ARI SHAPIRO, HOST:
Some of the worst coronavirus outbreaks across the country have been in long-term care facilities. More than one-third of all the deaths in America have been elderly residents and workers at nursing homes and assisted living facilities. Some states have taken aggressive actions to slow the spread of the virus in nursing homes. As NPR's John Burnett reports in Texas, they've called in a strike force.
JOHN BURNETT, BYLINE: On a bright South Texas morning in the parking lot of a suburban nursing home, paramedics from the San Antonio Fire Department are setting up swabbing stations and donning periwinkle-blue protective gowns. They're part of a massive state intervention in nursing homes hit hard by coronavirus. Their job is to test a quarter of a million residents, as well as staff.
TRAVIS HOPP: OK, guys. So we got 260 swabs we're going to do here today. It's 200 staff and 60 residents. We've got you all divided up in your teams already. We'll do three teams swabbing.
BURNETT: The briefer is paramedic Lt. Travis Hopp. His team's work is critical. In Texas, nearly half of the state's almost 1,900 COVID deaths have been tied to skilled nursing and assisted living facilities, an even greater proportion than the national COVID fatality figures.
HOPP: Be safe. Take care of each other. Stay clean. That's really about it. Any questions?
BURNETT: Here's a question. As the public health crisis that began in the winter enters the summer months, why is the virus still running rampant through nursing homes? The fundamentals of infection control are well-known by now - frequent handwashing, wearing masks, donning protective gear and disposing of it properly, isolating sick people. I put that question to Kevin Dinnin, president of BCFS. The nonprofit emergency provider of health and human services is part of the Texas Quick Reaction Force.
KEVIN DINNIN: Let me tell you some of this stuff is really basic. And I don't understand why they're not getting it. I've got a picture on my phone I can show you right now.
BURNETT: He shows me a photo from an East Texas facility of a nurse's aide standing in the hallway without a mask. And directly behind her is an elderly resident who is COVID-positive. BCFS medical teams have taken over operations at six Texas nursing homes where a third to a half of the population contracted COVID-19, and staffers were too afraid to come back to work. What's so alarming, Dinnin says, is that staffers are getting the sickness. They don't know they have it. And they're infecting the residents.
DINNIN: And they're moving from room to room to room with close patient contact. Certainly, if they're not wearing any mask at all to protect others from them, there's a good chance that they're shedding the virus, that they're exposing those high-risk patients to the virus.
BURNETT: His chief of operations, Todd Gates, has been working inside nursing home hot zones in Texas for weeks. Gates is alarmed, too.
TODD GATES: And so they're acting generally out of ignorance because they just don't know that what they're doing is wrong.
BURNETT: The nursing home industry has generally blamed its coronavirus crisis on the early scarcity of masks and other protective equipment and the lack of testing. Moreover, they say, aged residents are especially vulnerable. And no one saw this virulent disease coming. But infection control has been a perennial problem way before 2020. Nursing homes in Texas and throughout America have fallen short for years, according to a report released last month by the federal Government Accountability Office. John Dicken is director of the GAO's health care team.
JOHN DICKEN: We found that a number of nursing homes had deficiencies in their infection prevention and control efforts and that these deficiencies unfortunately were widespread across most nursing homes and persistent over multiple years.
BURNETT: The GAO report found that 82% of America's nursing homes got at least one deficiency in infection control between 2013 and 2017. And Texas, with more than 1,200 nursing homes, is always a trouble spot.
PATTY DUCAYET: This is a longstanding problem, particularly in Texas, with basic infection control practices.
BURNETT: Patty Ducayet is the long-term care ombudsman for Texas. Federal and state inspections show that Texas nursing homes have among the most citations for infection deficiencies in the country and that infection prevention is the No. 1 problem in the state. Ducayet says nursing homes conduct emergency planning. And infectious disease epidemics are supposed to be part of that.
DUCAYET: Without a doubt, nursing homes could've been better prepared for this.
BURNETT: In their defense, a nursing home trade association says they've taken stringent measures to stop the spread, like canceling family visits and eliminating communal activities such as dining and bingo. Kevin Warren is president of the Texas Health Care Association.
KEVIN WARREN: I think there's always room to look at infection control protocols and looking at, how do we improve the process? And how do we learn from this moving forward so that if and when something like this happens again or as we're continuing to manage it, we don't have concerns like this?
BURNETT: The Texas Health and Human Services Commission recently announced that in light of continuing serious problems with coronavirus and nursing homes, it is taking a new proactive measure. Special infection control assessment teams will now visit troubled facilities throughout the state to review their practices, so they can prevent further outbreaks of COVID-19.
John Burnett, NPR News, Austin.
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