With nursing home operators bleating up a storm of weak defenses and denials, soaring Covid-19 infections and deaths have laid siege to far too many long-term care facilities in Maryland, Virginia, and the District of Columbia. The consequences have been dire.
In Maryland, the Baltimore Sun reported:
“Nearly three-fifths of Marylanders killed by the coronavirus are residents of long-term care facilities, according to [a recent state] update of nursing home data …The Maryland Department of Health reported that 793 of the state’s 1,338 victims, almost 60%, were residents of nursing homes, rehabilitation facilities and similar long-term care facilities. An additional 11 deaths were staff members of those facilities, with more than one of every five of Maryland’s confirmed infections being a resident or staff member of congregate living facilities.”
In Virginia, the Richmond Times-Dispatch reported that:
“Outbreaks in long-term care facilities — nursing homes, assisting living and memory care units — account for more than half of the Covid-19 deaths in Virginia … Statewide, long-term care facilities account for 150 of the 260 documented Covid-19 outbreaks, 3,172 cases and 470 deaths.”
In D.C., the story is the same, a television station reported:
“Seventy residents and two employees of long-term care facilities in Washington, D.C., have died after they were infected with the coronavirus, [recent] data released by the city … shows. [On] April 22, D.C. reported that 14 residents had died of the virus. Residents of long-term care facilities now account for more than 25% of the 258 people counted by D.C. to have died of the virus. The total number of facility residents infected is 247, and 85 employees have tested positive.”
Officials’ frustration with at least one nursing home —the Sagepoint Nursing and Rehabilitation Center (pictured above) — has boiled over, with regulators imposing $10,000-a-day fines against the nonprofit facility’s operators, with the Sun reporting:
“Saying Sagepoint Nursing and Rehabilitation Center jeopardized the health and safety of its residents, the Maryland Department of Health is fining the Charles County facility $10,000 a day dating to March 30 for ‘widespread deficiencies’ in testing, providing its staff with protective equipment and isolating those who tested positive for the coronavirus. Sagepoint, which has more deaths than any other nursing home in Maryland, came under scrutiny as officials sought to control the spread of the virus through such facilities, sites of nearly three in five COVID-19 deaths in the state. According to Maryland data, at least 34 residents and one staff member at the home in La Plata have died of the respiratory disease and 97 residents and 32 employees have tested positive for the coronavirus.”
The Washington Post dug into what happened at Sagepoint, finding the situation there illustrative of calamitous decision-making, particularly by operators of such facilities:
“Former and current employees at Sagepoint and six other nursing homes in Maryland say the virus spread rapidly as their facilities struggled with shortages of staff, testing and personal protective equipment. At several nursing homes, employees said, managers played down the severity of outbreaks and did not provide masks and gowns until patients had tested positive. Staffing is so limited at one Silver Spring facility that the administrator sometimes sleeps there overnight. A nurse at a skilled-nursing facility in Rockville said there are coronavirus-positive patients ‘all over’ the building, even though managers say those patients have been isolated.”
“66 of the 95 residents of the nursing home … had tested positive for Covid-19. One, a man in his 90s, died in his bed. By morning, another resident would be gone. The nursing home’s medical director was nowhere to be found, according to two government officials, who said the doctor later explained he was self-quarantining because he believed he had been exposed to the virus. Nurses with limited supplies and little supervision were struggling to treat rapidly deteriorating patients. [The county health officer] had spent hours the previous day searching for backup, to no avail. A paramedic who responded to a 911 call found the halls eerily quiet, with staff members masked and not talking, and ragged coughing audible from behind closed doors … the fast-spreading virus had already overwhelmed the nursing home’s staff and filled nearby hospitals to capacity, according to interviews with 18 people directly involved in the crisis [events moved so fast that], 99 residents and staff [soon] had tested positive. Forty-two people were hospitalized, and six were dead. Four more people would die over the weekend.”
In Virginia, a Richmond-area nursing home, part of health system owned by a private equity investment group, with “one of the nation’s highest numbers of coronavirus deaths” at the time partly blamed society for its willingness to “warehouse” the elderly in underfunded public facilities for the Covid-19 nightmare that swept the Canterbury Rehabilitation & Healthcare Center. It would lead to the infection of 148 residents and staff, killing 40.
The facilities assert that “we did the best we could.” The reality is that alarms for such facilities rang loud and long for weeks, with their operators, politicians, and regulators stumbling and fumbling, failing to care for frail and vulnerable people in their care, whether due to age, illness, or injury.
Let’s recall that national news media reported widely, starting in early March about a disaster occurring in a Kirkland, Wash., nursing home, where too many residents were infected and died of the illness that would become known as Covid-19. The outbreak there also took down first responders and threatened the health care system in Washington state.
On March 9, this blog posted information about that outbreak and noted that “long before the world and nation struggled with the coronavirus, nursing homes — including the purported best of them — too often were tagged for infectious outbreaks …Paying heightened attention to the well-being of institutionalized loved ones may be an important way to safeguard them during these infection-challenged times. ”
For facility operators across the region, however, the path during the pandemic was to delay and deny. Read the news articles and the commonalities emerge: The homes were already short on staff and light especially on medical personnel like staff nurses and visiting doctors — not just titular medical directors. Instead, low-paid and often earnest but ill-trained, little equipped, and terrified hourly workers were left to deal with calamitous circumstances that worsened by the moment. And even many of them either were infected or simply decided the risks in their work was too great for too little pay and quit.
The health workers — no matter what their bosses insisted — lacked the needed personal protective equipment: face coverings or masks and gloves that would help keep them and their charges safer. Officials, with a shameful dearth of tests available, made residents of long-term care facilities near the bottom as a priority.
Federal officials, in an unacceptable response, halted inspection of nursing homes, claiming that greater attention would be paid to facilities with histories of infection control problems. The feds effectively not only abandoned the field, they also sent a powerful message to state and local regulators.
Further, politicians and public health officials stonewalled the public and media, declining to provide — even to loved ones — information about infections and deaths among institutions’ residents and staff. In Virginia, this nonsense hit a peak when the facilities themselves begged state officials for the disclosures because they could not compel them from their own staff — with many of the struggling workers hopping from facility to facility to piece together a living but also potentially carrying infections from their many different work places.
As families implored facilities and their operators, as well as politicians and regulators, for information, they too often learned that, with little regard for infection control or safety, nursing homes and other long-term care centers, if they knew of resident or staff infections, failed to separate the healthy and the sick. They then disrupted their existence, shuffling them around their buildings with few precautions and in the pretense of better treating the infected. Facilities would claim they followed federal guidelines in foregoing gloves, masks, and gowns for caregivers who moved from resident to resident, close up, to feed, clean, and medicate them. Don’t scare the residents, staffers were told. Facilities shut their doors, purportedly to safeguard residents from outsiders bringing in infections. But this meant that families and loved ones could not see how the scant and panicked health care workers were treating terrified residents — isolated and with challenges to basic care like nutrition and hygiene.
Maryland’s governor since has made nursing home and other long-term care facilities a top priority in the state’s evolving Covid-19 response with increased access to testing and PPE and the launch of a “strike force,” also emulated in Virginia, which has pulled in National Guard medical corpsmen to assist.
The ferocity with which the pandemic has staggered nursing homes and other long-term care facilities ought not to be a surprise — and it is a national shame, the New York Times reported, digging into the profit-seeking investors who have tried to capitalize on a graying America and its need for care for older, sick, injured, frail, and vulnerable people:
“When the pandemic struck, the majority of the nation’s nursing homes were losing money, some were falling into disrepair, and others were struggling to attract new occupants, leaving many of them ill equipped to protect workers and residents as the coronavirus raged through their properties. Their troubled state was years in the making. Decades of ownership by private equity and other private investment firms left many nursing homes with staggering bills and razor-thin margins, while competition from home care attendants and assisted-living facilities further gutted their business. Even so, many of their owners still found creative ways to wring profits out of them, according to an analysis of federal and state data by The New York Times. In many cases, investors created new companies to hold the real estate assets because the buildings were more valuable than the businesses themselves, especially with fewer nursing homes being built. Sometimes, investors would buy a nursing home from an operator only to lease back the building and charge the operator hefty management and consulting fees. Investors also pushed nursing homes to buy ambulance transports, drugs, ventilators and other products or services at above-market rates from other companies they owned. These strategies paid off handsomely for investors, but they forced nursing homes to skimp on quality. For instance, for-profit nursing homes — roughly 70% of the country’s 15,400 nursing homes and often owned by private investors — disproportionately lag behind their nonprofit counterparts across a broad array of measures for quality, The Times found. Also, they are cited for violations at a higher rate than nonprofit facilities. The toll of putting profits first started to show when the outbreak began. No nursing home could be completely prepared for a pandemic as devastating as Covid-19, but some for-profit homes were particularly ill equipped and understaffed, which undercut their ability to contain the spread of the coronavirus, according to interviews with more than a dozen nursing home workers and elder-care lawyers.”
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 nursing home neglect and abuse. The speed and devastation caused by the novel coronavirus has knocked the planet on its heels, overwhelming parts of the U.S. health care system with huge harms. That said, too many nursing homes and other long-term care facilities set up their residents and their loved ones for unacceptable consequences with poor planning, responses, staffing, equipment, and basic diligence and due care. Many of the facilities were wringing sky-high charges from those in their care or they rode well on government funding for programs for the debilitated elderly, chronically ill, and seriously injured. Financial legerdemain allowed them to maximize their profits, not with outstanding frontline care but with real estate leasing and equipment or services purchasing schemes.
Bad operators may need to be held accountable, not only by regulators, who too often were dozing themselves, but also by politicians and lawmakers. (Shame on the federal Centers for Medicaid and Medicare Services for its missing-in-action oversight of the facilities during the pandemic — and how little do we expect from its announced ‘independent’ review commission?) When Congress finally returns to full action, multiple House and Senate committees should jump on investigations of Covid-19’s toll on health care and especially nursing homes and long-term care facilities.
Here’s something else the folks on Capitol Hill should think twice about even trying to do — which is to yield to the bankrolls and sway of powerful business interests that want to shield nursing homes and long-term care facilities from lawsuits, granting them legal immunity from those seeking justice for harms caused by negligence, neglect, and abuse. The civil justice system may be imperfect, but it may provide a sorely needed disinfectant for a long-term care industry with its gaping flaws and challenges laid bare by a fast-spreading infection. Too many of us may require the too-costly for too-little services of these problematic providers as we age or suffer injury, so we not only have much work to do to make them safer, better, and more livable, Covid-19 has shown us we needed to undertake our big labors — yesterday.