Nursing Homes Were a Disaster Waiting to Happen Long Before Covid-19

Nursing homes are places to be avoided if at all possible and even having money and being placed in a "good facility" doesn't guarantee one will receive proper care (this happened to a friend last year), especially since many nursing homes are for-profit operations and maximizing profits is the number one concern despite lip service to the contrary.  There are state and federal standards that strive to enforce safety for patients and these were strengthened in 2016 under the Obama administration only to be weakened one year later under the Trump/Pence regime which time and time again places money making big business ahead of the safety of citizens (other examples are the gutting of clean air and clean water regulations). The sad reality is that too often, going to a nursing home is going to a place to die unless one is going for short term rehabilitation.  Most are understaffed and simple measures to avoid infection are all too often ignored.  A column in the New York Times looks at the state of nursing homes which have accounted for 25-27% of all Covid-19 deaths - perhaps more if accurate reporting was required nationwide.  Here are article excerpts:

It was clear almost from the outset that the elderly and frail were in the greatest danger from Covid-19. And it was clear to anyone familiar with American nursing homes that these facilities would not be up to the task of protecting their older and infirm residents.

As of Thursday, Covid-19 has killed over 10,000 residents and staff members in long-term-care facilities in 23 states that report fatality data, about 27 percent of the Covid-19 deaths in those states, according to the Kaiser Family Foundation.

The weaknesses in patient care and oversight at nursing homes that made those deaths more likely were longstanding, widespread and well known.

One-third of Medicare beneficiaries admitted to nursing homes suffer harm within about two weeks of entering the facility, according to a 2014 report from the federal Office of Inspector General. These are the short-term residents for whom facilities are paid the most and who are typically most able to articulate their concerns if something is wrong. Where does that leave a majority of residents who are in the facility long-term, most of whom are older, frail and cognitively impaired?

Despite the absence of federal reporting requirements, we are seeing that residents and families are being devastated by Covid-19. In New Jersey, an anonymous tip led authorities to a nursing home that was storing corpses in a shed. At least 29 of its residents have died from Covid-19 and many more residents and staff members have been infected. Unsurprisingly, this for-profit nursing home has a history of seriously low staffing and citations for substandard infection control.

The tragedy is that government standards of safety and care at homes certified under Medicaid or Medicare (a large majority) are strong. If enforcement of those standards had not been so lax, the devastation we have seen in nursing homes could have been mitigated.

The federal Nursing Home Reform Act of 1987, and the regulations and guidance through which the law is carried out, most recently revised in 2016, require effective infection control and prevention including hand hygiene and the use of personal protection equipment.The most important precautions against infection are inexpensive and simple, and the most common violations involve simple sanitation and hygiene practices, like hand washing. Nevertheless, infection control and prevention problems were the most frequently cited violation in nursing homes last year.

Such poor care persists because regulators let the nursing home industry treat standards of care as goals rather than actual requirements. The nursing home industry wields enormous influence in Washington and state capitals through multimillion-dollar trade associations, powerful law firms and generous contributions to politicians and political action committees. As a result, nursing homes, rather than nursing home residents, are often viewed by policymakers as the constituency whose interests merit protection. After President Trump was elected, the Centers for Medicare and Medicaid Services started openly referring to the nursing home industry as its “customer.”

Numerous federal and academic studies over the years have found that government inspectors do a poor job finding substandard care and, even when they do, are woefully disinclined to penalize a facility for it.

This is because of the persistent failure to identify when residents have been harmed or put in jeopardy. For example, while pressure ulcers (bedsores) are a potentially life-threatening concern for nursing home residents, proper care can prevent or minimize a vast majority of them. 

Nursing home industry lobbyists often claim that their clients cannot afford to improve conditions because they make so little money. In fact, the for-profit sector of the industry has been growing for years, belying the notion that it is not a profit-generating industry. Profit margins from Medicare reimbursements have been in the double digits for about 20 years, according to the nonpartisan Medicare Payment Advisory Commission. . . . . In addition, nursing home profits are increasing under the new federal payment methodology introduced last October.

So we can’t accept industry excuses about costs or give in to Trump administration efforts to undermine regulatory standards and reduce the already low frequency of inspections. Instead, existing standards need to be more strictly enforced, and tougher standards need to be put in place. Residents’ lives depend on it.

Federal minimum staffing standards are long overdue. A study in 2001 determined that the typical nursing home resident needs about 4.1 hours of care each day just to meet his or her basic clinical needs (not to mention live with dignity). The average facility reports only 3.7 hours per resident per day.

The pandemic has made this worse.

We need to establish how much Medicare or Medicaid funds go to care and limit how much revenue nursing homes can siphon into profits, unrestricted administrative expenses or unaudited contracts with companies they control.

While reimbursement rates for Covid-19 patients are very high, there are no requirements that those funds be used to buy protective equipment, boost staffing or help residents get through this crisis.

A pandemic is a force of nature that cannot be avoided. But years of neglect by nursing homes have left millions of older residents unprotected from it. Many of the deaths we’ve seen could have been prevented. More lives can be saved if we demand more from the industry and from its regulators.