Federal regulators have issued, at long last, the data they have collected on the novel coronavirus’ effect on nursing homes, giving an incomplete but still devastating look at how in just a few months some of the nation’s most vulnerable people have been savaged by Covid-19.
With 12% of the nation’s nursing 15,000 homes yet to report, the Centers for Medicare and Medicaid Services (CMS) has tallied “25,923 resident deaths tied to Covid-19 … and 449 deaths among the facilities’ staff. The [U.S.] survey also found about 95,000 infection cases at nursing homes across 49 states, about a third of them among staff members,” the Wall Street Journal reported.
The newspaper finds that figure far too low, noting:
“A Wall Street Journal tally of state data from around the U.S. shows more than 42,000 Covid-19-associated deaths in long-term-care facilities, including nursing homes and assisted-living sites, along with more than 200,000 cases. This tally, too, likely undercounts the full impact of the outbreak because of reporting lags and incomplete information from some states.”
NBC News also reported the CMS figures as inaccurate:
“[They] are significantly lower than other estimates, as they capture only a part of total coronavirus deaths associated with nursing homes. The federal government is not requiring facilities to report data on cases or deaths that happened before May … According to the latest NBC News tally, nearly 40,000 coronavirus deaths are associated with nursing homes, assisted living and other long-term care facilities since the beginning of the pandemic — representing almost 40% of all coronavirus deaths in the U.S. The NBC News tally is also likely to be an undercount, as a handful of states have still not released their nursing home death tolls.”
The grim news about the virus and nursing homes isn’t limited to fatalities alone, as the Washington Post reported:
“The data offer a statistical portrait of an industry at the center of the pandemic’s fury unable to properly care for its 1.4 million residents: Nearly 2,000 facilities reported a shortage of nursing staff and more than 2,200 said they lack enough aides … The figures on basic supplies are similarly dire: More than 250 nursing homes lack any surgical masks and another 800 are within a week of running out. More than 2,000 are a week away from running out of gowns and more than 800 are a week away from depleting hand sanitizer supplies. More than 500 lack any N95 masks used to prevent infection … ‘We have failed the residents and we have failed the staff as a society,’ said Michael Wasserman, president of the California Association of Long Term Care Medicine. Nursing homes with stringent infection control and adequate staffing were better equipped to prevent the spread of the coronavirus once it struck, Wasserman said, but even the best nursing homes lacked personal protective equipment and access to testing.”
Nursing-home owners and operators persist in arguing that they have done and continue to do what they can to cope with dire circumstances far beyond their control. But critics, including federal officials, have blasted back, emphasizing that facilities that had performed poorly before the coronavirus struck have fared far worse in the pandemic.
CMS Administrator Seema Verma, the Washington Post reported, argued that many nursing homes that made “stringent efforts” to screen staff and enforce hand-washing and other infection-control measures saw no outbreaks or deaths. Her “agency looked at homes with high rates of infection and death and noted that many of them had previously received poor grades for quality. Other academics, including Charlene Harrington at the University of California at San Francisco and Yue Li at the University of Rochester, have connected the outbreaks to shortages in staffing. ‘Not all nursing homes were hit. Not all nursing homes report cases,’ Verma said. ‘They took the appropriate steps and precautions and the virus didn’t spread. Our data shows something very different,’ she said.”
It also is true that facilities struggle still in “pitiful” fashion to pay for and find desperately needed testing and medical supplies, notably personal protective equipment for staff, the Washington Post reported, quoting Katie Smith Sloan, CEO for LeadingAge, the trade group for nonprofit senior care:
“Months into the crisis, it is pitiful that aging services providers are still scrounging for PPE. Too often, the only signs of [the Federal Emergency Management Agency’s] much-hyped promise of PPE shipments — an allotment of gowns, gloves, masks and goggles based on staffing size of the provider — are scattershot delivery with varying amounts of rag-tag supplies.”
The industry is just beginning to see $5 billion or so in congressionally approved rescue money, even as trade officials insist that at least twice that sum in taxpayer help is needed — along with consistent and sustained support from federal and state officials.
Indeed, CMS is only now catching up in informing the public about the coronavirus’ big harms in nursing homes and other long-term care facilities. The agency shut homes to outsiders and suspended its inspections of the care-giving sites, saying it wanted to target its oversight on the most problematic facilities.
But a clamor from the public, and especially excellent public service and digging by media organizations, forced state and local officials to stop attempting to keep secret Covid-19’s terrible toll on nursing homes and other facilities. CMS promised for weeks to provide the data it just released, and the agency now is talking tougher with owners and operators about complying with disclosure requirements and facing stepped up inspections.
Look at the agency’s own web site and the pitfalls become clear with CMS snarling at long-term care facilities about improvements: Before the pandemic, the agency said it had a network of 5,000 state-based inspectors checking on 15,000 facilities. CMS noted that many of its inspectors have been detailed to other duties, including providing front-line care.
That means more responsibilities fall on state partners, and they have struggled at their tasks, even in big and well-resourced states like California. That’s because they still lack the significant federal powers and resources. The Trump Administration, as the pandemic has raged, has steadily made it clear that the burdens of dealing with Covid-19 — with testing and getting needed supplies — would fall to states and that the federal government would not, in a departure from its usual role in a nationwide emergency, take a prime, leadership role.
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 abuse and neglect. While the coronavirus has sickened and killed people around the globe in a way that few could have anticipated, the dubious care-giving practices and profit-hungry business models of nursing homes and other long-term care facilities arguably left open to great and unacceptable harm those who rely on the facilities.
Their owners and operators, as well as those who have regulated them, need to be held to account in due time if they have allowed by neglect, willful or criminal action, for deficiencies to flourish, worsening the coronavirus’ effects.
That said, for the sake of the aged, sick, and injured, we can and must do more to stop Covid-19’s assault on nursing homes and other long-term care facilities. The coronavirus hasn’t gone away. There is no magic to stop it. State and federal officials must provide urgent testing, isolation, and treatment of residents who are sick. They must increase more their reporting and transparency about what’s going on in the facilities.
The Wall Street Journal, separately, has reported that nursing home long-term care centers have been emptied of 10% of their population — roughly 100,000 of the 1.5 million people who were estimated to be in the facilities. Some of the decline may be due to hospitals not racing to clear their beds by sending the sick or injured to them. As already noted, an unacceptably high proportion of that number may be due to deaths. Loved ones also may be keeping the elderly, sick, and injured in their care, foregoing institutionalization. The responsibilities in doing so are immense, and it is heart-wrenching to think about how this nation looks away from the burdens of caregiving by families and friends.
The nation is graying fast and we have much work to do to not only deal with our current, big problems but to make much, much better our nursing home and long-term care.