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RI CNA to Congress: “it was horrifying…our residents, staff kept getting sick and dying…we begged management…”
Rhode Island CNA tells her story from working at the Genesis-chain owned nursing home – Greenville Skilled Nursing & Rehabilitation – in Greenville, RI to Senator Elizabeth Warren’s Senate Finance Committee. The story, below, is excerpted from Medpage Today, by Cheryl Clark, March 18, 2021:
Why 130,000 Nursing Home Patients Died of COVID-19 – At Senate hearing, executive pay draws fire
by Cheryl Clark, Contributing Writer, MedPage Today March 18, 2021
Adelina Ramos told a Senate Finance Committee hearing last week what it was like to be a certified nursing assistant in a 160-bed facility where 20 patients and another co-worker died from COVID-19 within one month.
They were so short-staffed at the facility in Greenville, Rhode Island, they had to choose which of their dying patients needed care first, often leaving others scared and alone. They had to perform so many tasks, such as 15-minute oxygen checks on some, and help others eat, drink, or move. It was particularly frightening for the many residents with Alzheimer’s disease, but there was no time for comfort.
“It was horrifying. We begged management for more staff for each shift, but they said they couldn’t find anyone. And so our residents and staff kept getting sick and dying,” Ramos said. Her co-workers, meanwhile, were working for hourly pay as low as $12.34. Without testing, she too became infected, and unknowingly put her family and others at risk.
Her story of her year of terror, and those from other witnesses, provided a few reasons why 130,000 nursing home residents and some 1,600 members of their staff died of COVID-19. And they paved the way for some embarrassing questions and outrage from Sen. Elizabeth Warren (D-Mass.).
Addressing Ramos, Warren said, “Basically, what you’re saying is that you didn’t have the supplies, you didn’t have the staff you needed when the coronavirus hit.” That’s why Congress passed relief packages like the CARES Act earlier, to get providers the resources they need, she said.
Why, Warren wanted to know, didn’t Genesis, which provides services in 350 nursing homes in 25 states including Ramos’s, not hire more staff, despite receiving $665 million in state and federal grants and loans last year?
“Guess what Genesis did,” Warren continued. “It gave its then CEO a $5.2-million dollar retention bonus just a few months before he left the company, which was and is in dire financial condition.”
“In total, the CEO, George Hager, received $8 million in compensation since January of 2020,” Warren said. She then asked Ramos, as a person working for $14 an hour, “Should a top corporate executive have received a multi-million dollar bonus while you were struggling to keep yourself alive and your patients alive?…. What could have been done to improve patient care with that $5.2-million retention bonus that the CEO received?”
Ramos replied: “I don’t think they should make millions of dollars in bonuses…. we could have put in a higher wage so we could have actually attracted more staff.”
Warren said she is opening an investigation into for-profit nursing homes, including Genesis, which she said “will soon be under private equity ownership.”
She then turned to David Gifford, MD, chief medical officer of the American Health Care Association/National Center for Assisted Living, which represents 14,000 non-profit and proprietary nursing homes, assisted living communities, and homes for those with disabilities.
“Do you think it’s right that nursing home CEOs should receive multi-million-dollar bonuses while workers like Ms. Ramos fought for more PPE, more tests, and more resources? Dr. Gifford?” Warren asked.
Gifford responded that facilities were having trouble getting PPE and staffing, and what was available “was not prioritized for nursing homes. It was going to hospitals and elsewhere.”
Warren jumped in. “I’m sorry to interrupt, but that was not my question. My question was whether or not nursing home executives should be paid multi-million-dollar retention bonuses or whether or not those millions of dollars should be invested in resources that are needed to keep staff and residents safe and healthy.”
Gifford replied that he supports efforts in transparency to examine how relief funds were used, and “how compensation is done at all levels” but that didn’t satisfy Warren.
“I just want to be clear on this. We can’t allow corporate greed to determine whether or not workers and seniors in this country live or die,” she said. (Warren posted the virtual interchange with Ramos and Gifford to her Twitter feed.)
RINewsToday note: David Gifford, MD, MPH, Senior Vice President of Quality and Regulatory Affairs at the American Health Care Association, the largest association in the country representing long term and post-acute care facilities, speaks in this recording. Gifford is a former Director of the Rhode Island Department of Health and Chief Medical Officer for Quality Partners of Rhode Island where he directed CMS’ national nursing home-based quality improvement effort.
Several other speakers noted that while 1.4 million residents are cared for in 15,000 Medicare- or Medicaid-certified nursing homes, or less than 1% of the nation’s population, they made up 30% of the COVID-19 deaths reported by the CDC.
Witnesses called for more transparency within nursing homes, including disclosure of case reports and vaccination rates for both staff and residents on a daily basis and more support from “strike teams,” trained personnel who respond to a facility outbreak when resources are lacking.
John Dicken, director of the U.S. Government Accountability Office, told the senators that CMS — the lead federal agency overseeing nursing homes — has fallen short in important areas. While CMS has outlined actions it had taken, it hasn’t tracked their progress. Nor has it developed a strategy to capture COVID-19 data in nursing homes during the first months of the pandemic, from Jan. 1 to May 8, 2020, when reporting was designated as optional.
Another witness, R. Tamara Konetzka, PhD, a University of Chicago researcher specializing in long-term care quality and policy for 25 years, noted nursing home residents are now getting vaccinated, but warned against complacency. Many nursing home staff members are resisting inoculations, she said. And it remains unclear how long the vaccines will protect against new coronavirus variants.
Because of low worker wages, employees often work multiple jobs, in and out of other facilities. Without sick leave, “staff feel compelled to work even when symptomatic,” she observed.
Konetzka cited research showing that two predictors of the worst COVID-19 outcomes in long-term care facilities were larger institutional size and community prevalence of the virus.
“Nursing homes in the highest quintile of community prevalence averaged five more deaths per facility than similar nursing homes in the lowest quintile,” she said.
She emphasized that the spread of COVID-19 was not a “bad apples” problem, because there was no subset of nursing homes that kept the virus out. Rather, 99% of homes had at least one case and more than 80% more than one death.
Another influential factor appeared to be nursing home demographics and race.
When nursing home populations were more than 40% non-white, they experienced more than three times as many COVID-19 deaths as those serving primarily white residents.
“Of note: although non-white residents tend to be in lower-quality nursing homes, these quality differences do not appear to explain disparities in COVID-19 outcomes,” she told the committee.
Surprisingly, simply having more staff did not reduce the probability of an initial outbreak, Konetzka said. But higher baseline staffing ratios did help stem outbreaks once they began. Nursing homes that had the highest number of staff hours per resident-day had fewer cases and deaths than those with the lowest, she said.
Link to full story: https://www.medpagetoday.com/special-reports/exclusives/91695
RINewsToday Note: The RI Department of Health lists Greenville Skilled Nursing & Rehabilitation, the Genesis owned RI home where the CNA who worked testified, as having 90-94 cases since March of 2020, with 15-19 fatalities, and no current cases.
The six nursing homes with the most fatalities, on the RI Dept. of Health website, are:
Elmhurst – Providence (55-59)
Orchard View – East Providence (55-59)
Cherry Hill – Johnston (50-54)
St. Antoine’s – Woonsocket (45-49)
West Shore Health – Warwick (45-49)
Berkshire Place – Prov (40-44)
The nursing homes with over 140 cases, on the RI Dept. of Health website, (and deaths) are:
Elmhurst – Providence (210-214) with 55-59 deaths
Berkshire Place – Providence (195-199) with 40-49 deaths
Orchard View – East Providence (165-169) with 55-59 deaths
Evergreen – East Providence (145-149) with 25-29 deaths
Trinity Health – Woonsocket (145-149) with 25-29 deaths
Holiday – Manville (140-144) with 35-39 deaths
Hopkins Manor – No. Providence (140-144) with 25-29 deaths
St. Antoine’s – Woonsocket (140-144) with 45-49 deaths
Riverview – Coventry (140-144) with 25-29 deaths