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Florida nursing homes unprepared for emergencies like the coronavirus, audit finds

A federal watchdog that inspected 20 facilities says the state needs better oversight.
The U.S. Department of Health and Human Services has told Florida it needs to improve its oversight of nursing homes after its auditors found failures in emergency planning, along with widespread safety issues at a sample of 20 homes.
The U.S. Department of Health and Human Services has told Florida it needs to improve its oversight of nursing homes after its auditors found failures in emergency planning, along with widespread safety issues at a sample of 20 homes. [ DIRK SHADD | Times ]
Published May 7, 2020

TAMPA — About 155,000 people live in Florida’s nursing homes and assisted-living facilities. Most are seniors, the population most at risk from the coronavirus.

In recent weeks, the facilities have emerged as a hotspot for COVID-19 deaths, with one Pinellas home having to be evacuated. As of Wednesday, 577 long-term care residents and staffers had died from the virus, roughly one third of Florida’s total deaths.

By law, the homes must have approved plans to keep residents safe if they have to shelter in place or evacuate during emergencies like hurricanes, loss of power or emerging infectious diseases like the coronavirus.

But a federal audit released in March that looked at 20 Florida nursing homes revealed failures in emergency planning, along with widespread safety issues that put seniors at “increased risk of injury or death during an emergency or natural disaster.”

The report by the U.S. Department of Health and Human Services’ Office of Inspector General said Florida needs to improve its oversight of nursing homes. Auditors found fault with emergency plans in 16 of the homes and identified safety concerns in 19 of them. Some homes did not have adequate plans to shelter residents in place, or to keep track of residents and staff during and after an emergency. Three did not have a plan for how to transfer residents’ medical records in the event of an evacuation. One home did not have a large enough emergency water supply.

Among other failings:

  • Four homes had not properly tested and maintained their generators, and three had too little fuel on-hand.
  • Several homes in one county had designated the same nursing home as an evacuation site, which would result in it being overwhelmed.
  • Florida awarded new licenses to homes even though their emergency plans had not been approved by their county emergency management department.

The audit did not look at infection control measures.

Florida was not the only state to fall short. Federal audits of nursing homes in New York, California, Texas and Missouri revealed a similar number of nursing home failures.

Florida’s report blamed “inadequate management oversight and staff turnover.” The findings were not a surprise to Brian Lee, executive director of Families for Better Care, a national watchdog group for nursing home residents. One in four of Florida’s 700 nursing homes already are on the state’s watch list, he said. The criteria for that dubious distinction includes bankruptcy, chronic care problems, healthcare deficiencies, practices that put residents in immediate jeopardy and a failure to correct violations reported in earlier inspections.

“Florida nursing homes are not doing a good enough job,” Lee said. "Nursing homes have been unprepared to respond to emergencies and disasters. The oversight of them has been lax.”

Lee said it’s too early to say if there is a link between the high number of coronavirus infections and lapses in planning and said outbreaks have happened in homes that routinely pass inspections.

But it shows Florida’s homes need more oversight, not less, he said, and he criticized state lawmakers who this year proposed bills that would relax rules on infection control and make inspections less frequent, even for homes with recent violations. The bills did not pass.

The federal audit was required because the homes receive payments through Medicare or Medicaid. The homes received unannounced visits between July and November of 2018. A final report, including a response from Florida’s Agency for Health Care Administration, was issued in March. The report did not name the nursing homes, but some are listed in the agency’s response.

The audit took place while they were still surveying homes to ensure they complied with new federal emergency preparedness rules, agency officials said. They also questioned whether the federal auditors were as qualified as their own inspectors.

Following the audit, state agency officials visited each of the 20 nursing homes to ensure corrective measures were taken, and its life-safety staffers inspected every home that had not yet received a certification and licensure survey, said communications director Katie Strickland.

The agency is taking extraordinary steps to ensure the safety of nursing home residents during the pandemic, she said.

Since the public health emergency was declared, the agency has been on site at half of the 20 audited facilities and visited homes with previous infection-control issues. It has also made more than 1,400 onsite visits to homes in Florida and more than 11,000 telephone calls to residential providers to offer support and determine what they need.

“Long-term care facilities are the homes of many of Florida’s most vulnerable, and we will bring every resource available to prevent this virus from entering their front door,” Strickland said.

Federal auditors also found widespread safety failures, such as inadequate smoke alarms and storage of hazardous materials. As a result, “residents at the 20 nursing homes were at increased risk of injury or death during a fire or other emergency,” the report states. That included 10 homes with sprinkler heads that were blocked or obstructed.

Photographs taken by auditors inside Florida nursing homes show, left to right, an impeded emergency exit path, an exit sign covered by a paper sign, and a missing ceiling tile that could let smoke from a fire spread throughout the building.
Photographs taken by auditors inside Florida nursing homes show, left to right, an impeded emergency exit path, an exit sign covered by a paper sign, and a missing ceiling tile that could let smoke from a fire spread throughout the building. [ U.S. Department of Health and Social Services ]

Freedom Square in Seminole evacuated residents in April after the virus spread rapidly throughout the home, resulting in at least 18 resident deaths and one staff death.

The home is named in the state agency’s response, but was not one of the 20 visited by federal auditors, said Freedom Square of Seminole executive director Michael Mason. The home was inspected by the state in November 2018 and was levied a $2,000 fine because fire sprinklers were covered with tape, a state report shows.

Those issues were corrected within a 22-day period, Mason said.

“States are focusing more on life safety,” Mason said. “As providers, we’re giving that a lot of attention.”

Related: More Pinellas nursing home residents die of coronavirus in one of Florida’s worst outbreaks

Jack McRay, advocacy manager for AARP Florida, said the report and the pandemic have highlighted the need for a broader discussion about long-term care for the elderly among both lawmakers and the public.

"The COVID-19 crisis has illustrated that, despite some quality improvements in long-term care, much more remains to be done from routine care to emergency situational care,” McRay said in an email.

Times Political Editor Steve Contorno contributed to this story. It is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.

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