Nursing home deaths spiked 32% in 2020 due to pandemic, U.S. watchdog finds

covidnhomedatahhsig-300x175The coronavirus pandemic slammed nursing homes and other long-term care facilities hard in two heart-breaking waves eight months apart. Covid-19 caused the institutions’ fatalities to spike by almost a third over the year before, leaving roughly 170,000 of the elderly, injured, and ill dead, as well as 4 in 10 Medicare-covered residents infected.

Those are some of the grim statistical views of what occurred in nursing homes, notably to residents covered under the federal Medicare program, according to the Office of the Inspector General in the federal Health and Human Services agency (the HHS IG).

The top health watchdog examined “excess deaths” that occurred in 2020 during the pandemic among Medicare beneficiaries, noting that federal officials had exempted nursing homes from reporting Covid-19 cases and deaths in the early part of the year and such infections and fatalities often were not noted in official records, such as death certificates. As the Associated Press reported:

“Investigators used a generally accepted method of estimating ‘excess’ deaths in a group of people after a calamitous event. It did not involve examining individual death certificates of Medicare patients but comparing overall deaths among those in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus surge last spring. It does not attribute a cause of death but is seen as a barometer of impact.”

By all the new federal analyses, the pandemic’s toll on nursing homes was worse than even experts had thought.

Deaths in the facilities were up 32% over the year before, claiming just under 1 in 5 of all Medicare beneficiaries in nursing homes, the published report said:

“The pandemic had far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had Covid-19. Among all Medicare beneficiaries in nursing homes, 22.5% died in 2020, which is an increase of one-third from 2019 when 17.0% of Medicare beneficiaries in nursing homes died. This 32% increase amounts to 169,291 more deaths in 2020 than if the mortality rate had remained the same as in 2019. Each month of 2020 had a higher mortality rate than the corresponding month a year earlier.”

Residents of color were hit hard by the coronavirus, the AP reported of the IG study (see figure above):

“In another new finding, the report showed that cases and deaths among Asian American patients tracked with the more severe impacts seen among Blacks and Latinos. Indeed, Asian Medicare enrollees in nursing homes saw the highest increase in death rates, with 27% dying in 2020 compared to 17% the previous year. For whites, the death rate grew to 24% in 2020 from 18% in 2019, a significant increase but not as pronounced. Death rates for Hispanic and Black patients were 23% last year, up from 15% in 2019.”

Officials said that developing more and better information about the pandemic’s toll will be crucial in determining why it proved so awful — including the causes of the two lethal spikes, especially the one that occurred in December — and help them develop ways to deal better with future disease outbreaks.

Aggressive vaccination of nursing home staff and residents has proven decisive in quelling the disease and its harms in institutions: 80% of residents and 55% of staff now have been vaccinated.

Staffing shortages and harsh health restrictions persist

Still, the owners and operators of nursing homes and other long-term care facilities still face huge deficits in care laid bare by the pandemic.

They not only have struggled to get health workers and other facility staff vaccinated but simply to keep enough of them onboard. A recent survey by an industry group of 616 nursing homes found that 94% of them said they are grappling with staffing shortages and nearly three-quarters said they were in far worse personnel shape than they were in the year before. As a trade publication reported: “Facilities are actively trying to hire across the board, including registered nurses, licensed practical nurses, certified nursing assistants, dietary staff, and housekeeping.”

Studies have shown that calamitous conditions that prevailed in all too many facilities — including the spread and lethality of the coronavirus — were closely tied to nursing homes problems with staff. Too many were poorly paid, overworked, under trained, stressed to the max. The health workers all too often were forced to make ends meet by taking multiple nursing home jobs. This meant that they went from facility to facility, making residents sick and getting sick and dying themselves.

Loved ones also complain that nursing homes and long-term care facilities have not eased rigorous measures they put in place during the pandemic in hopes of reducing infections and deaths. These steps keep frail and vulnerable residents — even if they have been vaccinated and may not need intensive safeguarding from others — isolated, lonely, alone, and afraid, complaining families say, arguing the measures are contributing to their loved ones’ decline.

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 neglect and abuse in nursing homes and other long-term care facilities.

The pandemic became an unacceptable and deadly look for us all at the many ways that nursing home owners and operators pursued profits at the expense of residents and their loved ones. They claimed they did the best they could under dire and unforeseen circumstance.

Where’s the accountability for an inarguable debacle? 

But even as taxpayers have dumped billions of dollars to shore up the needed facilities, where is the accountability for the debacle that occurred with them — yes, including with the shambolic regulatory response to a mass incident responsible for roughly a third of all deaths in this country due to the coronavirus?

Critics love to slam malpractice lawyers and the civil justice system. But many nursing home residents and their families, struggling still with the consequences of the pandemic, are thinking hard as to whether their best recourse may be lawsuits to search for justice for wrongs done to them.

The inspector general, the Government Accountability Office, news organizations, and others digging into the nursing home nightmare with the pandemic deserve praise. But where are the staff members of congressional committees and lawmakers themselves? Where are legislative committees and governors across the country?

We have much work to do to learn what went wrong with nursing homes and other long-term care facilities during the pandemic, to fix the systemic problems, and to provide a reckoning to those who allowed tens of thousands to die and millions to suffer infection with the coronavirus.

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