The nursing home industry returned to the national spotlight this week as federal lawmakers called for for-profit ownership due to their lack of resources during the early months of the pandemic and overwhelmed corporate structures.
The Congressional Select Subcommittee on the Coronavirus Crisis, chaired by Representative James Claiborne, held a hearing Wednesday to dig deeper into the impact of Covid-19 on nursing homes.
“The ferocity with which the coronavirus swept our nursing homes in 2020 exposed vulnerabilities that have been piling up for years,” Claiborne said during the hearing. These protracted problems have helped spread epidemics and exacerbate risks.
What was notably absent, according to industry experts and advocacy organizations, were future conversations and actionable solutions to many of the concerns raised.
The scheduled meeting is accompanied by a report Released on the same daywhich specifically took on the task of several large nursing home chains including Genesis HealthCare, Life Care Centers of America, Ensign Group (Nasdaq: ENSG), SavaSraduateCare and Consulate Health Care.
Lifting the veil and finding solutions
Residents felt the pandemic had “lifted the veil” from a social disease unseen for decades, David Grabowsky, a professor of health care policy at Harvard Medical School and a witness during the hearing, said.
There have been more than 1.2 million COVID cases in the population resulting in nearly 172,000 Covid-related deaths. More than 2,600 nursing home employees have died from Covid, making the nursing home worker the most dangerous job in America,” he said during the hearing.
Grabowski urged members of Congress to increase vaccination levels by commissioning reinforcements, improving hiring, emphasizing current efforts to create a minimum federal hiring ratio, increasing employee wages and benefits, and providing workers with opportunities for career advancement and a better work environment.
These recommendations met with little follow-up from the congressional audience during the question-and-answer period.
“I feel like we had an opportunity here and we didn’t take that opportunity during this hearing, in terms of focusing on where we’re going and looking for a bunch of ideas,” Grabowski told SNN after the hearing.
One member, U.S. Representative Bill Foster of Illinois, asked how immigration could play a role in closing the employment gap. He called immigration reform an “obvious solution” to the labor shortage, with “hordes of highly qualified and well-trained nurses around the world” who have traditionally entered the US workforce to fill the employment pipeline.
Also speaking at the session were Adelina Ramos, a certified nursing assistant (CNA) in Rhode Island and 1199 member of SEIU New England, and Daniel Arbeni, the son of a nursing home resident who died during the pandemic.
Ramos said unions have helped the CNA and other essential nursing home workers get sick leave and better health insurance, while landlords and lawmakers continue to devalue the workforce more than two years into the pandemic.
“Contracting the union means that management must follow the rules,” Ramos said during the session. “This means that workers have a seat at the table. It means we can fight for our residents to get better care, but not every nursing home has a union and workers and residents suffer.”
Heard missed mark, systematic unfairness, and a call to action
A witness and a select group of members of Congress spent a significant amount of time discussing the infamous March 2020 guidance by former Governor Andrew Cuomo, which ordered nursing homes to accept patients with Covid despite their unwillingness to do so.
Other states like Michigan, New Jersey and Pennsylvania have followed suit with such a mandate, which has opposed federal recommendations and flew into the face of special units assembled specifically for Covid patients.
“I am a little frustrated in terms of the interest in… the actions that happened over two years ago, the lower focus on where we are going from here, in terms of making meaningful change in nursing homes and the processes that are being done,” said Yasmine Travers, Associate Professor. at NYU Rory Myers School of Nursing and a witness during the hearing.
With such an intense focus on New York, Travers added, the subcommittee missed an opportunity to present state decisions as a reflection of a systemic failure in how federal and state agencies respond to and address issues in the nursing home sector.
She told Skilled Nursing News, that subcommittee members were able to examine the ways decisions were made across state and federal lines, and how those decisions were detrimental to the health, well-being and safety of residents.
She hoped the subcommittee questions would focus more on ways to support nursing homes in the future while holding them accountable in appropriate ways.
In her testimony, Travers told the subcommittee that staff shortages, inadequate pay and benefits, and a lack of advancement opportunities—first identified by Grabowski—can be traced back to structural inequality.
“It is important to highlight the systemic disparities that have perpetuated inequalities among nursing home residents — homes with any black resident have suffered significantly more Covid infections and deaths than homes without black residents,” Travers said during the hearing. “Black and Hispanic residents are more likely to have pressure sores, falls and are under pain medication.”
She said more training is needed to better understand residents of other cultures, more scrutiny about biases and more effort to recruit culturally compatible staff with residents in the sector.
Alice Bonner, senior advisor on aging at the Institute for Healthcare Improvement and chair of Moving Ahead: The Nursing Home Quality Coalition, told the subcommittee that the need to address the long-standing issues of quality of care and inadequate support facing nursing homes has increased urgently. .
In a separate letter to Representative Claiburn and ratings member Steve Scales, Boehner drew attention to six key issues that lawmakers and nursing homes must work on in partnership, as an increasing number of seniors enter the acute aftercare continuum.
Funded by the John A. Hartford Foundation, the Alliance is a two-year initiative to present the recommendations in the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) Report.
“I think what we really wanted to convey was this sense that we have to take action now. It’s been a long time, and there’s been a lot of devastation,” Bonner told SNN. “This isn’t about writing another big report. We have a NASEM report — it’s 600 pages, it’s full of recommendations. It would keep us all busy for the rest of our jobs if we only focused on this report and the recommendations in that report.”
Report sheds light on the structures of profitable companies
Hours before the hearing, the subcommittee released a report detailing the “dire conditions” of for-profit nursing homes in the early months of the pandemic — where opaque corporate structures helped such companies hide profits and avoid legal and regulatory accountability, the authors wrote.
The report used Genesis as an example, pointing to over 700 separate corporate entities as of June 2020. Many acted as service providers to other facilities within the corporate structure.
The subcommittee continued to recognize that large nursing home chains, including Genesis, have undergone a “significant reorganization” since June 2020 – the furthest point at the time the data was collected.
Members of Congress refer to a shift to small market model It was first tested by Ensign, then Genesis, among other named entities. Larger companies are creating locally-oriented leadership teams to address unique challenges in individual markets across the country.
The model has allowed companies like Ensign to push for Covid trends, use government waivers effectively and navigate political climates, according to CEO Barry Port.
consulate subject Rebranding and restructuring after filing for bankruptcy and financial settlement with the Ministry of Justice last year.
In an email to Skilled Nursing News, Genesis spokeswoman Lori Mayer told Skilled Nursing News that it is “common practice for large companies to have diverse entities and structures,” in response to the report.
Kennett Square, Pa. Services at more than 200 affiliate sites.
Attempts to access Ensign, SavaSraduateCare, American Life Care Centers, and the Consulate were not immediately returned.
Legacy data goals for for-profit entities
Other key findings from the report indicate that many facilities were severely understaffed in the early months of the pandemic, and for-profit nursing home chains did not provide workers with appropriate personal protective equipment (PPE).
The report also found that nursing homes have pressured employees to continue working despite showing symptoms of Covid or testing positive.
Geriatric service organizations such as the American Health Care Association (AHCA) were quick to point out that every long-term care provider — regardless of business structure — was pleading with public health agencies and policymakers to send in support during the early days of the pandemic.
LeadingAge CEO Katie Smith Sloan said the nonprofit nursing homes “begged for important resources,” including PPE and Covid testing and increased support for staff, particularly nurse aides and other frontline workers.
“We ask Congress and [Biden] Management to take responsible action towards broader change. It’s time to fix our country’s broken system of funding, oversight, and support for nursing homes.”
Once the sector started getting the help they needed, long-term care providers began to see “tremendous progress” in reducing cases and deaths in nursing homes, said Mark Parkinson, chief executive of the AHCA.
“It’s unfortunate that we need to remind lawmakers of what those early days were like,” he said in a statement. “Almost every nursing home in the country is struggling to get PPE due to supply chain disruptions, testing due to limited supply, and extra staff support due to most government support being directed toward hospitals.”
AHCA urges Congress to focus on the serious challenges that remain at this point in the pandemic, including the historic workforce shortages.