Yale Law report: Workers facing difficult conditions
NEW HAVEN — Understaffing, lack of protective clothing and COVID testing, low wages and little state accountability are among the findings in a report on the working conditions at nursing homes during the pandemic.
The Worker and Immigrant Rights Advocacy Clinic at Yale Law School issued the document Monday on behalf of SEIU District 1199 New England as the nursing home industry has been put on notice of a potential strike by some 3,300 workers starting this week.
At a virtual press conference Monday, Jesse Martin of Local 1199, said strike notices have been sent to six additional nursing homes for May 28, which would bring the number of homes impacted to 39 and more than 4,000 workers.
In the 52-page report, the law students based their conclusions on interviews with the workers and a review of state Department of Public Health records from March 2020 to February 2021.
The union is seeking a boost in staffing as well as raises for workers who often work multiple jobs to make a living. Those covered by contracts include: registered nurses, licensed practical nurses, certified nursing assistants, dietary aides and housekeeping workers, among others. The contracts at some 33 long-term care facilities expired in March.
“The state has not adequately protected this workforce, which is predominantly working-class people of color, with a large proportion of women and immigrants. Further, worker testimony demonstrates that staffing, compensation, safety, and transparency problems predate the pandemic,” according to the report.
“These unresolved issues will continue to create perilous conditions for both workers and residents unless the state takes action,” it states.
Negotiations are ongoing between the long-term care facilities and the union, but recent statements from state lawmakers indicate there are funds that potentially could be tapped.
Further, Gov. Ned Lamont Monday offered $150 million more in Medicaid funding to the nursing home industry, an increase of 4.5 percent for wage increases in each of the next two years, in hopes of averting the impending strike.
His administration also would temporarily boost Medicaid reimbursement by 10 percent for a total of $86 million, and add $32 million in hazard pay and retirement enhancements, according to letters sent Monday from Lamont’s budget chief, Melissa McCaw, and Commissioner of the Department of Social Services Deidre Gifford, to the union threatening a strike and nursing home industry officials.
Connecticut also has a $3 billion Rainy Day fund; $6 billion in federal pandemic relief and is expected to end the fiscal year with a $950 million surplus. Still, the union and the nursing home facilities themselves, are just a portion of constituencies looking for assistance given losses during the pandemic.
“A major investment in nursing homes is needed now as a bridge to the other side of the pandemic, and even more resources are needed to address collective bargaining issues” said Matt Barrett, president and CEO of the Connecticut Association of Health Care Facilities. “It is simply unreasonable and unrealistic to expect nursing home operators to enter into costly multi-year increased funding commitments to address collective bargaining issues without the resources needed to pay for those increased costs.”
State Senate Pro Tempore Martin Looney, D-New Haven, said there will not be hard figures on a surplus until after this week’s filing date for taxes.
Barrett said he could not comment on the Yale report until he reads it.
David Dearborn, spokesman for the state Department of Social Services, said “DPH will review the (report) document in detail, but we’d point to the objective analysis by Mathematica Policy Research about the response by the state and nursing homes during the pandemic.
“Mathematica found that Connecticut made policy decisions and issued guidance based on the available knowledge at the time from national and state epidemiologists and public health experts (notwithstanding that knowledge was undermined by gaps in scientific understanding of the virus).”
Dearborn also said DPH, as regulatory agency, “worked in support of nursing home residents and staff, and has also held owners accountable when necessary — while amassing and distributing personal protective equipment,” conducted extensive inspections, and mandated special infection control monitoring.
Looney said he and House Speaker Matthew Ritter, D-Hartford, agree that “the capacity is there to substantially aid nursing home workers who were on the frontline of the pandemic and have borne the brunt of so much illness and fear. The revenues have been coming in above projected levels, especially because of the strong performance of the stock market.”
Looney said he and Ritter also feel strongly that “some of the federal money could be apportioned for this purpose. The governor in his budget had a pretty minimal amount for this, although the Appropriations Committee put in more. But there is certainly a capacity to go beyond that.”
In Connecticut, 3,875 nursing home residents have died from COVID-19-related complications, accounting for almost half of the state’s total recorded deaths from the virus, according to state data. More than 14,000 infections were reported in nursing homes and 20 workers died from the virus.
The Worker and Immigrant Rights Advocacy Clinic said the homes “repeatedly failed to conform to the recommendations of the Centers for Disease Control (“CDC”) for the proper distribution, use, and storage of PPE (Personal Protective Equipment.)
Staff are quoted in the report telling interviewers they had to share or used soiled PPE, or come up with makeshift solutions, such as donning trash bags. There were multiple news reports at the start of the virus on the shortage of PPE, but the report said this problem persisted throughout the pandemic. There were also complaints about a lack of testing and communication from administrators on the extent of COVID-19 cases in the facilities.
A major criticism involved the leadership at the Department of Health which the clinic said “made little use of its primary enforcement tools: inspections and fines.”
It said more than 90 percent of the inspection reports pointed to “violations of multiple regulations.”
Despite this, DPH issued citations for only 34 incidents related to COVID-19 from March 2020 to February 2021 for a total of $98,081 in fines, according to the report.
It said the average was $2,885, which is lower than the statutory limit for class B violations and much lower than the average fine for class B violations unrelated to COVID-19, which was $6,023. For violations that “present a potential for death or serious harm in the reasonably foreseeable future to any patient in the nursing home facility,” the DPH could fine up to $10,000.
“... for more than 170 facilities—in which a total of 3,398 residents and staff died of COVID-19 —there are no publicly available records of Citations or fines related to COVID-19 whatsoever. Furthermore, even if some of these facilities were cited or fined, the fact that none were posted publicly means that family members of residents were denied vital information about potentially dangerous life-threatening conditions in these facilities,” the report states.
The report said there were no fines at the 10 facilities with the highest number of resident deaths, according to publicly available data. Where there were fines, there did not seem to be a correlation between the amount and the seriousness of the offense.
“These fines are insufficient to disincentivize bad behavior. Their low amounts demonstrate a systemic failure to recognize the urgency and severity of the COVID-19 pandemic within nursing homes,” the clinic wrote.
It said, however, that the DPH reports validated the concerns of the workers as far as problems with “PPE, social distancing, cohorting residents who tested positive or quarantining residents exposed to positive cases, under-staffing, insufficient training, inadequate testing, and other practices that violated infection control guidelines.”
The DPH made findings that numerous facilities “failed to ensure that appropriate infection control practices were implemented to prevent and control the spread of infection,” the report states.
There are a total of 198 nursing homes in the state with some 18,402 residents, the majority of whom are single, white women.
The report recommended better funding for the nursing homes; increased worker pay and benefits to retain staff; establishment of medical loss ratios that would guarantee that a portion of funding is used toward direct care of the residents. It also made the argument for increased minimum staffing so residents receive adequate care and enhanced DPH oversight of the homes.