New health care leader looks to clean up the nursing home mess
Chiquita Brooks-LaSure has won U.S. Senate confirmation and will become the first black woman to lead the federal Centers for Medicare and Medicaid Services or CMS.
The longtime government official, who was an adviser to President Obama and has served in multiple other top federal roles (shown right, with her boss, Health and Human Services head Xavier Becerra), jumps into a role with gigantic challenges. These include:
- The administration by her agency of federal health insurance programs, including for children and those covered under the Affordable Care Act. The Biden Administration and Democrats, as part of coronavirus pandemic rescue efforts, bolstered Obamacare and opened enrollment in it, with subsidies, to millions of Americans slammed by the coronavirus pandemic. But those efforts, which have boosted ACA enrollment, also will need renewed legislative support — which may occur right as the midterm elections are under way. CMS also may be a key part of some Democrats’ plans to improve health care coverage in this country by lowering the qualifying age for Medicare for 60-something Americans who often must pay staggering premiums and who lose jobs and employer-related coverage at scary rates. This is an idea that Republicans reject.
- The running of Medicaid, another federal program that President Biden and Democrats gave a shot in the arm to as part of pandemic rescue plans. But can Brooks-LaSure and her agency push the ACA’s Medicaid expansion so millions more poor and working poor people can get health coverage in states that, so far, have declined to expand Medicaid? Her nomination was stalled over a CMS-Medicaid battle that preceded her and involved Texas, the GOP, hospitals, and billions of dollars in federal aid for health care for the poor. The Biden Administration rescinded its predecessor’s approval of a waiver that would have sent big sums to Texas, but which critics said would stall or prevent the state from expanding Medicaid to its citizens.
- The efforts to deal with skyrocketing prescription drug costs, notably with legislation that would the federal government (CMS) to negotiate medication prices for the huge number of older Americans covered by Medicare. Proponents say that giving the federal government, with its huge clout, more leverage with Big Pharma could lead to price reductions for many more consumers. But drug makers and their industry advocates, notably among the GOP, have battled against this move.
Fixing the long-term care mess
Her Herculean efforts, critics and advocates alike agree, also must focus on dealing with the coronavirus pandemic’s terrible toll on nursing homes and other long-term care facilities. They are regulated by CMS, which, under Brooks-LaSure’s predecessor, eased its oversight of the institutions with disastrous consequence.
The U.S. Government Accountability Office, in a series of stinging studies, has found that not only were nursing homes lax with infection control and prevention, a preponderance of them suffered long-lasting coronavirus outbreaks with deadly results. The top government watchdog reported this:
“According to [the federal Centers for Disease Control and Prevention], a [viral] outbreak starts the week a nursing home reports a new resident or staff Covid-19 case and ends when there are 2 weeks with no new cases. GAO found that nursing homes had an average of about three outbreaks during the review period, with most of the nursing homes (94%, or 12,555 of the 13,380 nursing homes) experiencing more than one Covid-19 outbreak. For each nursing home’s longest-lasting COVID-19 outbreak, GAO found that about 85% (11,311 nursing homes) had outbreaks lasting 5 or more weeks … over half of the nursing homes (66%, or 8,720 homes) reported that these outbreaks began with a staff member who tested positive the first week.”
An increasing body of research has shown how nursing homes, under spiking pressure from owners and operators for profits, struggled to retain low-paid, over-worked, and highly stressed staff and to keep them healthy, especially as they quit in droves during the pandemic or moved around facilities, toiling in several jobs to make ends meet.
CMS, critics say, bungled its part of the Trump Administration’s shambolic pandemic response, pulling inspectors from facilities and giving weak pushes to provide masks, gowns, gloves, and other protective equipment to health workers in nursing homes. The agency created a “testing hell” during the pandemic with suddenly toughened requirements and a spotty, at best, plan to provide screening equipment to facilities.
An agency-ordered, nationwide lockdown of nursing homes left residents alone, isolated, lonely, terrified, and ever-more vulnerable, researchers and loved ones have found. Already debilitated and frail, many residents lost huge health ground as the pandemic ground on — and infections and deaths did not decline.
The crisis has quelled, notably due to aggressive vaccination of residents and staff. But not before great damage was done: AARP, the nation’s largest advocacy group for older Americans, reported in mid-May that the pandemic killed more than 183,000 residents and staff of nursing homes and other long-term care facilities. CMS has reported that roughly 1.2 million facility residents and staff had confirmed coronavirus infections.
Loved ones and residents are still sorting out the chaos and destruction of the pandemic on nursing homes and long-term care facilities, confronting tough choices, for example, as to whether to sue owners and operators. Hundreds of lawsuits have been filed, Politico reported, with facilities seeking to shield themselves from damage claims by invoking protections accorded to health workers, hospitals, and nursing homes by the Trump Administration and lawmakers at the worst moments of the pandemic.
Not good. In my practice, I see not only the harms that patients suffer while seeking medical care, the damage that can be inflicted on them by neglect and abuse in nursing homes and other long-term care facilities, and ordinary folks’ struggle to access and afford safe, efficient, excellent health care.
We’ve got a ways to go to set ourselves right after seeing the calamitous results of political partisans efforts to deny science, reject evidence, accept counter factual nonsense, and kowtow to extremists and wealthy corporate interests, especially in health care. In the wealthiest nation in the world, health care must be a right, not a privilege for the rich, and our government leaders and regulators must work for the people not special interests. We’ve got much work to do to ensure this is so.