Nursing homes in NY had big problems before COVID pandemic. Why AG report may spark change
The COVID-19 pandemic laid bare fundamental flaws in the oversight, regulation and operation of nursing homes in New York, according to a state Attorney General’s Office investigation.
From nursing home owners potentially putting profits over resident safety to poorly trained workers stretched to the breaking point due to understaffing, the failure to protect frail and elderly New Yorkers most vulnerable to the coronavirus stemmed from systemic problems within the long-term care industry, the investigation asserted.
“New York needs to ensure that nursing homes take care of our seniors and our most vulnerable residents with dignity, respect and the sufficient care that the law requires — and that the public primarily funds,” investigators wrote in the bombshell report released Thursday.
And while politically charged debate over the report focused on state officials’ prior refusal to disclose the true nursing home death toll, which was revealed to be nearly 13,000 as opposed to the 8,700 previously reported, advocates and lawmakers have seized on the investigation’s call for reforming the industry.
“This shocking yet unsurprising report must serve as a wake-up call that vulnerable residents and their families deserve better,” said Richard Mollot, executive director of the Long Term Care Community Coalition.
“Many of the failures documented in this report have been going on for years and have only been exacerbated by the COVID-19 pandemic.”
The 76-page report provides insights into its potential ramifications for ongoing attempts to overhaul the nursing home industry.
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How nursing home staff shortages fueled COVID-19 crisis
Investigators described how some nursing homes’ pre-pandemic low staffing model “simply snapped under the stress of the pandemic.”
While the report did not name specific nursing homes due to ongoing investigations, it revealed key factors that allowed the coronavirus to overwhelm facilities statewide, though much of the probe focused on downstate communities hit hardest during the initial wave of infections in the spring and summer.
Among the examples:
- A facility where the leadership was out ill or working remotely, leaving onsite management of the entire facility in the hands of just two nurse supervisors. Several weeks later, residents started dying from COVID-19, including 33 residents in one week, or 15% of all the patients in the facility.
- One employee alleged staff shortage prompted certified nursing aides, rather than nurses licensed to do so, were dispensing medications.
- A nursing supervisor alleged in mid-April that she had been working for 21 days straight, 14 hours per day, and described a facility stretched to the absolute limit to care for its residents.
Investigators noted the staffing failures “occurred at the same time that necessary visitation restrictions removed the supplemental caregiving provided pre-pandemic by many family visitors at low staff facilities.”
Further, some nursing homes pressured, knowingly permitted, or incentivized existing employees who were ill or met quarantine criteria to report to work and even work multiple consecutive shifts, in violation of infection control protocols, the report said.
The investigation also drew connections between poor staff ratings before the pandemic and higher rates of deaths.
Of the state’s 401 for-profit facilities, over two-thirds – a total of 280 – entered the COVID-19 pandemic with the lowest 1-Star or 2-Star staffing ratings by the Centers for Medicaid and Medicaid Services, investigators found.
As of Nov. 16, 3,487 COVID-19 resident deaths (over half of all deaths) occurred in the 280 low-rated facilities, the report noted.
“There were too many instances of employees being pressured to work while contagious to ensure higher staffing levels. This put all residents and employees of the nursing home at risk,” the report added.
The report also recommended a series of steps to improve regulation and oversight of nursing homes, and called for imposing mandated staffing ratios, citing various nurse and other staff minimums required in other states such as California, New Jersey and Ohio.
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How legal immunity provisions impacted NY nursing homes
The investigation also raised questions about the potential far-reaching impacts of limited immunity provisions for health care providers relating to COVID-19, citing a law approved in March and amended slightly in July to narrow the scope of immunity.
“The intent was to support health care professionals making impossible health care decisions in good faith during this unprecedented crisis,” the report states, referring to the law.
But investigators found examples that “illustrate instances of facility decisions that relate to or affect resident care that are financially motivated, rather than clinically motivated,” the report added, noting investigations are ongoing related to those cases.
Much of the issue involved nursing home owners who potentially pressured staff to admit more residents to avoid losing money, despite staff shortages that left the facility incapable of providing adequate care.
In other words, investigators are digging into cases of nursing homes that may have put profits above resident and staff safety.
The report called on lawmakers and regulators to improve transparency and oversight of for-profit nursing home operators, citing the potential that resident admission decisions were made to improperly, and potentially illegally, sustain reimbursements from Medicaid, Medicare and other health insurance.
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How New York nursing homes failed at infection control
Accounts of violations of infection-control and prevention practices are peppered throughout the Attorney General’s report.
Some of the findings included:
- Numerous nursing homes that failed to isolate residents infected with COVID-19, which may have allowed the virus to spread in communal dining rooms and living spaces for months.
- Nursing homes that reportedly did not properly screen staff members before allowing them to enter the facility to work with residents.
- Some staff allegedly avoided having their temperatures taken and answering a COVID-19 questionnaire when one facility’s front entrance screening station had no employees, or when staff entered the facility through a back entrance, avoiding the screening station altogether.
One nurse alleged a supervisor put out bins of masks and gowns just before a safety inspection in an apparent attempt to misrepresent the facility’s personal protective equipment supply.
Inspectors later caught the facility violating rules, including the most severe “immediate jeopardy.”
What nursing home trade group says
Stephen Hanse, president and CEO of the Health Facilities Association in New York, noted the report underscored how state officials gave priority to hospitals over nursing homes when it came to addressing problems with everything from staffing and personal protective equipment shortages to financial challenges.
“The fundamental issue underlying the findings of the Attorney General’s report is that policy makers uniformly failed to treat nursing homes equally as hospitals throughout the pandemic,” he said.
Hanse, however, disputed the report’s assertions that for-profit nursing homes, in general, put residents at higher risk than nonprofit or government-run facilities.
“To state that there was financial motives there’s not substance to that allegation in the report, and it will be interesting over time to see how that plays out,” he said.
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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached atdrobinson@gannett.com and followed on Twitter:@DrobinsonLoHud