Avamere Transitional Care and Rehabilitation

The sign outside of Avamere Transitional Care and Rehabilitation in Boise.

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BOISE — Eighty-eight percent of Idaho’s nursing homes have been cited for infection control violations since 2015, according to an Idaho Press analysis of federal inspection data.

Nursing homes are closely monitored by state and federal regulators on their measures to prevent the spread of infection through handwashing, wound care and vaccinations against common illnesses. These procedures are important in normal times, but they have become paramount when faced with the deadly spread of COVID-19 in long-term care facilities nationwide. Infection control violations are the most common citations in nursing homes around the country.

Seventy-two of Idaho’s 82 nursing homes around the state received violations between 2015 and early 2020, which can range from issues with infection control planning paperwork to instances of improper handwashing. Several facilities were repeat offenders, with multiple violations during this time period. All of them were classified as ”no actual harm with potential for more than minimal harm that is not immediate jeopardy.”

Although Idaho has not made national news for strings of devastating deaths in nursing homes like in Washington or Virginia, its facilities have not been unaffected. A total of 202 residents and staff have confirmed or probable cases of COVID-19 in long-term care facilities statewide as of April 30, according to the Idaho Department of Health and Welfare.

At least 32 of the state’s confirmed and probable deaths from the disease have been associated with Idaho nursing homes. This makes up roughly half of the state’s 64 total COVID-19 deaths as of May 4.

Since the beginning of the pandemic, 18 long-term care facilities in Idaho, including skilled nursing homes, assisted living/memory care and intermediate residential care, have reported at least one case of COVID-19, according to Idaho Department of Health and Welfare. Nine of these facilities are no longer under investigation because they have seen no new cases for 28 days, but the other nine are still considered active clusters as of April 30.

On April 14, Central District Health, the public health district that includes Ada County, reported a death from COVID-19 at Avamere Transitional Care and Rehab in Boise. Since then, the public health district reports the outbreak has spread to 38 staff members and residents, according to CDH spokeswoman Christine Myron. The health district also reports 74 total cases in five facilities in Ada, Elmore, Boise and Valley counties as of May 5.

Avamere did not respond to a request for comment.

This is the only death statewide where the facility has been identified in a press release. Meanwhile in North Idaho, 17 residents of Life Care Center of Lewiston have died since the disease was detected in the facility on March 25, according to the Lewiston Tribune. It is unclear how many of these residents had COVID-19 because they had not all been tested, but eight were positive cases.

There are also outbreaks at facilities in the South Central Public Health District, which encompasses Blaine, Jerome, Camas, Lincoln, Cassia, Minidoka, Gooding and Twin Falls counties. Seven facilities throughout the health district had positive cases of COVID-19, but only four are currently being monitored for spread of the disease. Districtwide, 45 facility staff members and 47 residents have tested positive for the disease or are considered probable cases, according to district spokeswoman Brianna Bodily.

COVID-19’s devastating impact on nursing homes is the result of the convergence of multiple factors, including residents who are high risk for the disease living in close proximity to each other, high staff turnover in and low wages in the industry. It is common for workers to hold jobs at multiple facilities in order to make enough money to make ends meet, according to the Center for Medicare Advocacy.

The Centers for Disease Control and Prevention found infected nursing home workers working shifts at multiple locations was a major contributing factor to the deadly spread of the disease in Kirkland, Wash.

Dr. Julie Lyon, an associate professor of internal medicine at the Idaho College of Osteopathic Medicine, said low wages at nursing homes means workers might come to work sick in order to pay bills. She also said nursing homes are often staffed by licensed practical nurses, instead of more rigorously trained and higher paid registered nurses, which makes infection control harder to implement.

High turnover further exacerbates the problem, she said.

“A lot of people get their start in medicine at long-term care facilities, so they don’t have that knowledge. And if you don’t have a lot of people who have that training you can’t teach the people coming in, and they may not have the skills or thought processes they need to to interact with these sick people who are very susceptible to these diseases,” Lyon said.

‘HEIGHTENED AWARENESS’

Tamara Prisock, DHW’s administrator for the Division of Licensing and Certification, said her department and the federal Centers for Medicare & Medicaid Services have stopped sending inspectors into nursing homes during the pandemic, except to investigate allegations where residents are in “immediate jeopardy.” Instead, Prisock said her department has transitioned from regulation to supporting nursing homes to find solutions and keep residents safe.

Although the pandemic has been difficult, Prisock said the emergency has helped instill better infection control policies in facilities than before.

“What we have seen more of that the pandemic has heightened awareness in facilities,” she said. “Remembering to wash your hands to do after every single thing you do is difficult for a human being to remember to do, but when something as serious as this pandemic comes along and it appears to be so much more easily transmitted than other things we have seen in facilities it becomes so important.”

Robert Vande Merwe, executive director of the Idaho Health Care Association, the industry group that represents nursing homes, declined a phone interview last week to talk about outbreaks in nursing homes, but provided a lengthy email statement about COVID-19. He said infection control violations are the No. 1 regulatory issue in nursing homes nationwide, and that requirements are “extremely stringent” and have changed multiple times in recent years.

“Outbreaks are not the result of inattentiveness or a shortcoming of facility staff,” he wrote in a statement Thursday. “It is the combination of the behavior of this virus and the unique threat it presents to the people we care for older adults and those with disabilities who also have multiple underlying health conditions.”

He also praised “heroic” nursing home staff members for their work over the past several weeks as the disease has spread across the state.

“Criticism at this time is only designed to increase concern about the preparedness of our health care providers and is not helpful during a pandemic,” he wrote. “We hope that Idaho and America will rally around our residents and caregivers the same way they have around hospital patients and workers.”