Better protections
COVID-19 shows we must step up regulation of nursing homes and long-term facilities.
If you could urge your government to do more to protect the most vulnerable residents in our society from the ravages of COVID-19, would you?
Even Americans who generally oppose more government regulation make some exceptions when lives are at stake. And that’s exactly the case right now at nursing homes and long-term care facilities across the country, which account for about 30,000 COVID-19 deaths.
In Texas, 3,011 residents at 311 nursing homes have tested positive and 490 have died.
The reason residents in these facilities are most vulnerable isn’t just because they’re elderly, medically frail and often unable to advocate for themselves. It’s also because state and federal governments have failed for decades to provide the regulatory oversight needed to keep them safe, and as we speak, proposals are in the works to dismantle some of the few safeguards implemented during the previous administration.
The spread of infection was a threat to nursing home residents even before anybody ever heard the term COVID-19. A recent analysis by Kaiser Health News found that 63 percent of nursing homes had violated infection control standards and many had repeated lapses.
Yet, few facilities faced disciplinary action. All but 1 percent of violations were classified as minor and didn’t earn fines, Kaiser found.
Before the coronavirus pandemic, the Trump administration was working to weaken oversight even further, including proposing rule changes that would loosen Obamaera infection control standards and lowering fees for violations that put residents in harm’s way. The administration has already imposed a moratorium on civil penalties for violating many of the Obamaera standards, which were the first major overhaul of nursing home regulations in decades, as the agency rewrites the rules.
The Obama-era reforms had imposed a range of staffing requirements and other steps to improve care for residents, and bolstered enforcement.
One key change was to require every nursing home to employ one infection control specialist at least part-time. But that reform was on the chopping block by last summer when, after fierce lobbying by the nursing home industry, the federal Centers for Medicare and Medicaid Services, or CMS, proposed letting nursing homes use consultants instead and require only that the specialists spend “sufficient time” at the facility.
That proposed rule change, a CMS spokesperson told the editorial board, is not yet final and is part of the Trump administration’s effort “to allow nursing homes to devote more of their time and resources to residents instead of unnecessary paperwork by eliminating obsolete or excessively burdensome regulations and allowing commonsense flexibilities.”
That rationale doesn’t hold water. Since when is controlling infection obsolete or excessively burdensome? It’s more important than ever.
That’s why, back in 2018, attorneys general in 17 states wrote to CMS in 2018 and called efforts to roll back the Obama regulations a threat to “the mental and physical security of some of the most vulnerable residents of our states.”
Now, we can see all too clearly how quickly an infection can spread through nursing homes, long-term care facilities and other facilities for the elderly.
“The infection preventionist is a really important concept. I thought it was one of the most important things that came out of the Obama regulations because we were going to be more serious about this,” Toby Edelman, a senior policy attorney at the nonprofit Center for Medicare Advocacy, told the editorial board. “We have too many infections, too many deaths, too many hospitalizations. Not all are inevitable. Some of them could be avoided if we did a better job.”
The Trump administration has also put nursing home residents at greater risk by lowering the fines imposed on facilities when they violate safety standards. Instead of fining homes for each day they were out of compliance — as was done under the Obama administration — regulators are encouraged to issue a single fine per instance.
An NBC News investigation found that change resulted in a 34 percent drop in the overall amount of nursing home penalties from 2017 to 2018. That gives unscrupulous or lax nursing home owners little incentive to fix deficiencies.
That is even more dangerous now, when family members and other visitors are barred from seeing nursing home residents. Under normal circumstances, those visits can help ensure that residents are getting the care they deserve.
Even government surveyors, whose job it is to inspect facilities, currently have limited access, which may allow violations to go unchecked and put residents at risk.
Federal and state officials have taken action to combat the spread of COVID-19 in nursing homes and other long-term care facilities. The Trump administration this week released guidelines for safe reopening of nursing homes, which include regular testing for residents and staff, providing protective gear for staff and banning visitors until no new cases are reported.
In Texas, Gov. Greg Abbott has ordered COVID-19 testing for all nursing home residents and staff in the state.
Those are good and necessary steps — and they show what can be done to safeguard the health and well-being of the people we love: the elderly and ailing grandparents, parents, and relatives who are residents in nursing homes, along with the staff who care for them.
Such efforts should not be limited to halting COVID-19. This pandemic has shown that we need more regulation of long-term care facilities, not less. Now — and after this public health crisis has been contained.