At least 14 employees and 12 residents of a nursing home in southwest Missouri have contracted the coronavirus, a spokesperson confirmed Thursday.
The new reported cases at Carthage Health and Rehabilitation Center come about a week after a few employees began experiencing symptoms of COVID-19. No coronavirus deaths have been reported at the facility.
Carthage Health and Rehabilitation Center is one of two skilled nursing facilities in Carthage, located about 17 miles northeast of Joplin. Carthage, like the rest of southwest Missouri, is experiencing a surge in coronavirus cases.
The nursing home cases follow a national trend of COVID-19 outbreaks in long-term care facilities. Missouri nursing homes reported 1,831 coronavirus cases and 429 deaths as of July 5, the latest date for which statewide data is available.
NHS Management operates Carthage Health and Rehabilitation Center in addition to 49 other nursing homes in four states. Joe Perkins, a spokesperson for NHS Management, said the Carthage facility is equipped and prepared to handle an outbreak.
Government inspection documents show the facility - like many across the U.S. - has been cited for health violations in recent years. NHS Management said the violations have been addressed. But two staff members said other employees weren't taking safety precautions seriously in recent weeks.
As soon as cases of coronavirus were identified, Carthage Health and Rehabilitation Center set up an isolated unit for residents with coronavirus and notified all residents' guardians of the outbreak, Perkins said. All staff and residents have been tested for coronavirus and continue to be tested weekly.
Perkins also said most of the employees and all of the residents who have tested positive for coronavirus said they are not experiencing symptoms.
In the COVID-19 unit, staff wear full personal protective equipment, including an N95 mask, face shield, surgical gown, gloves and shoe covers, Perkins said. Staff who work in the COVID-19 unit don't work anywhere else in the facility, he added.
Nursing homes residents are especially vulnerable to coronavirus because they often have pre-existing conditions and can struggle to recover from illness.
"A consistent theme is that the outbreak in a nursing home often starts with staff," said Erik Martin, an emergency medicine specialist. He's been treating coronavirus patients since the start of the pandemic, first in New York City and now in southwest Missouri.
The Missouri Department of Health and Senior Services does not release the names of long-term care facilities with coronavirus outbreaks, the St. Louis Post Dispatch reported in April. The Centers for Medicare and Medicaid Services does publicize the names of nursing homes and information about coronavirus cases; however, the data is updated on a weekly basis and on Thursday only showed cases through July 5.
Employee concerns
Two employees cited staffing shortages and improper mask-wearing as reasons for the rapid spread of the virus. The employees asked not to be named for fear that they'd lose their jobs.
Carthage Health and Rehabilitation Center policy requires employees to wear surgical masks at all times. In the weeks leading up to the outbreak, some employees stopped wearing a mask properly, the employees said.
"I've seen several staff members wearing their mask like a chinstrap," one employee said.
Martin, the emergency medicine doctor, said the best way to prevent coronavirus spread from staff to patients is through proper mask wearing.
"If we are wearing proper equipment, we won't give germs to them, and they won't give (germs) to us," he said.
Residents must wear cloth or surgical masks, but staff said they struggle to enforce the policy. Employees said the outbreak has occurred in the dementia unit, and residents with dementia often don't understand why they have to wear a mask. Others simply refuse to wear them, according to the employees.
One employee said a staff shortage has left certified nursing assistants, who are residents' primary caretakers, stretched thin since before the pandemic.
"We've been short-staffed, it seems like, for years," one employee said. "There's not enough staff to do everything the way it should be done."
Sometimes one nursing assistant might be responsible for feeding, dressing, cleaning and moving dozens of residents, forcing them to work quickly and forego showers for residents or proper hand-washing, the employee said.
Perkins said staff and administration may have different ideas of what full staffing looks like.
"We are maintaining the staffing levels that are necessary to provide the highest quality of care for our residents," Perkins said.
Because NHS Management operates several nursing homes in Missouri, including one in Joplin, administration can transfer employees as needed to fill staff shortages, he said.
Infectious disease control violations
Government inspection documents show Carthage Health and Rehabilitation Center violated infectious disease control regulations several times in the past four years.
The number of citations issued to the nursing home is on par with the seven other skilled nursing homes in Jasper County that have been open since 2016, all of which have received at least seven inspections resulting in a "plan of correction" - a document in which nursing home administrators tell regulators how they will fix the issues they were cited for.
A Washington Post analysis in April found 40 percent of more than 650 nursing homes nationwide with publicly reported cases of the coronavirus had previously been cited for failure to follow infection control regulations.
In April 2019, investigators found one resident at Carthage Health and Rehabilitation Center often went without a bath or shower for a week at a time, and on two occasions, did not receive a bath for 14 days. A second resident, who had "chewing tobacco residue under his/her chin and and crusting in and around his/her ears," also complained to investigators of a lack of bathing.
The same inspection report also cited Carthage Health and Rehabilitation Center for failure to follow infectious disease control regulations when the nursing home failed to report the second step of a two-step tuberculosis test for three staff members.
In April 2016, investigators reported the staff and residents were using the ice machine without washing their hands or the ice scoop. Investigators also observed medical technicians dispensing medication to various residents without following hand-washing and sanitizing protocol.
In August 2017, another investigation found Carthage Health and Rehabilitation Center "failed to initiate a surveillance plan" when six residents in two different halls developed similar rashes.
In February 2018, one nursing assistant tended to at least six residents - checking for incontinence, changing soiled briefs, lifting and repositioning residents in their beds - without washing or sanitizing his or her hands, only changing gloves.
After each violation, Carthage Health and Rehabilitation Center enacted a plan of correction to address the issues found by investigators. On multiple occasions, management re-trained staff on proper hand washing and sanitizing.
Perkins, the spokesperson, said the facility has resolved all issues raised by inspectors.
This story was produced by the Missouri Information Corps, a project of the Missouri School of Journalism.