By Thomas Howard and Steven Vanderlinden

The first severe outbreak of Covid-19 coronavirus in the U.S. – resulting in at least 13 deaths to date – occurred at a nursing home: The Life Care Center of Kirkland, Washington. New Jersey is nearly 3,000 miles away, but the east coast is sure to be next. As Dr. David Dosa, geriatrician and professor of medicine at Brown University told the New York Times, “We have to prepare for the inevitability that there are going to be facilities like the one in Washington where you’re going to have the virus, and have it move rapidly through nursing homes and assisted living facilities.”

Why are more nursing home outbreaks considered inevitable? The problem is two-fold:

  1. The elderly and infirm are especially susceptible to the coronavirus.  According to reports from Kirkland, residents went from having no symptoms to life-threatening illness in a matter of hours. And while it has been compared to the flu, World Health Organization statistics show that Covid-19 is far deadlier. The death rate for the flu is 0.83% for people 65 and older; Covid-19 has a 3.6% death rate for people in their 60s, 8% death rate for those in their 70s, and a 14.8% death rate for those 80 and older.
  2. 2. Even before Covid-19, nursing homes were not doing a good job preventing infections. Nursing homes have struggled to cope with existing and better-understood pathogens: Consider the bacterium known as Clostridioides difficile, or C. diff., which according to a 2011 CDC-funded study was responsible for over 450,000 infections and 29,000 deaths. One-quarter of those cases were contracted in nursing homes, where infection control continues to be an issue. A recent Kaiser Health News analysis of federal records found that 9,372 nursing homes – 61% of facilities surveyed – had been cited one or more times for not following basic infection prevention protocols.

Unfortunately, we can’t rely on government regulators to solve the issue. In 2016, the Obama administration set out new rules calling for long-term care facilities (LTCFs) to develop more comprehensive infection control and prevention plans, which included keeping infection prevention specialists on staff. But the current administration has relaxed enforcement: An NBC News investigation documented a 34 percent reduction in nursing home fines and penalties from 2017 to 2018, and the Trump administration has proposed eliminating the “excessively burdensome” staffing mandate for infection prevention specialists.

In an effort to protect those who are “at the greatest risk of serious illness”, the Centers for Medicare and Medicaid Services (CMS) issued clear “actionable guidance”, specific to nursing homes, on the screening and treatment procedures necessary to help prevent the spread of the virus. The newly issued CMS guidance states that facilities should actively screen and restrict visitation by individuals meeting specific criteria, increase visible signage, offer temperature checks, and increase the availability of hand sanitizer, among other recommendations.

So, what can you do to help protect a loved one in a nursing home or other LTCF? Avoid going to visit if you have any sickness symptoms, especially fever, coughing or sore throat. Just as important: Ask key questions to ensure the facility is doing all it can prevent the introduction and spread of Covid-19:

  • What is the facility doing to minimize the risk of infection – and specifically to address the risks of the Covid-19 coronavirus? Do they have a written policy and action plan that you can review?
  • What is the handwashing protocol?
  • Does the facility have a  responsive procedure upon finding a communicable infection?
  • Have the staff been educated about the risks of Covid-19?
  • Are the procedures and protocols being monitored and enforced?
  • Does the facility have a leave policy for staff who show symptoms or may have been exposed – and what is the plan to replace them?
  • Does the facility monitor and restrict visitors to prevent bringing infections into the facility? Are they following CMS issued guidelines directing nursing homes to screen visitors?
  • If you cannot enter the facility, are there other ways that you can connect with a loved one?

Remember to follow up with the nursing home in writing to confirm the answers you receive. 

A final note of caution: Don’t rely on the star rating system from the Centers for Medicare and Medicaid Services (CMS) for assurance that your facility is complying with infection control standards. The Kaiser Health News analysis found that 53% of five-star facilities received violations in the last three years. One of those 5-star facilities was the Life Care Center of Kirkland.

For more information read our article on the three steps you should take to protect Nursing Home Patients during the pandemic.

Thomas Howard is a founding partner at Howard Law, LLP, where Steven Vanderlinden is a senior litigation associate.  TheHackensack, NJ based legal firm concentrates on nursing home neglect, medical malpractice, estate and probate, and business litigation. They suggest that everyone with a loved one in a long term care facility find out what preventative steps are being taken to protect those at risk during these challenging times.


Centers for Disease Control   Clostridioides difficile (C. diff)

CMS 2019 Guidance for Infection Control and Prevention of Coronavirus Disease

CMS Clear and Actionable Guidance for Providers about Covid 19 Virus

CNN Even without coronavirus, many highly rated nursing homes have infection-control lapses

Kaiser Health News  Coronavirus Stress Test: Many 5-Star Nursing Homes Have Infection-Control Lapses

McKnight’s Long Term Care News C. difficile infection in long-term care facilities: A diagnostic challenge

National Geographic These underlying conditions make coronavirus more severe, and they’re surprisingly common

The New York Times  Nursing Homes Are Starkly Vulnerable to Coronavirus

CDC Infection Control guidelines