By some estimates, nursing homes account for roughly 40% of deaths associated with COVID-19 in the United States.
As staggering as that number is, it’s important to remember that nursing home residents represent just 0.62% of the overall U.S. population.
How is a tiny fraction of America bearing the brunt of the coronavirus devastation?
Families of residents are all too aware of the dangers posed by ill-equipped, understaffed facilities, and nursing home abuse. Unfortunately, their pain and suffering remain strangely invisible to the public at large.
Writing for Bloomberg, George Mason University economist Tyler Cowen noted the seemingly “subdued” public response in relation to the number of people who have died in nursing home care due to COVID-19:
“Yes, there has been ample news coverage, but there are no riots in response, no social movement to “clean up the nursing homes,” no Ralph Nader-like crusader who has made this his or her political cause.
Nor has there been much resulting vilification. There are plenty of condemnations of technology billionaires, but very few of nursing-home CEOs.”
Cowen floated several possible explanations, but whatever the case, the plight of the nation’s most vulnerable patients continues to fly under the radar.
Nursing home reform needs to take center stage in the national discussion. Tens of thousands of nursing home residents have already died as a result of COVID-19, and that number is sure to climb.
Nursing Homes Were ‘Tinderboxes’ and Went ‘Up in Flames With Just a Spark’
In a recent article for the New England Journal of Medicine, a team of researchers from the University of Pennsylvania argued that the current problems plaguing nursing homes are sadly nothing new.
Bringing perspective from medicine, economics, healthcare management, and law, authors Rachel M. Werner, Allison K. Hoffman, and Norma B. Coe described how “long-term care in the United States has been marginalized for decades.” They write:
“U.S. nursing homes were unstable even before COVID-19 hit. They were like tinderboxes, ready to go up in flames with just a spark.
The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy.”
The authors called for immediate reforms.“We are in a moment of crisis for nursing homes,” they concluded:
“Now should be a time of reckoning with the fundamental flaws in the organization of long-term care in this country. There are no easy fixes, but we must do better.”
The sad reality is that many nursing homes are not doing better — at all.
Regulators Promise to Crack Down on Nursing Homes That Don’t Protect Patients
Well into the COVID-19 pandemic, inspections by federal regulators have revealed that infection control is still a major issue within many nursing homes.
This is after widespread warnings from public health advocates and mandatory regulations laid out by the U.S. Centers for Medicare & Medicaid Services (CMS), the federal agency which oversees nursing homes certified by the 2 largest public health programs in the country.
Under the new COVID-19 inspection program, CMS has received the required data from some 12,500 facilities, which is approximately 80% of the total they oversee.
So far, the agency has reported:
- Over 60,000 confirmed COVID-19 cases
- Almost 26,000 confirmed COVID-19 deaths
- Approximately 1 in 4 nursing homes had at least one case
- Approximately 1 in 5 nursing homes had at least one death
Critical information is still outstanding from some 3,000 nursing homes, and CMS said that they are imposing penalties for delays in reporting information.
Nursing Home Compare COVID-19 Data
The agency also noted that, “Early analysis shows that facilities with a 1-star quality rating were more likely to have large numbers of COVID-19 cases than facilities with a 5-star quality rating.”
The CMS rating system is part of Nursing Home Compare, an online service that allows people to find information about different facilities, including past health and safety inspections. Nursing Home Compare scores facilities based on a 5-star scale, with 5 being the highest.
The fact that 1-star nursing homes are handling the coronavirus poorly will surprise no one who has been watching.
These are places with many violations and fines for nursing home abuse, neglect, and failing to implement safety protocols. The most problematic are clearly flagged by an alert icon on Nursing Home Compare in order to warn prospective residents and their families.
“While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe,” said CMS Administrator Seema Verma, “we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”
Verma said that new data about COVID-19 in nursing homes would soon be released on Nursing Home Compare “so the public can view general information of how COVID-19 has impacted nursing homes in a user-friendly format.”
She promised that the data would be updated weekly, and hopefully, the increased transparency will promote safer conditions, especially at the nursing homes that are struggling the most.
Nursing Home Violations Continue as Coronavirus Deaths Climb
The first major coronavirus outbreak in America happened at the Life Care Center nursing home in Kirkland, Washington in February. In the months that followed, government inspectors documented lapses in infection control at other facilities operated by the facilities parent organization, Life Care Centers of America.
After obtaining a batch of CMS inspection reports, the Washington Post found breakdowns in infection control and prevention at 10 Life Care nursing homes. This number does not include the notorious Kirkland facility.
Inspectors in Michigan saw residents and aides interacting without personal protective equipment (PPE), and another watched a nurse’s assistant roll equipment between insolation and non-COVID-19 rooms without sanitizing it.
With such a vulnerable patient population, these types of mistakes can turn 2 infections into 20 within hours.
By the time the CMS inspectors arrived on site to conduct their COVID-19 specific assessment, Life Care Centers had no excuse for such reckless behavior.
A History of Nursing Home Violations and Million-Dollar Fines
Without a doubt, nursing homes are facing an unprecedented crisis, but some large chains, such as Life Care Centers of America, have been cutting corners for years, laying the groundwork for disaster.
The Washington Post highlighted the serious issues at nursing homes operated by Life Care Centers of America in the decades leading up to the current outbreak:
The HHS inspector general ordered $1.6 Million in Medicare services returned because the company billed for “inappropriate services,” such as billing for occupational therapy sessions for an 84-year-old resident in a semi-comatose state.
The company settled a whistleblower claim in Georgia with the Justice Department for $2.5 Million. Family members had come forward after their loved ones died in the Life Care facility alleging that it was dangerously understaffed and poorly managed.
The Justice Department took on 2 more whistleblower cases against the company in 2008. In Tennessee, a registered nurse sued Life Care, her employer, alleging that management pressured staff to increase profits by scheduling unnecessary therapy, even when it endangered the patient. A complaint filed in federal court said:
“The therapists would essentially drag the resident down the hall and document the patient as having ambulated. The resident would gain a false sense of being able to walk and would fall when he tried to walk on his own.”
In the second case, a Life Care occupational therapist in Florida made similar claims, which Justice investigated. As the Post recounts:
“In Florida, prosecutors noted that a 92-year-old man dying of metastatic cancer that had spread to his brain and lungs was sent to rehabilitation therapy for at least 2 hours a day, including when he was spitting out blood.
On the day he died, according to prosecutors, therapists recorded 35 minutes of physical therapy, with occupational therapy scheduled for later that afternoon.”
Life Care settled these claims in 2016, paying $145 Million and submitting to an annual, independent review as part of a corporate integrity agreement.
A Florida man was awarded $150,000 by an arbitration panel that found his mother’s death in a Life Care facility was caused by negligence. Residents had been left in their rooms for 3 days without air conditioning.
These serious failures, along with the ordinary lapses in care that were common in some Life Care nursing homes, do not paint a promising picture of a facility ready to handle the needs of a vulnerable patient population in the best of times, let alone keep residents safe during a public health crisis like a viral pandemic.
Nursing Home Reform Cannot Wait
Many of the systems that people depend on in life and death situations have been put to the test in 2020. Those employed by nursing homes and police departments know that some mistakes are permanent.
So do the families of those hurt and killed.
Right now, instead of racing to deliver the best protection possible, the nursing home industry is lobbying for immunity from nursing home lawsuits.
As if nursing homes are the ones in critical danger — not patients.
The federal guidelines are clear, the risks of the virus are well-known, the death toll is already sickening, and, still, some nursing homes want to provide subpar care without accountability.
Moving forward, Americans need to see their leaders and other stakeholders come together to provide real, long-term solutions for their aging citizens. Congress has had harsh words for nursing homes, as have regulators, but the situation is not improving.
It’s too late for too many, yet meaningful justice can be found in every life saved and prolonged by better nursing home practices. It’s a goal worth fighting for.
Days spent alive are precious. Let’s start with that.