The Bloomington nursing home that has become McLean County’s largest COVID-19 outbreak—with six deaths and dozens infected—struggled to provide quality care and adequate staffing even before the virus hit, according to government inspections.
Bloomington Rehabilitation and Health Care Center earned 1 of 5 stars (“Much Below Average”) for its overall rating from Medicare, based on inspections and complaints. Drilling down, its Health Inspection and Quality Measures ratings were also “Much Below Average,” and its Staffing rating was “Below Average,” according to Medicare’s Nursing Home Compare website.
Bloomington Rehab faced 33 health citations stemming from its inspection Aug. 8, 2019. That’s about three times as many as the average for a facility in Illinois and the U.S. In February 2020, just a month before the coronavirus became a household name, inspectors found it was operating without a licensed administrator running the facility, according to government records. The former administrator had moved into a business office role. That was resolved by early March, records show.
Outbreaks have not hit only poorly rated facilities. The Villas East nursing home in Sherman, near Springfield, has seen 23 patients die after contracting COVID-19. Presence Merkle-Knipprath Countryside in Clifton in Iroquois County has lost three patients. Both earned 4-star “Above Average” ratings from the government.
“There’s a certain amount of luck involved with this,” said Dr. Ronald Hershow, associate professor of epidemiology and biostatistics at the University of Illinois at Chicago. “It’s just a matter of luck whether somebody who’s a staff member at a given facility happens to catch COVID-19. What that indicates is that occasionally you can have a pretty horrendous nursing home that just gets lucky and none of their staff happen to catch it. Conversely, you can have a stellar nursing home that gets unlucky and the staff member catches the disease and brings it in.”
McLean County Health Department administrator Jessica McKnight has said repeatedly there were no obvious “red flags” or concerns about Bloomington Rehab that contributed to the outbreak.
The nursing home moved to test all residents and employees after the first five cases emerged. Those results turned up 30 residents and 18 staff with the virus. Six residents have died. The facility averages around 50 residents, records show.
Bloomington Rehab has taken additional precautions, McKnight said. That includes restricting congregate activities and visitors, which it did in mid-March, and assigning staff to only certain wings.
“This just shows us COVID is a very infectious illness and how quickly it can spread. Even when you’re taking all the necessary precautions, there’s still a chance for this illness to spread,” McKnight said.
The facility’s corporate parent, Peoria-based Petersen Health Care, deployed its own “strike team” in response to the outbreak, McKnight said. Petersen has not returned repeated requests for comment from WGLT.
Death Toll Driver
The coronavirus has ravaged long-term care facilities across the country. By one estimate, nearly half of Illinois’ COVID-19 deaths have been tied to long-term care.
“If you wanted to create a setting that would be conducive to the spread of COVID-19 with devastating outcomes, you couldn’t create a more terrible one than the nursing home,” Hershow said.
Older people, especially those with underlying health conditions, are especially vulnerable to the virus. And nursing homes are, by design, all about doing activities and eating together.
Another dangerous ingredient is that nursing home employees, who are underpaid despite their essential function in society, often work at multiple facilities to make ends meet.
“So a staff member may be exposed at a lot of different places, and so it can spread between facilities,” said Mary Dyck, a former nursing home administrator who is now associate dean for research at Illinois State University’s Mennonite College of Nursing. “And very often you have younger people working as CNAs (certified nursing assistants), and those individuals may be less symptomatic, so maybe it hasn’t shown up as much in that person and they’re still giving care and exposing people.”
Dyck said surveyors—the ones who help set those government ratings—tend to be “extremely black and white and don’t always consider everything in the context of what’s happened in that situation.”
Still, she said staffing is a key indicator of quality. Bloomington Rehab had around 47 employees as of 2018, including seven registered nurses (RNs), four LPNs, and 18 certified aides, records show. It earned 2 of 5 stars (“Below Average”) on Medicare’s Staffing rating, with fewer “nursing staff hours per resident per day” than state and national averages.
“When I was a (nursing home) administrator, I always said, I’m only as good as probably my worst staffer,” Dyck said. “You can’t control 100 people on your staff to do everything exactly the way you would want to do it. It’s a tough kind of spot in terms of managing that.”
It’s especially challenging for facilities that rely on Medicaid, the health care program for low-income and older people and those with disabilities. Around 85% of Bloomington Rehab’s revenue in 2018 came from Medicaid, records show. Of the 43 residents at that time, 38 were paying via Medicaid.
Illinois’ Medicaid reimbursement rates are among the lowest in the country for nursing homes, said Dyck. (A recent report pegs Illinois at 49th out of 50 states.) That makes it hard to invest in staff, Dyck said.
“That really underlines part of the issue where you get into trouble,” she said. “If the reimbursement isn’t there, and there are a lot of fines and citations given, and the owner has to pay out for those fines they’re given, then how are they going to pay their workers to give better quality care?”
As former CDC chief Dr. Tom Frieden put it: “Infectious diseases, including COVID-19, tend to be guided missiles aimed at the poor and disenfranchised. It's crucially important that we prevent and stop spread in nursing homes, prisons, jails, shelters, meatpacking plants, and anywhere extensive spread may occur.”
More Testing Coming Soon?
The Illinois Department of Public Health has devoted more resources to prevent and control outbreaks at long-term care facilities, including a contract with Quest Diagnostics to run 3,000 tests per day at no cost to the facilities.
In late April, Gov. JB Pritzker said the state planned to offer free testing for all residents and staff at facilities without outbreaks. But it’s unclear if that’s made its way to McLean County yet. This week Jessica McKnight with the McLean County Health Department said there isn't any proactive testing happening at other long-term care facilities locally because the state is only doing that in hot spots.
“There aren’t any that are receiving that increased attention from the (Illinois Department of Public Health), but we’re in constant contact with all of our long-term care facilities,” McKnight said. “Our communicable disease staff is regularly checking in with them. They are regularly checking in with us.”
One barrier to testing is the cost. It would cost $21.4 million to test every nursing home resident and staff member in Illinois just once, according to a new estimate from the American Health Care Association and National Center For Assisted Living. They argue the cost of ongoing testing of residents and staff is unsustainable without additional funding and support from federal and state governments.
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