After tending to a resident, a staff member leaves their room at Tall Pines in Belfast. Credit: Linda Coan O'Kresik / BDN

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While Maine has seen nursing home residents become infected with and die from the coronavirus at one of the lowest rates in the country, it has lagged most states in performing the in-person inspections of those homes that the federal government has ordered as part of its response to the pandemic.

Those in-person inspections can be an important step in identifying whether facilities are taking appropriate precautions and have enough resources to protect their staff and residents from COVID-19, the disease caused by the virus that has caused deadly outbreaks in nursing homes across Maine and the rest of the country.

But during the first three months of the pandemic, as nursing home residents accounted for more than half of the state’s coronavirus deaths, Maine sent inspectors to less than a third of its nursing homes to perform the federally required inspections. Inspectors had visited 28 of the state’s 93 nursing homes, or 30.1 percent, through June 12, according to federal data, meaning the state was inspecting its nursing homes more slowly than all but nine other states.

State officials said that they plan to complete the inspections before a newly imposed deadline of July 31 and that state inspectors mostly avoided in-person visits to nursing homes between March and late May because they did not have enough personal protective equipment to safely visit the homes, which had been shut off to outside visitors.

Jackie Farwell, a spokesperson for the Maine Department of Health and Human Services, said that the agency has taken many other steps to prevent the spread of coronavirus in nursing homes. She also pointed to federal data showing that Maine has some of the nation’s lowest rates of COVID-19 infections and deaths among nursing home residents.

Given how susceptible nursing homes have been to outbreaks of the virus, the federal government put a hold on its general inspection process for those facilities in March and instead asked states to focus their inspections on infection control practices.

This month, after it became clear that fewer than half of the nation’s nursing homes had undergone those inspections, the federal Centers for Medicare and Medicaid Services required states to complete those inspections by July 31 or risk losing out on funding. Among the things inspectors are supposed to check is how well employees are washing their hands and being screened for virus symptoms, and how much access they have to protective equipment.

“We are saying you need to be doing more inspections,” Seema Verma, the head of the federal Medicare agency, told reporters, according to Politico. “We called on states in early March to go into every single nursing home and to do a focused inspection around infection control.”

By the end of last week, seven states had completed their on-site inspections and 25 more had completed at least half of them, according to federal data. Maine was among the minority of states that had inspected less than half of their nursing homes.

However, the state has visited more facilities this week and now says it has completed 39 percent of its inspections. It expects to complete them by mid-July.

In addition to those coronavirus-specific inspections, Farwell said that Maine DHHS has conducted 10 other inspections of nursing homes during the pandemic, but that it was limited in how often it could send inspectors to facilities because of a federal directive in March that they would need to wear protective equipment on those visits.

Maine was able to resume the coronavirus-specific visits to nursing homes in late May after obtaining a sufficient supply of equipment for the inspectors, Farwell said.

She also said that the state’s general support of nursing homes has included conducting a remote survey of their needs in April, holding regular conference calls with their directors and providing widespread testing and supplies of emergency equipment to facilities that have had confirmed outbreaks.

Some public health experts have criticized states for not prioritizing the use of protective equipment to let inspectors visit nursing homes earlier on in the pandemic, given how vulnerable their elderly residents are to COVID-19 and how quickly it can spread in close quarters.

“I think after those first few weeks we should have had personal protective equipment in place for the inspectors and doing these inspections remotely is really second best,” David Grabowski, an expert in aging and long-term care at Harvard Medical School, told Politico. “I think having more eyes on what’s happening is really important.”

But several people involved with Maine’s long-term care community defended the state’s approach. Brenda Gallant, executive director of the state’s long-term care ombudsman program, said that Maine was “proactive” when it asked her group to conduct a statewide telephone survey of nursing homes and other long-term care facilities in April to assess what help they needed to fend off COVID-19.

“We were ahead of the country in terms of reaching out to facilities by phone, in terms of intensive outreach to ask them about all practices for infection control,” Gallant said.

While there have been COVID-19 outbreaks at about a dozen of Maine’s long-term care centers, including some that have caused multiple deaths, the state’s nursing homes have overall fared well compared to the rest of the country. There have been an average of 22 coronavirus cases and 4.7 deaths for every 1,000 nursing home residents in Maine, which are both among the lowest rates in the country, according to federal data.

Joel Rogers, the administrator of Market Square Health Care Center, a 76-bed nursing home in South Paris, said he understands the need for state inspections to highlight deficiencies in elder care facilities, but he thinks officials were right to spend the early days of the pandemic collecting protective equipment, boosting testing and helping facilities to understand the new health threat they were facing.

“Not sending surveyors into a building was probably a good thing until we learned more about how to protect ourselves,” he said. “We had tremendous shortages of [personal protective equipment] throughout the state. We were having to use masks more than once and not having enough gowns. All of that was, in my opinion, a much better focus.”