Long-term care needs overhaul in Pennsylvania

A report released Monday by advocates for Pennsylvania nursing home residents offers something sorely needed: a road map for overhauling the state’s beleaguered homes, whose mismanagement has created a crisis.

The report calls for dozens of immediate operational and regulatory enforcement improvements so these facilities can better meet COVID-19’s challenges.

The product of several months of work by Community Legal Services of Philadelphia, The Center for Advocacy for the Rights and Interests of the Elderly, or CARIE, and six other organizations, it’s a reminder of how often and how long Pennsylvania has rightly been criticized for flaccid oversight of a long-term care industry dominated by for-profit corporations, and a warning to be prepared for the pandemic’s next wave.

The industry, the state, and individual nursing homes were underprepared for and overwhelmed by the coronavirus. More than 5,000 of Pennsylvania’s 7,500 COVID-19 deaths — 67% — have been among nursing and long-term care home residents.

These tragic deaths are part of a national crisis, where more than 40% of COVID-19 deaths have occurred in nursing homes. Decades of neglect — in policy, resources, and oversight — left nursing homes “sitting ducks for COVID-19,” according to a recent article in the New England Journal of Medicine. It went on to argue that long-term care in the United States has been marginalized, poorly funded, and insufficiently monitored.

The proposed reforms in the state report would correct some of the catastrophic shortcomings that helped spread the virus, targeting nursing homes and assisted living facilities which together serve about 122,000 people statewide. Most of the residents are elderly, ill, or both; many are people of color, who can be especially vulnerable to COVID-19.

The 30-page document makes 42 recommendations, the most crucial calling for universal, comprehensive, and regular testing of residents and staff, higher infection control and employee hygiene standards, and additional staff training and compensation, including hazard pay. More rigorous annual surveys (also called inspections) and greater transparency of information for patients, families, and the public are also critical.

As the report urges, Pennsylvania must assume responsibility for purchasing and distributing personal protective equipment such as masks and face shields, to nursing homes and longterm care centers.

Pennsylvania has made some commendable changes by increasing staffing, testing, and sanitation. Advocates also call for annual surveys that have been paused due to the pandemic to be resumed immediately. The report raises doubts about whether the state’s grudging move toward transparency about nursing home case statistics — two months into the pandemic — was as comprehensive or complete as it could be.

The report builds on decades of advocacy on the part of CLS and CARIE. Both have called on Pennsylvania to take regulatory and enforcement steps to improve the lives of nursing home residents; in 2015, CLS published a report, titled “Careless,” about potentially life-threatening deficiencies in state oversight.

Clearly, that report was not heeded. Here we are, five years later, with too many lives lost. The governor, the secretary of health and state lawmakers must take these latest recommendations seriously — not only to address the current pandemic but to protect the future well-being of this vulnerable population.

—The Philadelphia Inquirer/ The Associated Press