July 14, 2020


Trump reduced fines for nursing homes that put residents at risk. Then Covid-19 happened.: The Obama administration cracked down on nursing homes with infection control problems. Trump reversed course. (Dylan Matthews,  Jul 14, 2020, Vox)

Estimates vary, but analysts Gregg Girvan and Avik Roy found that as of June 29, 50,779 of the 113,135 US deaths from Covid-19 (or 45 percent) were deaths of residents of nursing or long-term care facilities. Their numbers suggest that about 2.5 percent of all nursing home residents have been killed by the disease; in New Jersey, which is particularly hard hit, the share is over 11 percent.

This is partially due to the disease being particularly lethal among older people, and an early acute shortage of personal protective equipment (PPE) like masks across the board. Death rates have been high for seniors in general, not just those in nursing homes. A CDC report found that as of July 1, more than 80 percent of Covid-19 deaths were among people 65 and over.

But investigations have since revealed that the conditions at too many nursing homes were conducive to the coronavirus's spread, abetted by both state and federal policies. New York Gov. Andrew Cuomo (D) ordered nursing homes to take in Covid-19 patients discharged from hospitals, contributing to superspreader events like one in Troy, New York, documented by ProPublica. Connecticut Gov. Ned Lamont (D) also signed executive orders offering partial legal immunity to nursing homes during the crisis, limiting families' abilities to seek redress when the state's strategies failed.

An important context for these events, however, is federal policy. Since well before the coronavirus pandemic, the Trump administration has been targeting regulations in the nursing home industry, pushing a deregulatory agenda that advocates say has worsened conditions for residents and will make them worse still in the pandemic era.

Covid-19 is a once-in-a-lifetime health crisis that is catching almost all institutions -- and politicians, regardless of party -- ill-prepared. But there is no question that the administration, at the prodding of industry, has enacted and proposed moves aimed at easing regulations on nursing homes -- moves that patient advocates have said were increasing health risks for residents well before Covid-19 came to the US.

The Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare and Medicaid, is in charge of regulating and overseeing the nursing home industry. (The large majority of funding for nursing facilities comes from Medicaid or Medicare, meaning that CMS certification is a key prerequisite for most to function.) The agency outsources the job of conducting inspections to state surveying agencies, operated by state governments. Together, CMS and its surveyors are the main system of accountability for the 15,600-odd nursing homes in the US and their 1.3 million inhabitants.

The Trump CMS moved to curb fining nursing homes that were found violating regulations -- in particular, regulations meant to prevent the spread of infectious disease. Infection control deficiencies are by far the most cited regulatory failing in nursing homes, and the Trump administration has acted to reduce the amount of money fined, and to move away from a system of daily fines that experts say is more effective at changing facility behaviors. (In the face of the coronavirus outbreak, the administration last month announced it would increase fines; more on this below.)

If the move to cut fines worries experts, future changes heralded by the Trump administration are even more concerning. Under the Obama administration, the Centers for Medicare and Medicaid Services issued a rule requiring all facilities to employ a dedicated "infection prevention specialist" at least part time. CMS Administrator Seema Verma has proposed rolling back that rule and only requiring such specialists to serve as consultants, potentially covering many different nursing facilities.

Posted by at July 14, 2020 12:00 AM