Watchdog groups laud proposals to improve nursing home care and call for other changes

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By Rachel Baldauf, The Washington Post, March 9 2021

Legislative action targets infection control and financial transparency

Patient advocacy groups are praising two proposals by state and federal lawmakers aimed at improving infection-control protocols and financial transparency in nursing homes, struck by a crushing stretch of deaths since the start of the pandemic.

The Covid-19 Nursing Home Protection Act, introduced by five U.S. senators late last month, would provide $750 million to states to fund local strike teams of health and emergency workers who would cover staffing shortages during coronavirus outbreaks in nursing homes. The bill would also deliver $210 million to the Department of Health and Human Services to help shore up practices meant to prevent or contain the spread of communicable diseases.

For years, the nursing home industry has faced criticism for failing to abide by federal infection-control standards, including proper hand-washing and the use of protective gear. As the coronavirus sickened or killed tens of thousands of residents, government inspectors continued to cite facilities for breakdowns.

“Long before the pandemic, nursing homes struggled to meet infection-control standards,” Sen. Robert P. Casey Jr. (D-Pa.), who introduced the legislation, said in a statement. “The essential steps that need to be taken to maintain proper infection control protocols are made even more difficult when nursing homes do not have an adequate workforce.”

The bill — also introduced by Sens. Sheldon Whitehouse (D-R.I.), Cory Booker (D-N.J.), Richard Blumenthal (D-Conn.) and Raphael G. Warnock (D-Ga.) — would require the federal government to collect and publish demographic data on coronavirus cases and deaths in nursing homes, including information about residents’ race and ethnicity.

The pandemic has disproportionately affected communities of color. A Washington Post analysis last year of data from more than two dozen states found the covid-19 death rate was more than 20 percent higher in majority-Black nursing homes compared with majority White facilities.

“We know there are serious inequities baked into our healthcare system, yet we’ve just barely scratched the surface on collecting the data we need to identify the root causes,” Whitehouse said in a statement. “If one positive thing comes out of this pandemic, I hope it’s a better understanding of where those inequities are and how to fix them so that nothing like this happens again.”

Watchdog groups praised the proposed legislation but said additional, more permanent solutions are needed to tackle chronic staffing shortages and address facilities with a history of dangerous lapses in patient care.

“Until we address the underlying failure to enforce minimum standards, we will constantly find ourselves in this position of throwing money at an industry that too often puts profits over care,” said Richard Mollot, executive director of the Long Term Care Community Coalition.

The proposed federal legislation comes as vaccination efforts are underway in facilities across the country. This month, the American Health Care Association and National Center for Assisted Living said vaccinations in nursing homes have led to the lowest number of new coronavirus cases in months.

“Congress should ensure long-term care remains the highest priority for additional aid, vaccines, testing and personal protective equipment,” Beth Martino, the organization’s spokesperson, said in a statement.

In California, state Sen. Henry Stern (D) is also moving to address nursing home finances. He recently introduced a bill that would require nursing home operators to report comprehensive financial information about profits and expenses to government regulators and the public.

A majority of nursing home providers in the United States use operating funds to pay themselves through related parties — companies they or their family members own. Though the practice is legal, watchdog groups say owners can overpay themselves with public funds meant for patient care.

Washington Post investigation in December found California’s largest nursing home chain paid related parties tens of millions of dollars in 2018 for such things as supplies, administrative services and rent.

The proposed legislation would expose the corporate structure of for-profit homes and chains and require operators to submit annual financial reports for all operating entities, related parties and others.

“There’s so much happening in the shadows, and we just desperately need some sunlight here,” Stern said.

Michael Connors, an advocate with the California Advocates for Nursing Home Reform, said the measure would ensure state and federal funding is properly spent on the care of residents.

“Right now regulators and the public are in the dark about the vast sums of public funds nursing home operators are laundering through related companies to hide profits,” he said.

Watchdog groups have been pressing the Biden administration for similar corporate transparency rules nationwide. The proposal would require owners to submit documents, including tax returns and financial reports, and cap profits and administrative costs at reasonable levels. About 85 percent of nursing home revenue comes from Medicare and Medicaid, federal data shows.

“You have nursing homes claiming that they’re going broke, and they have no money and that Congress needs to give them billions of dollars,” said Charlene Harrington, a sociology and nursing professor at the University of California at San Francisco who worked on the proposal. “We’re never going to really know where the money is going until we get better financial reporting.”

Debbie Cenziper contributed to this report.