With the calendar pages flying off to the fall presidential elections, why isn’t today an excellent time for President Trump to thank Seema Verma for her service and send her packing as head of the Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services?
Two news organizations — Vox and Politico — have posted detailed and disturbing takedowns of CMS and its oversight failures that have helped to worsen the terrible Covid-19 toll in the nation’s nursing homes and other long-term care facilities.
CMS, for example, halted nursing home inspections as the pandemic broke out — with disastrous consequences, as the Washington Post explains in a separate report. The agency earlier had also acceded to industry bleating about tough regulation, with Verma and her agency relaxing fines on owners and operators for detected problems and easing training requirements for under paid, over worked, and already ill-trained caregivers. The training standards have gotten so lax that a reporter, in 40 minutes of online effort, became certified temporarily to be a 24/7 caregiving aide.
These sort of regulator bungles, news organizations say, played key roles in what has become a lethal and sickening debacle: The New York Times updated its accounting of the ugly data on nursing homes and other such facilities, tallying 57,000-plus deaths of the aged, sick, and injured, as well as their health care workers, and at least 316,000 confirmed infections. That represents 42% of all coronavirus deaths in this country during the pandemic and 9% of the nation’s diagnosed infections.
Long-term care deaths, at a more granular level, have been most of the coronavirus fatalities in 23 states, the newspaper reported, with the percentages even higher and more staggering in state-by-state scrutiny. In Maryland, for example, they amount to 60% of the Covid-19 deaths, while they are 59% of Virginia’s toll, and 30% in the District of Columbia.
The situation also is going downhill, with coronavirus surges in the South and West — with nursing homes and other long-term care facilities hard hit there, too. Owners and operators have insisted they are doing the best they can in hard circumstances unseen before. They say they lack sufficient testing, timely results, desperately needed personal protective equipment and other medical supplies. And CMS is not assisting with these challenges, as it might.
Resumed inspections show dismal practices
Inspections have resumed, and their results are concerning, the Washington Post reported, describing findings at a facility with “the most coronavirus infections in Virginia” and others. The newspaper story starts with a description of how facility staffers, frustrated by bungled temperature checks at the start of their shifts, simply walked past this screening and into work:
“Common mistakes at Virginia facilities [also] included staffers failing to wear masks or wash their hands and allowing residents who had tested positive for the coronavirus to mix with those who had not, according to public records reviewed by The Washington Post. Most facilities, including Annandale, quickly submitted corrective plans and have not been fined. Only two, in Richmond and Luray, received the most severe citation. Advocates for the industry say the inspections offer just a snapshot of the care being provided at facilities as they have dealt with the unprecedented challenges presented by the coronavirus.
“Fred Stratmann, a spokesman for the Annandale facility’s parent company, CommuniCare, said inspections helped identify areas for improvement and ‘showed that we needed to reeducate staff on a couple of areas.’ A nurse is now assigned to screen employees at the front desk from 6 a.m. until the receptionist arrives at 8 a.m. Signs have been posted in the elevators saying only two people should be inside during each ride.
“Relatives of some of those who died at Annandale Healthcare say the inspection reports are proof of missteps and oversights that increased the risk to their loved ones, especially as the virus overwhelmed long-term care facilities and left employees struggling to keep relatives informed of who was sick. ‘It’s just a mess there,’ said Chris Duncan, whose mother, an Annandale Healthcare resident, died on her 75th birthday, three days before the inspector arrived. ‘Probably how it started was one person didn’t get the [temperature] check. One person was contaminated and lit the gas on fire.’”
The Vox news site delves deep into how owners and operators of nursing homes and other similar facilities reached out to President Trump almost from his inauguration to seek lighter oversight, a request Verma grants, as reporters (notably from the independent, nonpartisan Kaiser Health News Service) have documented.
Regulators become industry lapdogs
CMS, for example, backed off from hefty fines against facilities, and the agency took the option of penalizing violations with lesser, one-time levies, rather than daily, accruing charges designed to get problems rectified — or else.
While the Obama Administration campaigned to require each facility to have its own trained infection control specialist as part of its staff, Verma and CMS proposed to allow these experts to be retained as consultants, instead. The agency’s re-envisioned role for these important infection-fighters would be that they would roll around multiple facilities, as many medical doctors do while serving as medical directors for multiple nursing homes. That sharing of medical expertise seems fine. Until crises erupt — including pandemics, earthquakes, and wildfires.
In the meantime, residents, of course, rely on their loved ones and hourly caregivers for their 24/7 needs. CMS, as Vox noted, based on Kaiser reporting, got so lax about regulating nursing home staffing that the agency effectively permitted facilities to self-police. They self-reported staffing data, including duty time for nurses, the key medical expertise at many facilities — until a Kaiser Health reporter cross-checked public payroll data against nursing home figures and found embarrassing discrepancies.
Politico reported dismaying information about how CMS has slashed at already minimal training and certification required for nursing home caregivers. As mentioned, it has become so spare that a reporter got it done in less time than most kids eat their lunch. How was this allowed? Politico explained:
“Shortly after the first coronavirus outbreak ravaged a nursing home in Kirkland, Wash., the Trump administration moved to fulfill a longstanding industry goal — waiving the requirement that nurse’s aides receive 75 hours of training and allowing people who study only eight hours online to become caregivers during the pandemic. The industry had been fighting for years to reduce training requirements, saying they make it harder to recruit staff. The day after the administration announced the change, the industry rolled out a free online training program for certifying the new role — called a ‘temporary nurse aide’ — that has since been adopted by at least 19 states.
“Now, after more than 55,000 nursing home residents and workers across the country have died from the coronavirus, advocates for older adults and families of residents say they fear the change was premature and contributed to the spread of the disease. Nurse’s aides are often the main caretakers of residents, some of whom need round-the-clock monitoring; nurse’s aides are also on the front lines in implementing the cleaning and disinfecting practices that prevent the spread of Covid-19.”
Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by abuse and neglect in nursing homes and other long-term care facilities. Yes, states and other lower levels of government have big roles in overseeing these centers (notably assisted living and memory care facilities) and safeguarding residents.
Holding officials accountable
But the chief oversight role with nursing homes and long-term care facilities falls on CMS and Verma. Are she and her boss, HHS Chief Alex Azar, and, yes, the president, responsibility free for the infections and deaths that have savaged residents of nursing homes and similar institutions and caused so much pain and heartbreak for their loved ones? When expensive jets don’t perform up to snuff, or when illness flares on a military vessel, or even when a company’s founder seems to go astray from an organization’s mission, executive heads roll. Why is Verma different?
By the way, she’s also the subject of a scathing report by her own agency’s inspector general, who found she mishandled millions of dollars of public money by going outside of normal bounds and actual needs to hire politically connected Republican consultants. Their job for her (um, and not for the good of we simple taxpayers, by the way)? To burnish her image, notably by seeking squishy coverage for her, including glamorous and fawning placements on women’s magazine covers. Really?
We’ve got huge work to do to improve and safeguard residents of nursing homes and similar facilities, during the pandemic and long after. We’d be better off in our labors, too, the record shows, without Verma.