As part of the Affordable Care Act, the Obama administration aimed to use the leverage of billions of dollars paid out through Medicare and Medicaid to these facility operators to get them to be more accountable and, in the process, reduce the costs incurred from unnecessary recurring hospitalizations from avoidable infections.

It was long overdue.

In December of 2017, the Los Angeles Times published an eye- opening investigative report by Jordan Rau with Kaiser Health News that told us all we would have needed to know about just how vulnerable these facilities would be to COVID-19 in 2020.

"Basic steps to prevent infections -- such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work -- are routinely ignored in the nation's nursing homes, endangering residents and spreading hazardous germs," Rau wrote in 2017. "A Kaiser Health News analysis of four years of federal inspection records shows 74% of nursing homes have been cited for lapses in infection control -- more than for any other type of health violation."

And while citations were common, "disciplinary action such as fines is rare: Nationwide, only 1 of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty," according to the Kaiser study.

Rau quoted Michael Connors of California Advocates for Nursing Home Reform, a nonprofit in San Francisco, who said the industry was "getting the message that they don't have to do anything" because they are only getting "low-level warnings year after year after year and the facilities have learned to ignore them."

But even as Kaiser Health News was shining a national spotlight on the lack of infection control in facilities where an increasing number of Americans will spend their last days, the Trump administration was busy doing all it could to roll back the Obama administration's effort to improve infection control in these places.

As the New York Times reported on March 14, the "federal regulator overseeing nursing homes proposed the rule changes last summer, before the coronavirus pandemic highlighted the vulnerability of nursing homes to fast-spreading diseases. The push followed a spate of lobbying and campaign contributions by people in the nursing-home industry, according to public records and interviews."