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Lawyer Blog: Baltimore, MD

Richard Mollot: Infection Control Problems in Nursing Homes and Assisted Living Facilities

About Richard Mollot: Richard is an attorney and the Executive Director of the Long Term Care Community Coalition, or LTCC for short. The LTCC is a nonprofit, nonpartisan organization dedicated to improving care and quality of life for residents in nursing homes, assisted living, and other residential care settings, through policy analysis and advocacy. 

In this episode, Steve and Richard discuss:

1. How has the long term care industry handled protecting our seniors and elderly from COVID-19?

  • We know that nursing homes are not great places to live, generally speaking, that care tends to be pretty poor and living conditions aren’t great. I think that most people were really shocked to see that preventing infections was such a big issue and the implications of not having enough staff on a regular basis has greatly amplified the harm that residents have experienced both directly to COVID-19 and indirectly, due to what we’re seeing more and more of the past at least a month and a half has been just abject neglect and substandard care.

2. Are you also concerned that the industry is not checking the temperatures, vetting their staff, or other people that were coming in and out of their facilities? 

  • The Trump administration just started as of earlier this month, May 8, 2020 requiring for the first time that nursing homes report the cases among residents staff, suspected cases, deaths, both related to COVID and non-related to COVID as well as the variability of ppe and other necessary equipment for dealing with this pandemic. We did go March and April without having any of that information recorded. We do know that there has been a tremendous, frankly horrifying impact on residents in nursing homes and adult care facilities and that the only people who have been coming in and out of those facilities since early March when families and ombudsman were blockaded are the staff.

3. What is the state of infection control presently in the nursing home community?

  • Leading up to COVID-19, and for years we’ve known that inadequate infection control and prevention is a serious problem. 

4. Why do you believe that one-fourth or one-fifth of the nursing home and assisted living population is dying?

  • Nursing homes are allowed to operate without providing good care and without having enough staffing. Most of it comes down to staffing, especially when you talk about infection prevention. We’re talking about hand washing, we’re talking about changing gloves.

5. Is the lack of staff causing more infections, or is it staff indifference and really not caring about proper sanitary measures like washing their hands?

  • I think it’s lack of staff. There are certainly bad apples in terms of care staff and most people who go into nursing homes want to do a good job, but the nursing home is such a toxic working environment that it makes it impossible. So the residents are dehumanized and to some extent, care staff is also dehumanized.

6. Has the federal nursing home reform law helped or made the situation better? Is it just an enforcement issue? 

  • That’s exactly right. The standards have been around for quite some time and the standards are really good. One of the small changes that were important that was made in 2016 to address this very issue of infection control and prevention in facilities, and the long standing failures to undertake appropriate protocols is that nursing homes are required to have on a part-time basis an Infection Preventionist. But unfortunately, when the Trump administration came in they have been undertaking a lot of regulatory reduction, which in the nursing home world means reducing safety standards, and one of the things that they proposed is to actually reduce that requirement for having an infection preventionist on a part-time basis.

7. Is sterilization of equipment a problem in nursing homes?

  • Yes. It is that the just the equipment is not cleaned appropriately, even equipment that is in contact with a feeding tube, or something else that is actually going into a resident’s body. The standards are really good. They’re just not enforced. The industry is extremely powerful in the state capitals and Washington DC so they fight against enforcement, even before the Trump administration for many years. They have worked successfully to weaken enforcement. So we do have persistent issues of not only poor infection control and prevention with respect to washing hands and just basic cleanliness of some of the equipment.

8. Why is there such a problem with linen control in that residents can’t get clean linens but instead have dirty linens that are also causing infections?

  • One problem is the lack of enforcement of the rules. Another issue is that there is virtually no accountability for how nursing homes spend the money that they receive to provide care. Just to get the linen issue, you can be a nursing home and you can own a laundry company, you can own a therapy service company, you can own the underlying property to own nursing home and pay yourself whatever you want for those linens services, for the rent on the underlying property, for therapy, services, etc. There’s so little accountability of what’s going on here, both in terms of where’s the money going, how it’s being spent? Are the ensuring that the residents are getting good services? It’s an utter absence of both the regulatory enforcement of those safety standards and the integrity of the Medicare and Medicaid programs that pay for most care to ensure that the money spent is actually going to clean the laundry, for reasonable rent, and etc.

9. What are some of the most common infections that you’re seeing in nursing homes and assisted living facilities?

  • There’s not a lot of good tracking there. In terms of infection it may be pressure ulcers, that can lead to infection. MRSA has been an issue. Influenza is not an infection, but it’s related to COVID-19. 

10. As bad as things are in nursing homes are they worse in assisted living facilities?

  • Yes, it really varies. You could have facilities that are good that have an RN on staff, but most facilities don’t. The ownership may change or they want to save money or, cut back on costs. The RN who was there when you signed, the contract could be gone. The issue, as I see it is that those facilities operate, as far as the state is concerned, kind of like a hotel, or like an independent housing facility. When they’re in fact providing more and more care services to people who have vulnerabilities and needs that are similar to those in nursing homes, but without any of those protections that we’ve been talking about.

11. Is infection control actually less effective in assisted living than it is in nursing homes?

  • Yeah, absolutely. That’s true, pretty much for everything. The staffing requirements are different. The skilled nurse staffing in nursing homes, you have to be at least a certified nurse aide to provide care in a nursing home that requires a minimum of 75 hours of training. Under federal regs and assisted living. You could have paid 15 hours of training and there’d be no RN, maybe no one who’s even awake 24 hours a day in the building to provide and to ensure that a resident in need is cared for in some way.

12. Is the assisted living facility population growing more, as opposed to nursing homes?

  • Yeah, the trends are that they are growing in most states, I think 48 states now have some kind of Medicaid assisted living program to enable people who are on Medicaid, to avoid a nursing home placement, and go into assisted living. It’s considered a home community-based service. We are seeing growth there but we’re not seeing the regulations that ensure that care is safe and appropriate for those residents.

13. What are some actionable steps that can be taken if you’re a resident of a long term care facility such as nursing, home assisted living, or a loved one of a member to prevent or protect against infection?

  • Be a strong advocate for yourself, or for your loved one, to monitor to the extent you can. I would strongly recommend forming a family council or resident council. Those can be very, very powerful in terms of sharing information, sharing your experiences, and speaking out in a united voice, which makes it much more likely that will be heard by the administrator of the facility. And certainly speaking out when you have a concern. Filing a complaint can be useful, but sometimes it’s not because the state some do a great job. In respect to oversight, we’re saying speak to your congressional office, call your state legislator and let them know.

14. Can you briefly explain to our injured senior community what the role of the Ombudsman is?

  • The Long Term Care Ombudsman Program is in every single state under the Older Americans Act. Under that act, Ombudsman have the right to help the resident personally, had the right to go into a facility anytime, they have a right to review a residents medical records from the facility with the resident or the residents representatives permission, and they can help and they can oftentimes be very effective in helping residents address some of these issues.

15. If a nursing home gets sued for millions of dollars in damages for the resident, do you think that that has some effect on implementing reform?

  • Absolutely. That is something we have always strongly supported. Most people don’t want to sue even when something terrible has happened to their residents, but our position has always been based upon everything we’re talking about today that the rules are there and lawsuits are based upon those rules, not being when there’s a failure to implement them, that if the state is not holding, and CMS is not holding centers for Medicare, Medicaid services, accountable for meeting these minimum standards, the only way that will happen is if facilities and in the industry are sent a message and a lawsuit. Not only is it compensation for the harm and the suffering of that resident and the heartbreak of the family, but it sends a message to the facility and to the industry in the community, in the state. That this is not acceptable. You’re not going to get paid and get away with providing such substandard care.

To find out more about the National Injured Senior Law Center or to set up a free consultation go to or call 855-622-6530

Connect with Richard Mollot:

Twitter: @LTCconsumer
Facebook: LTCCC 



Show notes by Podcastologist: Kristen Braun

Audio production by Turnkey Podcast Productions. You’re the expert. Your podcast will prove it.