The Centers for Medicare and Medicaid Services (CMS) are tasked with keeping an eye on health care providers, including nursing homes, for situations that can lead to serious infections. But what you may not know is that the CMS has cracked down on hospitals for high rates of common infections, but has not put similar pressure on nursing homes. Perhaps as a result, 74 percent of nursing homes in the U.S. have been cited for infection-control violations.
Some of the citations mean that lapses leading to severe infections can cause untold misery, re-admittance to a hospital, and even death. Repeat citations occur frequently, with fines and other disciplinary actions rare. Often, low-level citations are handed out when a more stringent citation would be called for. As Michael Connors of California Advocates for Nursing Home Reform, a San Francisco nonprofit, noted, “The facilities are getting the message that they don’t have to do anything. [CMS inspectors are] giving them low-level warnings year after year after year and the facilities have learned to ignore them.”
It’s a medical fact that common infections in nursing homes are largely avoidable. Such infections are responsible for one-fourth of the medical injuries that happen to Medicare residents of nursing homes.
A generation ago, the average hospital stay was 7.3 days (1980). In 2012, stays had shortened to 4.5 days. Extra time in the hospital decades ago meant that patients could more fully recuperate before going home. These days, patients are released to nursing homes and rehabilitation facilities to finish recuperating. The patients sometimes have surgical wounds that have not closed, or they are in weaker condition and thus more susceptible to infections. They often require ventilators and other medical equipment such as urinary catheters that can create healthcare-acquired infections (HAIs).
Some of the many citations by the CMS arose from situations like the following ones:
- In Sylmar, California, one nursing home resident suffered from a nasty case of Clostridium difficile (often called C-diff) that sickened her for months. The son of the sick woman commented that “workers were coming in and out [of her room] without washing their hands.” C-diff is extremely contagious.
- At the same California facility, an aide did not wash her hands after bringing a meal to a contagious resident; another resident suffered from an unsanitary intravenous line left in longer than was advisable.
- A nurse at a Decatur, Texas, facility picked up medication that fell on the floor, without washing her hands afterward; another nurse was observed cleaning a syringe insufficiently.
- A different nurse at the same Texas facility allowed a contagious resident with the flu to leave quarantine conditions too early, resulting in another resident catching the flu and dying.
- In Albuquerque, New Mexico, aides and nurses cleaned the residents’ genitals using unsanitary methods, with the result that 25 residents developed urinary tract infections (UTIs) from their catheterization. UTIs are a primary cause of sepsis.
Staff are also often strongly discouraged from calling in sick. When sick staff attend nursing home residents, those with weakened immune systems end up exposed to illnesses that, while mild for a healthier person, could cause severe illness in a frail and ill elderly person.
Combine all of these factors with lax oversight from the CMS, and it’s a wonder that more nursing home residents are not dying from infections.
The Top Five Common Infections In Nursing Homes
Are you ready to learn about the most common infections that plague nursing home residents? Each of these five infections has their own unique and dubious distinction:
- Urinary Tract Infections (UTIs): UTIs are the most reported infection in nursing homes. While many of these infections are CAUTIs, or catheter-associated urinary tract infections, nursing home residents without catheters also suffer from UTIs at a higher rate than the general population in hospitals. This is partially due to normal aging changes. But the worst thing about UTIs in the elderly is that fully half of the blood infections they can develop—also known as sepsis—are related to a urinary tract infection. Sepsis develops when the body is overwhelmed by infection, creating an exaggerated immune system response that can quickly turn fatal. Each year, sepsis kills over a quarter-million persons.
- Pneumonia: Pneumonia caused by Streptococcus pneumoniae is the most deadly infection in nursing homes. Approximately 1.4 out of 1,000 persons in the U.S. as a whole will catch an infection of the lower respiratory tract or pneumonia, but 33 out of 1,000 nursing home residents will become infected with pneumonia. Nursing home residents who have feeding tubes are the most susceptible to the disease. Elderly patients often do not show the same symptoms as younger persons, so diagnosis can be delayed until it is too late.
- Clostridium difficile infections (CDIs): CDIs are the fastest-growing type of infection in nursing homes. C-diff cases have doubled in their prevalence since 2000 and cause a much larger proportion of deaths than would normally be expected. The nursing home resident in Sylmar, California, mentioned above, though extremely sick for months, was one of the lucky ones who survived. C-diff often arises because the patient has gone through a round of antibiotics which kills the good bacteria in the gut, leaving the door wide open for the extremely antibiotic-resistant C-diff to take over.
- Flu is the most preventable infection in nursing homes and is still a leading cause of death among residents. Persons over 65 account for 90 percent of the annual deaths that can be traced to influenza. The close proximity of residents makes it easy for the flu to be transmitted. Studies have shown that the incidence of flu goes down when both residents and staff receive flu shots.
- Methicillin-resistant Staphylococcus aureus(MRSA) and Group A Streptococcus (GAS). Both GAS and MRSA are the infections most closely associated with environmental factors in nursing homes. These two microbes are implicated in infections resulting from pressure ulcers (bed sores) and can lead to sepsis. Among nursing home populations, 58 percent of residents carry MRSA, and both MRSA and GAS can live on dry objects for more than six months. It’s critical that nursing homes minimize contamination among weakened and infected patients by practicing basic hygiene such as washing hands between patients and isolating contagious persons. MRSA, as its name implies, is especially problematic because of its resistance to most antibiotics.
Negligence Can Be the Reason
All of these infections, under certain conditions, can be traced back to negligent care on the part of the nursing home and its staff. When serious injury or death occurs as a result of an infection, a legal case can sometimes be brought. Determining negligence in nursing home cases can mean many hours spent interviewing doctors and expert witnesses and reviewing all medical records in depth. You are best served by securing an experienced and compassionate attorney to help you sort things out if your loved one has suffered or died from a nursing home infection.
Listening Hard and Working Harder for Seniors
When someone you love has been hurt, it can feel like nothing will ever be right or fair again. When this happens, the nursing home injury lawyers at the Louthian Law Firm can review your legal options and work with you to determine the most appropriate next step.
Many South Carolina assisted living facilities and nursing homes are part of a larger chain, complete with their own legal department. The nursing home’s lawyers may try to dispute abuse and negligence claims, but we have successfully represented nursing home victims. We understand how to deal with negligent facilities and the nursing home attorneys who represent them. While a lawsuit cannot restore someone’s health, a claim can help recover the large sums spent on a negligent or abusive nursing home, as well as the medical bills created by that abuse or negligence. You may also be able to hold them accountable for the pain and suffering they caused.