This week, the nursing home industry was once again in the national spotlight as members of Congress called for for-profit ownership as resources were scarce and corporate structures were disrupted in the early months of the pandemic.
A congressional special subcommittee on the coronavirus crisis, chaired by Rep. James Cliburn, held a hearing on Wednesday to further delve into the impact of Covid-19 in nursing homes.
“The ferocity with which coronavirus swept through our nation’s nursing homes in 2020 has exposed vulnerabilities that have been built over the years,” Cliburn said at the hearing. “These long-standing problems have helped fuel the outbreak and exacerbate the risk.”
What was particularly lacking, according to industry experts and advocacy groups, were forward-looking conversations and practical solutions to the many concerns raised.
Scheduled hearings combined with report Issued on the same dayhas worked on several large nursing home chains, including Genesis HealthCare, Life Care Centers of America, Ensign Group (Nasdaq: ENSG), SavaSeniorCare, and Consulate Health Care, among others.
Lift the veil and find solutions
David Grabowski, a professor of health care policy at Harvard Medical School and a witness at the hearings, said residents have “lifted the veil” while the pandemic was an invisible social illness for decades. ” he said.
“There have been more than 1.2 million COVID cases among residents and about 172,000 Covid-related deaths. More than 2,600 nursing home staff have died from Covid, and nursing home workers have It’s the most dangerous job.
Rep. Grabowski urged members of Congress to increase vaccination levels and improve staffing through booster mandates, establish federal minimum staffing ratios, increase staff salaries and benefits, and provide workers with career opportunities. highlighted existing efforts to provide opportunities for advancement and a better working environment.
These recommendations were met with little follow-up from parliamentary delegates during the question-and-answer period.
Grabowski told SNN after the hearing, “We feel we have an opportunity here, but we didn’t take it at this hearing. In terms of actually drilling down into the
One member, Rep. Bill Foster of Illinois, asked how immigrants can play a role in filling the talent shortage. He called immigration reform the “obvious solution” to the labor shortage, saying that “hordes of highly qualified and well-trained nurses from around the world” have traditionally entered the U.S. I have filled in the line.
Adelina Ramos, a Rhode Island Certified Nursing Assistant (CNA) and member of 1199 SEIU New England, and Daniel Arbiny, son of a nursing home resident who died in the pandemic, also spoke at the hearing.
Labor unions have helped CNAs and other essential workers in care homes get sick leave and better health insurance, Ramos said, but owners and lawmakers have been asking for more than two years before the pandemic. The value of labor continues to fall.
“A union contract means management has to follow the rules,” Ramos said at the hearing. “It means workers are seated at the table. It means residents can fight to receive better care, but not all nursing homes have unions and labor People and residents are suffering.”
Misplaced hearings, systemic injustice, calls to action
One witness and a hand-picked group of congressmen spent a good deal of time discussing former Gov. Andrew Cuomo’s infamous March 2020 directive.
Other states, such as Michigan, New Jersey and Pennsylvania, have also followed suit by imposing such mandates in the face of task forces specially formed for Covid-positive patients, contrary to federal recommendations. Did.
“I think about the attention to … that took place over two years ago and the waning interest in where we are going when it comes to making meaningful changes in care homes and current processes. It’s a little disappointing, said Jasmine Travers, an assistant professor at New York University Laurie Myers College of Nursing and a hearing witness.
With such a focus on New York, the subcommittee made state decisions reflect systemic failures in how federal and state agencies respond to and address issues in the nursing home sector. Travers added that he missed the opportunity to see it as done.
Subcommittee members could have examined how decisions were made across state and federal lines and how these decisions were detrimental to the health, well-being and safety of residents. is.
She hoped the subcommittee’s questions would focus more on how to support nursing homes in the future while holding them accountable in an appropriate way.
In testimony, Travers told the subcommittee that the staffing shortages, inadequate wages and benefits, and lack of advancement opportunities initially outlined by Grabowski could be traced back to structural inequalities. said.
“It is important to highlight the systemic inequalities that have perpetuated disparities among nursing home residents. Homes with Black residents have significantly more Covid infections than homes without Black residents. and death,” Travers said at the hearing. “Black and Latinx residents are more likely to receive treatment for pressure ulcers, falls and pain.”
The department needs more training to better understand residents of different cultures, more scrutiny on biases, and more efforts to hire staff who are culturally aligned with residents, she said.
The need to address long-standing issues of quality of care and inadequate support facing nursing homes is only becoming more urgent, said Senior Advisor on Aging at the Institute for Healthcare Improvement, Moving Forward: Alice Bonner, chair of the Nursing Home Quality Coalition, said at the subcommittee.
In a separate letter to Congressman Cliburn and Ranking member Steve Scalise, Bonner identified six areas that lawmakers and nursing homes must work on together as older adults enter the post-acute care continuum. Called attention to important issues.
Funded by the John A. Hartford Foundation, the coalition is a two-year initiative to advance the recommendations in the 2022 National Academy of Sciences and Engineering (NASEM) report.
“I think what we really wanted to convey was this feeling that we have to act now. There’s been too much devastation in too long,” Bonner told SNN. “This is not about writing another big report. There is a NASEM report, which is 600 pages and full of recommendations. We will all be busy.”
Report sheds light on commercial enterprise structure
Hours before the hearing, the subcommittee released a report detailing the “dire situation” of for-profit nursing homes in the early months of the pandemic. Such companies, the authors write, have helped opaque corporate structures mask profits and avoid legal and regulatory accountability.
This report uses Genesys as an example and references over 700 individual business entities as of June 2020. Many of them acted as service providers to other facilities within the corporate structure.
The subcommittee acknowledged that these large nursing home chains, including Genesis, have undergone “significant restructuring” since June 2020, the furthest point from when the data were collected.
members of parliament are small market model Tested first by Ensigns, then by Genesis, among other named entities. Large companies establish regionally-led leadership teams to address the unique challenges of individual markets across the country.
According to CEO Barry Port, the model has allowed companies like Ensign to push the Covid trend, effectively use government exemptions and navigate the political climate.
consulate experience Rebranding and restructuring after last year’s bankruptcy filing and financial settlement with the Department of Justice.
In an email to Skilled Nursing News, Genesis spokesperson Lori Mayer told Skilled Nursing News in response to the report that it is “a common practice for large companies to have different entities and structures.” .
The Kennett Square, Pennsylvania company serves more than 200 affiliated locations.
Attempts to contact Ensign, SavaSeniorCare, Life Care Centers of America, and consulates did not return immediately.
Old data is intended for commercial organizations
Other key findings of the report were that many facilities were severely understaffed early in the pandemic, and that for-profit nursing home chains were not providing workers with adequate personal protective equipment (PPE). suggesting that
The report also found that nursing homes are pressuring staff to continue working despite having Covid symptoms or testing positive.
Aged services organizations such as the American Health Care Association (AHCA) noted that all long-term care providers, regardless of business structure, were asking public health agencies and policy makers to send support early in the pandemic. I pointed it out right away.
LeadingAge CEO Katie Smith Sloan said nonprofit nursing homes are “seeking critical resources,” including PPE, Covid testing and increased support for staff, especially nursing assistants and other frontline staff. ‘ said.
“We are with Congress [Biden] Governments act responsibly towards broader change. It’s time to fix our broken systems of funding, oversight and support for nursing homes,” Sloan said in a statement.
AHCA CEO Mark Parkinson said AHCA CEO Mark Parkinson has seen “great progress” in reducing patient and death rates in nursing homes as the sector begins to receive the help it needs.
“It’s disappointing to have to remind lawmakers what those early days were like,” he said in a statement. “Almost all nursing homes in the country have struggled to obtain personal protective equipment due to supply chain disruptions, limited supplies of testing, and additional staff support as most government support is directed at hospitals. did.”
AHCA urges Congress to focus on serious remaining challenges at this point in the pandemic, including historic labor shortages.
