Grim reprise in nursing homes: four-fold infection hike and doubling deaths

apnursinghomesurgechart-270x300Coronavirus cases are spiking among residents and staff at nursing homes and other long-term care facilities. They increased four-fold between May’s end and late October — even as deaths among the vulnerable also doubled, disturbing new data show.

Those are the findings of Rebecca Gorges and Tamara Konetzka, University of Chicago researchers who analyzed federal data at the request of the Associated Press. They focused on 20 states hard hit by the latest pandemic surge.

Konetzka said the data raise major questions about the Trump Administration’s efforts to safeguard the aged, ailing, and injured in institutional care by sheltering them from infections in their surround areas and increasing testing for residents and health workers. But Koentzka, an expert on long-term care, told the AP this about such a plan:

“Trying to protect nursing home residents without controlling community spread is a losing battle. Someone has to care for vulnerable nursing home residents, and those care givers move in and out of the nursing home daily, providing an easy pathway for the virus to enter.”

For long-term care facilities, unhelpful delays in test results

The independent, nonpartisan Kaiser Health News Service reported with CNN another significant failing in the federal pandemic response for long-term care facilities:

“Nursing homes are still taking days to get back Covid-19 test results as many shun the Trump Administration’s central strategy to limit the spread of the virus among old and sick Americans. In late summer, federal officials began distributing to nursing homes millions of point-of-care antigen tests, which can be given on-site and report the presence or absence of the virus within minutes. By January, the Department of Health and Human Services is slated to send roughly 23 million rapid tests. But as of Oct. 25, 38% of the nation’s roughly 15,000 nursing homes have yet to use a point-of-care test, a KHN analysis of nursing home records shows.

“The numbers suggest a basic disagreement among the Trump administration, state health officials and nursing home administrators over the best way to test this population and how to strike the right balance between speed and accuracy. Many nursing homes still primarily send samples out to laboratories, using a type of test that’s considered more reliable but can take days to deliver results. As a result, in 29% of the approximately 13,000 facilities that provided their testing speed to the government, results for residents took an average of three days or more, the analysis found. Just 17% of nursing homes reported their average turnaround time was less than a day, and the remainder tended to get results in one or two days. Wait times for test results of staff members were similar.

“Those lags could have devastating consequences, because even one undetected infection can quietly but rapidly trigger a broad outbreak. It’s especially concerning as winter sets in and the pandemic notches daily records of infections.”

The Centers for Medicare and Medicaid Services (CMS), the federal regulator of much of the nation’s long-term care, disagreed with the AP and KHN reports, arguing the administration is doing the best it can in battling the coronavirus in institutions. As the AP reported:

“The administration has allocated $5 billion to nursing homes, shipped nearly 14,000 fast-test machines with a goal of supplying every facility and tried to shore up stocks of protective equipment … [CMS] issued a statement saying that ‘the bottom line is that the COVID-19 pandemic’s effect on nursing homes is complex and multifactorial.’ The agency noted different ways the administration has worked to help nursing homes and said its focus now was on ensuring that residents and staff would ‘immediately’ have access to a vaccine once approved. But it also added that facilities ‘bear the primary responsibility for keeping their residents safe.’”

Months into the pandemic, home owners, operators, state officials, and health workers have complained that CMS has provided insufficient support and leadership, leaving front-line care givers to struggle with coronavirus illness themselves, inadequate staffing, pay, and training. Facilities also are struggling with personnel shortfalls that heighten residents’ health risks and inadequate supplies and resources, notably of personal protective equipment.

Financial problems rise in care industry

These concerns are not disappearing, and financial analysts say that the industry itself may be hitting its limits to deal with the coronavirus. As the Market Watch financial news site reported recently:

“The Covid-19 pandemic is plunging U.S. nursing homes into a major financial crisis and many of them could go out of business, says a survey released by the industry’s trade association, the American Health Care Association/National Center for Assisted Living, or AHCA/NCAL. In a poll of nearly 500 nursing home operators, 72%, said they couldn’t keep going for another year under current conditions while 55%, said they were running at a loss. As politicians on Capitol Hill grapple with another rescue package, nearly all nursing home operators—92%—say they’ve received financial aid during the crisis, and 58% say they’ll face ‘significant’ financial problems when it ends. University of Alabama Health Administration professor Robert Weech-Maldonado, an expert in the field of nursing home economics, says the findings of the survey are credible and even unsurprising. The pandemic has forced homes to spend a lot more money, especially on extra staff and personal protective equipment.”

The longer-term viability of long-term care should be raising big alarms among the nation’s policy makers, Market Watch reported:

“The question is going to be where this leaves the industry and indeed the aging population. The over-75 U.S. population is forecast to double over the next 20 years to about 5.5 million, which is more than three times the current number of nursing home beds. Meanwhile costs have already been rising sharply and at the moment it costs on average about $100,000 a year to stay in a nursing home. How many elderly Americans can afford that?”

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. The terrible toll that the novel coronavirus has taken on the vulnerable has not lessened, despite purported pushes against the disease by federal and state officials. The New York Times reported this:

“At least 87,000 coronavirus deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults in the United States … As of Oct. 30, the virus has infected more than 581,000 people at some 23,000 facilities.”

This is unacceptable, as is the apparent federal torpor in responding to the pandemic, particularly in nursing homes and other long-term care facilities. It will be an imperative of the post-pandemic era, which the nation eventually will get to, to investigate and hold accountable politicians, regulators, owners, and operators of long-term care facilities for the suffering and death that has occurred in nursing homes during the pandemic. Some of the harmed — residents and their loved ones — may seek justice in the civil system.

Even before then, though, we have much work to do to safeguard the elderly, ailing, and injured, and to ensure that they and the facilities they live in do not collapse into worse conditions during the difficult days ahead. We’ve got a lot of work to do.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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