Letters to the Editor • Opinion
The coronavirus pandemic is not over
Letters to the Editor • Opinion
We already know how to prevent pandemics
The Washington PostDemocracy Dies in Darkness

Maryland fines two dozen nursing homes for failing to report covid-19 information, reports deficiencies in others

Sage Point Nursing Home experienced one of the largest outbreaks in Maryland. (Marvin Joseph/The Washington Post)

Maryland has fined at least two dozen nursing homes for failing to provide information on covid-19 cases and deaths to state health officials.

According to letters and reports dating back to March 1 from the state’s Office of Health Care Quality, 24 Medicare-certified facilities were fined between $250 to $750 in early May for failing “to submit daily reporting information,” violating an executive order issued by Gov. Larry Hogan (R) in April. Fran Phillips, Maryland’s deputy secretary for public health, said compliance with reporting was about 50 percent before the state started issuing fines.

As of Saturday, she said, it was 98 percent.

“We wanted to know where the vulnerabilities were,” Phillips said. “It was super super important that we got compliance.”

The documents, which were provided to The Washington Post on Friday evening, include reports that detail deficiencies in infection control measures found during nine “covid-19 focused emergency preparedness surveys” by the federal Centers for Medicare and Medicaid (CMS) in late April and early May.

Too few masks, tests and workers: How covid-19 spread through Maryland nursing homes

These reports are among the first government-issued documents indicating that some Maryland nursing homes were ill-prepared for the deadly coronavirus even as it tore through the state. Some facility leaders dispute the findings of the CMS surveyors and argue that government agencies share blame for failing to provide adequate support to nursing homes. In May, employees at Maryland’s hardest-hit facilities told The Post that shortages in testing, protective equipment and staffing contributed to the rapid transmission of covid-19 among residents and staff.

As of Friday evening, 11,999 staff and residents at Maryland long-term care facilities have contracted covid-19, said Mike Ricci, Hogan’s spokesman. More than 1,700 have died, accounting for 60 percent of the total toll in the state.

Phillips said more than 58,000 testing kits have been distributed by the state to 227 nursing homes and are currently being processed by the state lab. Results of the universal testing, which was announced by Hogan in April, will likely be made available this week.

Nursing homes are required to submit information about deaths and infections to the state’s health information system, CRISP, daily from midnight to 11 a.m.

Phillips said nursing homes were given a grace period of several days after the system was instituted before the state imposed fines. But Joseph DeMattos, president of Health Facilities Association of Maryland, said that in the first weeks after Hogan’s order, the state was not issuing receipts, making it difficult for nursing homes to determine whether their information had been received.

“There likely were instances where nursing homes did not file the CRISP report on time because they were actually focused on real-time hands-on care,” DeMattos said.

State officials also provided covid-19 “preparedness surveys” reports for nine facilities that were conducted by CMS, the federal agency that regulates nursing homes. Five were reportedly in compliance with regulations, and four were not. Philips said she is not immediately clear whether more than nine facilities were surveyed by CMS.

At the Villages at Augsburg in Baltimore, an inspector who arrived on April 28 determined that the facility’s lack of compliance with infection control measures warranted a classification of “immediate jeopardy,” meaning that it “placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death,” according to guidance from CMS. This classification for Augsburg was removed on May 4.

By April 28, there were 15 residents and staff at Augsburg who had tested positive for the virus, but those suspected of being ill were still interacting freely with others, often without masks, the inspection report says.

Eight residents, including three who were suspected of having covid-19, were reportedly sitting in proximity at the dining area. Employees were unclear of what personal protective equipment they needed to wear and sometimes failed to wash their hands when exiting patient rooms. One employee said she did not know she needed to wear eye protection, the report said, while another noted that the day of the inspection was the first time staff members had gowns.

Augsburg, a nonprofit facility, was last cited for infection control deficiencies in 2017. As of Friday evening, 77 of its 114 residents have tested positive for covid-19 and 35 have died. A spokeswoman for Augsburg said on Saturday that most patients have recovered and that the facility no longer has “active” cases of covid-19. It submitted “Plan of Correction” for the noted deficiencies was accepted by CMS on May 28.

Maryland orders coronavirus tests for all patients, staff at nursing homes

At Athlea Woodland, a 50-bed nursing home in Silver Spring, inspectors reported that employees did not seem to have adequate protective equipment; one employee in a covid-19 wing was in a disposable yellow gown, which was inside out and had a large hole in it. The nursing home administrator told the inspector that his director of nursing and infection preventionist were “missing in action,” the report said.

Althea Woodland owner Philip Meyer said the facility has formally disputed the inspector’s findings, adding that “this surveyor did not like certain things, but we feel they were not deficiencies.” Meyer acknowledged that their director of nursing had “abandoned” the facility in the middle of the outbreak but argued that this was not the fault of the facility. “CMS just kicked us when we were down,” he said. “We filled the position as soon as we could.”

At Bedford Court Healthcare Center in Silver Spring, which is part of the Sunrise Senior Living chain, the executive director told inspectors that there was no designated covid-19 section. For three patients who had symptoms of covid-19, there was no signage to indicated they should be isolated, inspectors found.

Denise Falco, the vice president of operations at Sunrise, said in a statement that the facility “submitted a plan of correction, which was subsequently accepted, and all corrective actions have been taken in regard to isolation and proper signage within the community.”

In March, before CMS suspended non-emergency inspections of nursing homes, inspectors conducted annual surveys of at least 30 facilities, including some that would later go on to report among the highest cases and deaths related to covid-19.

At Sagepoint Senior Living Services in La Plata, where 97 residents contracted covid-19 and at least 34 died, a federal inspector determined on Feb. 15 that the facility was in compliance with all state and federal regulations. Three months later, the facility was cited for not using appropriate personal protective equipment, not separating residents with suspected or known covid-19 cases and not obtaining lab results in a timely manner.

Sagepoint president and chief executive Andrea Dwyer said in a statement that Sagepoint has not paid any fines because it has filed an appeal with the state.

“Sagepoint fully expects to be absolved of all of the citations issued by the state, as we believe the deficiencies cited were made in error,” Dwyer said.

Too few masks, tests and workers: How covid-19 spread through Maryland nursing homes

Inside Maryland’s worst coronavirus outbreak

Isolated and at risk

Local newsletters: Local headlines (8 a.m.) | Afternoon Buzz (4 p.m.)

Like PostLocal on Facebook | Follow @postlocal on Twitter | Latest local news

Coronavirus news in D.C., Virginia and Maryland

The latest: More than two years into the pandemic, covid cases in the D.C. region are rising again, , while liberal Montgomery County asks who deserves credit for its robust covid response. Meanwhile, Black funeral directors still face a daunting amount of deaths from covid and the omicron wave has had an unequal toll in the DMV.

At-home tests: Here’s how to use at-home covid tests, where to find them and how they differ from PCR tests.

Mapping the spread: Tens of thousands have died in the local region and nationwide cases number in the hundreds of thousands.

Omicron: Remaining covid restrictions in the D.C.-area, plus a breakdown of variant symptoms and mask recommendations.

Get the latest local news: Sign up for the Morning and Afternoon newsletter