Scabies cases at Arkansas nursing home, surrounding community linked to inaction

Posted: January 22, 2018 at 4:30 a.m.

A scabies outbreak at a Camden nursing home last month spread throughout the facility and into the community after those in charge failed to act, according to watchdogs.

Government documents show that leaders at Longmeadow Nursing Care in Camden, in some cases, told nursing staff not to leave a paper trail indicating residents there were receiving treatment for scabies. Scabies is a highly contagious skin condition caused by burrowing mites, according to the U.S. Library of Medicine.

Residents with the condition weren't isolated, and proper procedures were ignored, causing employees to contract the bugs, which then spread outside the facility to their families, government reports show.

Just weeks before scabies afflicted every resident at Longmeadow, state regulators cited the facility for failing to properly address a smaller infestation affecting a handful of residents in July. The facility didn't document the outbreak.

When state inspectors asked why, a nurse said instructions came from above.

"They didn't want us to document the residents had scabies on any of the paperwork, but that's what we were treating them for," the nurse said in an inspection report.

The problem worsened, and after a December inspection, the state Office of Long Term Care rated the infractions an "L," the most severe in a 12-letter rating system.

"The failed practices resulted in Immediate Jeopardy, which caused or could have caused serious harm, for all 28 residents who resided in the facility," the Office of Long Term Care's report reads.

Phone calls to Longmeadow and an email to the facility's owner, Jackie Kilgore, weren't returned last week.

It's unclear how often scabies infestations pop up in Arkansas nursing homes, but outbreaks are rarely found, no more than one or two per year, said Marci Manley, a spokesman for the Arkansas Department of Human Services.

The Office of Long Term Care wouldn't know about an infestation if a case of scabies was handled correctly, Manley said. Those procedures include isolating affected people, requiring direct-care personnel to wear protective equipment and using special cleaning techniques on material exposed to the bugs.

State regulators' reports document how Longmeadow failed to follow almost every scabies mitigation protocol.

Surveyors, after entering the facility in December, found that protective equipment had been stored in close proximity to residents with scabies. They also found that infected residents weren't kept separate from their uninfected peers.

They discovered that nurses, housekeepers and certified nursing assistants weren't properly monitored to ensure they didn't develop the bugs.

Furthermore, a housekeeper at the facility told inspectors that the director of nursing told her she could enter infected residents' rooms without protective gowns as long as she didn't touch the residents.

One nurse assistant told state surveyors she cared for residents after developing skin rashes herself.

Longmeadow declined to treat afflicted staff members, and the director of nursing told one nurse assistant that her rash wasn't scabies, according to the inspection report.

The facility declined to treat several staff members who developed scabies, which eventually spread to their spouses and school-aged children, the report shows.

When inspectors asked why staff members weren't treated for the mite infestation, the director of nursing blamed the administrator.

"I went over and asked the administrator about it, and she said she would have to think about it," the director said in the inspection report.

A person can have scabies for one or two weeks without showing any symptoms, according to the U.S. Centers for Disease Control and Prevention. Meg Mirivel, a spokesman for the Arkansas Department of Health, said the agency had no reason to suspect the outbreak had reached schools around Camden.

The state Health Department learned of the outbreak after the Office of Long Term Care discovered the problem, and the department has been working with the facility to resolve the issue ever since.

There's no documentation whether residents ever received the treatment cream a doctor prescribed to eradicate the scabies, according to the report. State surveyors were unable to find documentation in the facility's records -- which is required -- that the cream was ever applied.

A nurse told inspectors that the cream was administered, but that nursing assistants applied it to the residents, a violation because only nurses can administer medication.

Longmeadow must submit a plan of correction, and regulators must revisit the site before it can begin receiving Medicare and Medicaid payments for new residents. Payments for new residents stopped Thursday, and Manley, the Human Services spokesman, said the facility had not yet come into compliance.

If Longmeadow doesn't come into compliance before March 22, it will no longer be certified to receive Medicare and Medicaid payments, effectively shutting the facility down.

Additionally, the facility stands to be fined $146,916 plus $1,255 per day from Dec. 14, the inspection date, until the home comes into compliance.

Metro on 01/22/2018