their own April 14 -- nine days after the first staff member tested positive -- and tested the staff April 16. Those samples were picked up by the National Guard and delivered to a commercial lab for testing. Kimble said that Eldercare properly handled the situation.
"Numbers were not hidden," Kimble said. "In fact, the Jackson County Health Department has reported numbers daily to the State Bureau for Public Health and they have been included in the daily counts posted on Facebook. They were not however identified specifically as Eldercare patients/staff. We have never released information on any facility or the number of cases within. The facility can choose to do so; however, the focus of Eldercare was on patient care and their responsibility to keep in touch with patient's medical powers of attorney."
Nursing homes have been the location of several coronavirus outbreaks in the state recently. The New York Times reported Friday that more than 7,000 coronavirus-related deaths in the U.S. were attributed to nursing home residents -- one-fifth of all U.S. deaths -- with more than 36,000 residents and staff being infected nationwide.
The Wayne Nursing and Rehabilitation Center south of Cabell County had 72 residents and staff test positive for COVID-19. Riverside Health and Rehabilitation Center in St. Albans reported 16 positive cases last week. The Sundale Rehabilitation and Long-Term Care in Morgantown had 29 cases in March.
All three nursing homes had fewer health citations than Eldercare and had above average ratings on the CMS Nursing Home Compare website. However, both Sundale and Riverside were both cited in 2019 for failing to provide and implement an infection prevention and control program.
Steven Allen Adams can be reached at sadams@newsandsentinel.com.