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Oregon's failure to inspect and penalize nursing homes and other long-term care facilities that aren't stopping the spread of COVID-19 has probably resulted in the deaths of seniors and could lead to more, a state auditor's report says.
"Outbreaks continue, with memory care communities carrying the greatest burden for the disease," says the advisory report, released by Oregon Secretary of State Shemia Fagan this morning. "Long-term care staff are bringing the virus into facilities, but the state has limited oversight on whether staff have been trained on, and are complying with, infection control protocols. Also, response priorities have reduced oversight of facilities. Recertification and licensing inspections of facilities, which ensure further safeguards for residents, have stopped."
The report identifies alarming gaps in regulation that left Oregon's nursing home residents vulnerable to the COVID-19 virus—both because the law doesn't set strict rules for controlling infections and because the Oregon Department of Human Services hesitated when it saw disasters unfolding.
Among more than a dozen findings in the report, two stand out and are linked: First, DHS stopped conducting its most rigorous inspections of long-term care facilities as the pandemic hit, because its staff was stretched thin responding to outbreaks. Second, state regulators have been reluctant to penalize nursing homes and other long-term care facilities that aren't protecting residents, even when inspectors identify dangers.
The report points to DHS ceasing its recertification and licensing inspections of long-term care facilities starting last March as the pandemic descended. Those inspections, which are supposed to be conducted every two years, are the most rigorous and lengthy inquiries DHS performs of how the facilities operate.
"Oregon was already behind on these surveys before the pandemic," the report says. "As a result, by November 1, 2020, Oregon had the second-highest percentage, at 53.5%, of nursing homes without state recertification surveys completed over the last 18 months. The national average was 21.5%, with Washington and California at roughly 20%."
In a joint response with the Oregon Health Authority to the report, DHS director Fariborz Pakseresht says his agency has resumed recertification inspections, at least in part.
The report says that not only did DHS lessen its inspections during the pandemic, but also that—when it did spot safety failures—it was slow to act. The agency issued infection control deficiency notices in 6% of its visits to nursing homes, below the national average of 9%. More than a quarter of the 75 notices were issued only after a COVID-19 outbreak.
That may have led to more COVID-19 deaths at the Southeast Portland nursing home that became an early hot spot in the pandemic and still has the most deaths in the state: Healthcare at Foster Creek. DHS revoked the home's license on May 5.
"However, the May 5 order came nearly three weeks after the facility was cited for immediate jeopardy because of its substandard infection control practices," the report says. "The delay is an indication of the lack of advance preparation for the pandemic and a hesitancy to take proactive actions in a crucial case."
The report, which was conducted more swiftly and with less rigor than a traditional audit, acknowledges that Oregon has performed better than many U.S. states in protecting residents from the pandemic. But it warns that a lax regulatory system still leaves many nursing home residents at risk—especially in memory care facilities, which care for people with dementia and Alzheimer's disease.
The rate of COVID-19 deaths in memory care homes is more than double that of other facilities.
"A common characteristic of people with dementia is their tendency to wander…making isolation of infected residents a challenge," the report says. "It is also difficult for these residents to understand why they need to wear masks."
But in the same paragraph, auditors note: "Limited regulation may contribute to higher case and death rates" in memory care homes.
The report recommends that the state more aggressively inspect facilities that struggle to limit the spread of infections, and start fining them to make them comply with the law.
In his response, Pakseresht says state regulators issued $500,000 in penalties for infection-control violations over the past year.
"ODHS and OHA use appropriate escalation of regulatory tools when needed," his response says, "but our first approach is to educate, collaborate and focus on continuous improvement, prevention and learning."