Nursing homes to face more virus safety fines
NEW YORK >> As the delta variant of the coronavirus raises fresh concerns about the safety of the nation’s nursing homes, the Biden administration has quietly reversed a controversial Trump policy that had limited the fines levied on facilities that endangered or injured residents.
Deaths in nursing homes, which peaked at the end of last year, have plummeted since the introduction of COVID-19 vaccines. They account for nearly a third of the U.S. pandemic’s overall death toll.
But inadequate staffing, protective equipment shortages and poor infection control remain concerns at the nation’s 14,000 skilled nursing facilities, advocates and some officials say.
And although 81% of nursing home residents are vaccinated, only 58% of workers are immunized, according to federal data, heightening the risk of outbreaks even among fully vaccinated elderly residents.
With the delta variant driving the recent swell of cases, there are signs of a creeping uptick of infections in nursing homes, particularly among workers. The Centers for Disease Control and Prevention is also investigating the source of outbreaks in Colorado
nursing homes where there may be low vaccination rates.
The policy favoring lower penalties, adopted in 2017 by the Trump administration, directed regulators at the Centers for Medicare and Medicaid Services to shift from fining a nursing home for each day it was out of compliance with federal standards. The relaxed policy reduced many penalties to a single fine, effectively lowering amounts from hundreds of thousands of dollars to a maximum of $22,000.
The shift sought by the nursing home industry, a powerful lobby was part of the Trump administration’s rollback of government regulations across many business sectors.
“It is the most obvious change the Trump administration made,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “It’s a much, much lower penalty amount.”
Many of the nursing homes cited for poor infection controls, failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores, are repeat offenders. Larger fines act as a deterrent and are more likely to signal strong enforcement of the rules, Edelman said.
With little fanfare, the Biden administration revoked the earlier guidance on the Centers for Medicare and Medicaid Services website in early July, saying it had “determined that the agency should retain the discretion at this time to impose a per-day penalty where appropriate to address specific circumstances of prior noncompliance.” Under the new policy, regulators can impose either per-day or per-instance penalties.
Consumer groups had challenged the policy in a federal lawsuit in January, arguing that the weakening of enforcement put residents at greater risk. The AARP Foundation, which filed the lawsuit along with the firm of Constantine Cannon, applauded the Biden administration’s decision. Citing the lawsuit, Medicare officials declined to comment.
The main industry trade group, the American Health Care Association and National Center for Assisted Living, said in a statement that fines levied on a perday basis “only take precious resources away from an already underfunded industry, especially during an unprecedented time when nursing homes need every support to protect their residents.”
But critics of the Trump policy say it offered a mere slap on the wrist for nursing homes, even those at the greatest risk for harming patients and workers.