Report: Experts from Connecticut nursing homes -- where more than 3,000 died -- were “somewhat neglected” as state focused on hospitals in early days of the coronavirus pandemic

Connecticut officials were so focused on the potential impact of COVID-19 on hospitals that they neglected suggestions and guidance from the nursing home industry in the early stages of the coronavirus pandemic, a new report released Thursday says.

The report, prepared at the request of the state, analyzed Connecticut’s response as COVID-19 devastated nursing homes from March through June. More than 3,000 nursing home residents -- about 70 percent of the state’s total death total from coronavirus -- were claimed by the deadly virus.

"The earliest response to COVID-19 in Connecticut did not include these perspectives (referring to long-term care providers) and, as a result, those settings were somewhat neglected due to the focus on hospitals,” the report from a private consulting company, Mathematica, concluded.

The 157-page final report from the New Jersey consulting firm makes several short-term and long-term recommendations -- including many it says the state should implement to prepare for an anticipated second wave of the virus. The report acknowledges that some of their recommendations have already been adopted.

It also reached several conclusions about which facilities had the most deaths, and what were the critical factors in allowing it to spread.

The report’s recommendations include:

Requiring a full-time infection prevention expert in nursing homes and increasing minimum required staffing levels.

Make sure all nursing home staff have access to appropriate PPE and have guaranteed paid sick leave.

Developing a framework to guide visitor policies on the facility or community level, rather than one standard for the entire state.

The report also reached several conclusions about why some facilities had higher death and infection rates than others. One key factor, the report found, was staffing levels -- nursing homes with high staffing ratings had significantly fewer cases and deaths per licensed bed.

Homes with large numbers of patient leaving the facility for cancer or dialysis treatment were also at higher risk. Also, nursing homes situated in towns that had more cases experienced more cases and deaths.

The report also said the state needs to focus better on insuring that residents are getting visitation privileges from their loved ones and that a one-sized fits all policy isn’t necessarily the best way to do that.

“The prevalence of symptoms of depression increased by 15 percent and rates of unplanned weight loss nearly doubled right after the peak of the COVID-19 outbreak,” the report said. “These outcomes suggest measuring COVID-19 cases and deaths alone does not capture the full impact of the pandemic on residents' well-being.”

Mathematica officials conducted 52 interviews from state officials to nursing home providers to employees and families who had loved ones in long-term care facilities. They issued an interim report in mid-August that concluded the state’s “existing emergency response and surveillance systems were insufficient for the COVID-19 outbreak.”

Connecticut, with the highest death rate in the Northeast in its long-term care facilities, hired the company to asses its response to the pandemic. The state paid them $450,000 for the report.

Nearly three-quarters of deaths due to COVID-19 have been in long-term care facilities, which includes both nursing homes and assisted living facilities. There have been 3,259 deaths as of last Thursday in long-term care facilities in Connecticut which accounts for more than 70 percent of the state’s deaths.

Lamont ordered the review so that the state could prepare for a possible second wave of the virus and to see what went wrong that led to so many deaths.

The situation in nursing homes vastly improved once the state started a testing regiment that led to every nursing home resident getting multiple COVID tests. The increased testing, which started in late May, allowed facilities to identify asymptomatic carriers of the virus and isolate to keep the virus from spreading.

The state later also implemented a testing program for all employees of long-term care facilities. The massive testing initiative slowed the deaths in long-term care facilities down considerably to only a few a week compared to weeks in April and May where 50 or more long-term care residents were dying.

But even still there have been outbreaks.

This week DPH investigators are dealing with an outbreak at the Harrington Court nursing home in Colchester where 40 people, including 32 residents, have tested positive for the virus. Last month more than three dozen people were infected, and at least three died, during an outbreak at the Three Rivers Healthcare Center in Norwich.

The review also found that for-profit nursing homes fared far worse than non-profit ones with 60% of the COVID cases and deaths occurring in for-profit institutions. Larger national chains also fared worse than independently owned facilities -- large chains had 40% more deaths.

The report also pointed out how providers weren’t prepared for the pandemic.

Before the outbreak, 68% of Connecticut nursing homes had been cited for an infection-control deficiency at least once in the previous three years of inspections. the report said.

There also were concerns about staffing, particularly once the pandemic spread in April when at one point 50 people a day were dying in long-term care facilities.

Providers said the increased staff absences were the result of difficulties related to child care, pre-existing conditions that placed staff members at greater risk of coming to work, and fear of catching the virus or bringing it home to their families. They also faced competition for staff with other nursing homes and New York City, where hospitals and other settings were offering very competitive financial incentives.

The report said two initiatives by DPH helped offset the staff shortages -- waiving the licensing requirements for out-of-state nurses to come work here temporarily and starting a nurse’s aid program designed to quickly get people trained and working.

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