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Maine health officials regularly inspect nursing homes to determine how well they’re following federal rules meant to prevent infections from spreading through their facilities.
But as the coronavirus has spread through at least four Maine facilities over the past week, the novel respiratory infection at the root of a global pandemic hasn’t appeared to discriminate between places that score high on federal quality measures and those with below-average scores.
Three of the facilities that have seen outbreaks of the infection have received above-average scores for the quality of their care. A 72-bed nursing and rehab center in Augusta has received the highest possible score for its quality, yet 69 cases of the respiratory virus have swept through the facility, infecting a majority of residents and killing two.
The other two well-rated facilities with outbreaks are a 125-bed veterans home in Scarborough — which had 38 cases and two deaths as of Wednesday — and the Cedars retirement community in Portland, which had five cases. (As of Wednesday afternoon, the outbreak at the Cedars had been detected in its assisted living facility, but not in its nursing facility, according to spokesperson Katharine Oneill.)
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Only the fourth facility with a confirmed outbreak, Tall Pines Retirement and Healthcare Community in Belfast, has received below-average quality scores from the federal Medicare program. That facility, which has 64 residents, now has recorded 25 positive coronavirus cases, including two deaths.
The indiscriminate spread of the virus points to how difficult it has been for long-term care facilities to quickly adapt to its contagiousness and behavior — factors that even disease experts are still struggling to understand.
COVID-19, the disease caused by the new virus, “can be transmitted extremely quickly,” Nirav Shah, director of the Maine Center for Disease Control and Prevention, said earlier this week.
“What we’ve seen across the country is that facilities of all different types can and have experienced COVID-19 outbreaks,” he continued. “We haven’t learned anything in particular about any of these facilities that has suggested, based on the COVID-19 outbreak only, that a different course of action should have been pursued.”
The operators of the facilities that have seen outbreaks have all said that they carefully followed guidelines from the Maine CDC about restricting visitors and screening staff as the pandemic reached the state. Some of them have also expressed concern about the limited availability of protective gear for their workers.
State officials have expressed particular concern about the coronavirus reaching long-term care facilities because their elderly residents are more vulnerable to its damaging health effects and because it can quickly circulate among people in close confines. The Maine CDC has provided emergency shipments of protective equipment to all the facilities that have documented outbreaks, and it has also widely tested the people who lived and worked there for the virus.
That bump in testing partly explains the rapid increase in the total number of confirmed infections at those places over the last week. In total, 94 residents and 43 staff have so far tested positive for the virus in the four outbreaks, according to the Maine CDC. There have been a total of six deaths connected to the ones in Scarborough, Augusta and Belfast.
The lack of correlation between the past performance of long-term care facilities and their ability to keep out the coronavirus has also pointed to the limits of the federal system for evaluating nursing homes, according to Dr. Jabbar Fazeli, a leading Maine geriatrician who is a spokesman for the Maine Medical Directors Association, which represents the physicians and staff of long-term care facilities.
While those ratings offer some useful indicators about a facility’s efforts to prevent infection — such as what portion of residents have received vaccinations to prevent flu and pneumonia — they do not capture more intangible factors that can affect a facility’s preparedness for the current pandemic, according to Fazeli.
That includes the involvement of medical directors in their operations and how rigorously staff and residents have been screened for the mild symptoms of the disease. He noted that the early detection would be easier if testing for COVID-19 were more widely available in Maine.
“People can miss the first couple cases,” Fazeli said. “By time you have people with heavy symptoms, that piece right now determines whether a facility has one or two or 20 or 30 cases.”
In general, it can be hard for even the best-run nursing facilities to get through an inspection by state health officials without being docked for some minor deficiencies, according to Joel Rogers, the administrator of Market Square Health Care Center, a 76-bed nursing home in South Paris, which has received above-average scores for its quality.
While it’s important for facilities to fix any violation, Rogers said that anyone seeking to learn about the quality of a facility should read through the inspection reports on the Medicare website and evaluate whether they show a pattern of severe deficiencies.
Rogers said that he can’t see how the infection control measures that are evaluated in those reports have any bearing on a facility’s readiness to handle the spread of COVID-19, given how little is still known about the contagion.
While habits such as washing hands are clearly important, he said, it’s still unclear how contagious the virus is in some bodily fluids that employees must clean up, for example. For now, Rogers said that he is working to implement guidance provided by the Maine CDC and North Country Associates, the company that operates Market Square.
As someone who worked in a substance-use treatment facility during the AIDS epidemic, Rogers said that the current crisis has been staggering.
“At the time, I thought that would have been the defining moment of my work,” he said. “Now, I think that was a cakewalk compared to COVID-19.”
Watch: Should you remove loved ones from care facilities during the outbreak?