You’ve likely heard the tragic story of the LifeCare Center nursing home in Kirkland, Washington, an early epicenter of the COVID-19 outbreak in that state. At least 35 residents and staff from that long-term care community died after contracting the virus.
What went wrong
Senior living communities are generally prepared to confront contagious illnesses such as the flu, gastrointestinal viruses, and even COVID-19. They maintain well-established protocols designed to protect residents and limit the spread of infection, and these measures are intensified when an outbreak is suspected nearby.
Given those safeguards, the scale of the outbreak at the Kirkland facility raised concerns. LifeCare Center held the highest rating from the Centers for Medicare and Medicaid Services (CMS), so how did the virus spread so rapidly? CMS published initial findings that shed light on the situation. Inspectors identified three “Immediate Jeopardy” conditions—situations that pose an imminent danger to patients. Their March 23 report concluded that, in the early stages of the outbreak, LifeCare failed to:
- Rapidly identify and manage ill residents
- Notify the Washington Department of Health about the rising rate of respiratory illness among residents
- Maintain an adequate backup plan when the facility’s primary clinician became ill
Those lapses are troubling, but it’s important to recognize that SARS-CoV-2 behaves differently than many other pathogens. This virus can be transmitted before symptoms appear, and people may remain asymptomatic yet infectious for up to two weeks. That makes early detection and containment especially difficult.
While LifeCare could have implemented stronger early detection and contingency measures, the unique transmission characteristics of COVID-19 created challenges that few facilities had encountered before.
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The value of a CMS rating
On medicare.gov’s Nursing Home Compare, CMS publishes an easy-to-understand five-star rating based on periodic inspections and reported performance for skilled nursing facilities. The rating reflects health inspections, staffing levels, and quality measures.
When evaluating continuing care retirement communities (CCRCs or life plan communities), note that CMS ratings apply only to skilled nursing facilities within a community, not necessarily to all services the CCRC provides. CMS ratings are also limited to providers that participate in Medicare and/or Medicaid—private pay facilities may not have a CMS rating.
A CMS rating is a useful indicator of how well a skilled nursing provider meets regulatory and industry standards: a five-star facility generally demonstrates higher compliance than a one-star facility. However, the Kirkland tragedy shows that even highly rated facilities can experience lapses that result in serious consequences.
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Following protocol
When standard infection-control protocols are followed and staffing is appropriate, nursing facilities are typically safe environments. Common practices used to protect residents include:
- Early detection of an outbreak (often defined as two or more related cases)
- Timely reporting to local public health authorities
- Isolating affected residents and conducting contact tracing
- Thorough and repeated deep-cleaning of facility spaces
- Reducing and controlling entry points
- Screening visitors and vendors and maintaining visitor logs
- Limiting or temporarily suspending visitation during active outbreaks
- Clear signage and reminders about infection-control measures
The initial CMS report indicated breakdowns at LifeCare around detection, reporting, and contingency planning—areas that are critical when a highly transmissible disease emerges.
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What’s next
According to data shared between the CDC and CMS, as of last week 147 nursing homes in 27 states had reported at least one resident with COVID-19. Although this represents a small portion of the nation’s roughly 15,000 nursing homes, each affected facility is cause for serious concern because older adults and people with chronic conditions are at higher risk of severe illness and death.
In response to the pandemic, CMS has revised certain approaches and intensified oversight with the goal of improving safety in nursing homes. CMS and the CDC are closely monitoring facilities with active COVID-19 cases and using reported data to prioritize targeted infection-control inspections in areas where the virus is spreading.
Federal efforts to strengthen monitoring and guidance are essential, but they cannot replace the responsibility of each senior living community to consistently follow protocols, maintain adequate staffing, and place resident safety first. Without that local commitment to best practices, broader initiatives will have limited impact on preventing future outbreaks.