The Coronavirus Outbreak at the Heartland Health Facility in Hanahan, South Carolina Illustrates the Dangers of Nursing Homes and the Coronavirus

A nursing home in South Carolina’s Lowcountry, Heartland Health and Rehabilitation Care Center on Eagle Landing Boulevard in Hanahan, reportedly now has more coronavirus cases than any other nursing home in South Carolina. The South Carolina Department of Health and Environmental Control reported 57 cases at the Heartland facility as of April 21. The next highest number of cases in a nursing home was 29 cases at a facility in Columbia.

Coronavirus outbreaks at nursing homes are especially troubling given that the elderly are particularly susceptible to the disease. DHEC refers to the elderly as the “most vulnerable,” and new research finds that the coronavirus is lethal for 13% of those infected in their 80s whereas COVID-19 is lethal for only 1% of those infected in their 50s and only 0.3% of those infected in their 40s. The elderly generally have weaker immune systems and more health problems than younger people, both of which make them more susceptible to death or serious complications from the virus. A CDC report on the COVID-19 outbreak in a Kirkland, Washington nursing home finds that:

• “Outbreaks of COVID-19 in long term-care facilities can have a critical impact on vulnerable older adults.”
• “Once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors.”
• “It is critical that long-term care facilities implement active measures to prevent introduction of COVID-19.”

Sadly, the coronavirus outbreaks at nursing homes may have been preventable or significantly reduced had nursing homes been following proper protocols and using necessary equipment. Reports from around the United States (see here, here, here, and here) indicate that many nursing homes were not following the required infection control procedures and did not have necessary protective equipment, and that there may be a link between those facilities and the ones with the largest coronavirus outbreaks. For years, nursing homes subjecting their residents and employees to serious infection risks have been cited by state regulators but have not been fined a single dollar. Ben Elgin and Peter Waldman, investigative reporters for Bloomberg, repeat a common concern that this “pattern of light regulation has put nursing home residents at extra risk of contracting the Covid-19 virus.”

Information on the quality of nursing homes, inspection reports, and citations for failing to properly protect patient health are available from Medicare.gov and the South Carolina Department of Health and Environmental Control. The Heartland facility in Hanahan was cited for several deficiencies in a 2018 inspection of the facility including not providing sufficient nursing staff on the majority of days, a nurse’s failure to wear gloves when performing a test exposing her to bodily fluids, incomplete vaccinations,

What are the Centers for Medicaid and Medicare Services (CMS) and Centers for Disease Control and Prevention (CDC) guidelines in relation to COVID-19 in nursing homes?

The CMS and CDC issued guidance for long-term care facilities (also known as nursing homes) for reducing the spread of the coronavirus. The first guidelines is that nursing homes immediately ensure they are complying with infection control procedures, the same procedures referred to previously that many nursing homes have been cited for violating. The remaining guidelines include:

• Every resident should be daily assessed for coronavirus symptoms.
• Full personal protective equipment (PPE) should be worn by any healthcare worker interacting with any person with a known or suspect coronavirus infection.
• If COVID-19 is present in a nursing home, all workers should wear full protective equipment for the care of all residents, regardless of whether a particular resident has been diagnosed with the coronavirus or shows any symptoms.
• Workers treating nursing home residents infected with COVID-19 should not also treat non-infected residents, and workers treating non-infected residents should not also treat infected residents.

The Center for Medicaid and Medicare Services (CMS) is a federal government agency that implements Medicare and Medicaid and sets standards for nursing homes. The Centers for Disease Control and Prevention (CDC) is a federal government agency that protects public health through controlling and preventing diseases.

What are the Center for Medicaid and Medicare Services’ infection control procedures required for nursing homes?

The CMS requires every nursing home to have an “infection prevention and control program” in place and has a lengthy list of infection control steps required by federal regulations. Among the infection control procedures that nursing homes are required to follow:

• Must have a system for identifying infectious diseases in the facility before they can spread to other residents;
• Must have a procedure for when and to who disease infections must be reported;
• Provide for isolation of infected residents;
• Hand washing (“hand hygiene”) protocols for nursing home staff;
• Must have a designated employee responsible for carrying out the infection control program and who has completed special training in disease prevention and control; and
• Vaccinations are offered to residents.

Nursing homes are also required to have a sufficient number of nurses and nurse aides working in the facility.

What should nursing homes do to protect residents and employees from the coronavirus?

Nursing homes should have been following proper infection control procedures since before anyone had even heard of COVID-19. Following those procedures is the minimum nursing homes should be doing to prevent the spread of infectious diseases. Now that the coronavirus is present in South Carolina, nursing homes should also be following the CMS and CDC coronavirus guidelines for nursing homes. Nursing homes that do not follow those procedures are needlessly and recklessly endangering the health and lives of their residents and employees.