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Tackling surge of COVID-19 in Nursing Homes – Herb Weiss

By Herb Weiss, contributing writer, aging issues

Over the months, while public health officials watch the uptick in new COVID-19 cases, Congress releases two reports, one taking a snapshot of nursing home performance and resident deaths throughout the first eight months of the pandemic, and the other one sounding the alarm about the impact of COVID-19 on the nation’s nursing homes and warning it is now getting worse.  

About three months ago, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) announced the release of a 67-page report on care provided in nursing homes and other long-term care facilities throughout the nation during the ongoing COVID-19 pandemic. The comprehensive report, titled “COVID-19 and Nursing Homes: What Went Wrong and Next Steps,” reviewed U.S. nursing home performance during the early fall and summer months of the pandemic. According to the report, more than two out of five deaths due to COVID-19 in the United States are linked to nursing homes and other long-term care facilities.

Stopping the Spread of COVID-19 in Nursing Homes

“Partisan finger pointing, rather than meaningful analysis, cannot serve as a useful guide for policymakers in crafting the necessary bipartisan reforms in response to the unprecedented challenges facing this entire sector and its employees working on the frontlines during this pandemic,” says the Senate Finance committee report, released on Sept. 23. It stressed that suggestions that coronavirus-related deaths in nursing facilities “are attributable solely, or even primarily, to acts or omissions by the current administration falls well short of addressing the multi-faceted problems in this sector.”

The report added, “Such a one-dimensional approach necessarily overlooks several factors that fueled the outbreak of COVID-19 in nursing homes across the United States, and around the world. Minimizing, or devoting scant attention to such factors, makes it enormously difficult for members of Congress to come together in support of long-overdue reforms and bipartisan solutions to the complex problems facing nursing homes today.” 
The report, produced by the majority staff of the Senate Finance Committee, examined what steps might have prevented these fatalities by minimizing the spread of COVID-19 in the facilities and discussed what actions could be taken now to slow the surge of deaths in nursing homes during this and future pandemics.  

While new coronavirus cases have surged to nursing homes throughout the nation and despite federal and state efforts to stall the spreading of the virus, the Senate Finance Committee report noted that facilities have already received significant relief assistance from Congress and the Trump administration totaling approximately $21 billion in addition to technical assistance, guidance and training.

The report’s findings noted that for years preceding the COVID-19 outbreak in March, private nursing homes have had widespread deficiencies in infection control and prevention.  The majority staff also found that state governments and health officials in some of the hard-hit states fell short of their responsibility to ensure quality care, and in multiple states, staffing and supply shortages persisted for years prior to the pandemic. 

Nursing homes around the world have struggled with many of the same issues as the United States during the pandemic, including Europe, the United Kingdom and Canada, noted the report.

State governments in some cases also failed to enforce federal guidelines for these care facilities as required through their participation in Medicare and Medicaid, particularly guidance provided to minimize coronavirus transmission in their facilities, noted the report. In addition, the majority staff found that nursing home staff who work in multiple facilities unknowingly played a key role in spread of COVID-19 in nursing homes. 


Finally, the Senate Finance Committee report also noted that several governors pressured nursing facilities to accept COVID-19 patients when personal protective equipment (PPE) was still in short supply and some did so even after the federal government made temporary hospitals available in their jurisdictions. 
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The Senate Finance Committee report provided, to members of the Senate Finance Committee with detailed background information on the many challenges that nursing homes continue to face during this year’s public health crisis. It provides Congressional lawmakers with specific recommendations, based on best practices that some facilities and public officials adopted during the ongoing pandemic to protect their residents and staff.  It also includes additional suggestions to better protect the nation’s older Americans from elder abuse, neglect and exploitation.

 
Updating the Grim Toll of COVID-19 Deaths in Nursing Homes 

Last week, U.S. Senators Bob Casey (D-PA), Ranking Member of the Special Committee on Aging, and Ron Wyden (D-OR), Ranking Member of the Finance Committee, released their report that warned that the already dire situation in nursing homes is worsening.

“It’s with great sadness that we are once again giving a grim update on the toll that COVID-19 is continuing to take on nursing homes. It’s abundantly clear that inaction has contributed to the loss of more than 104,000 mothers, fathers, grandparents, friends and neighbors who lived and worked in nursing homes and long-term care facilities across the country,” said Senators Casey and Wyden, in a statement announcing the report released on Dec. 10. “Experts are predicting that we are heading into the most severe months of the COVID-19 pandemic, marred by climbing caseloads and increasing stress on our Nation’s health care system,” they say, calling on the Senate colleagues to hammer out and pass a comprehensive COVID-19 relief bill. 

According to the eight-page report, entitled, “The Cost of Inaction: 19 Deaths an Hour and Rising,” last month, more than 15 nursing home residents died from COVID-19 per hour, with 19 residents dying each hour during the week of November 22, 2020, the most recent week reported.

The Senate Aging Committee report noted that the number of weekly COVID-19 deaths among nursing home residents has increased 133 percent since Labor Day, and 96 percent among nursing home workers during the same period. Workforce shortages have also increased since Labor Day: In November, one in six nursing homes nationwide reported that they do not have a sufficient workforce, says the report.

The Democratic Senators warned that COVID-19 cases will surge in nursing homes if Congress does not come together to hammer out bipartisan legislation to stop the spread of the pandemic.

These new report findings serve as a warning as to what will come if Congress does not come together to alleviate the COVID-19 crisis in nursing homes, says Casey and Wyden. It calls for a national strategy to save lives in nursing homes, including providing facilities with a sufficient supply of PPE, ample access to testing, resources for vaccine distribution, funding for strike teams and adequate workforce supports, and accountability measures to uphold resident rights and permit safe visits with family.

Finally, in the Ocean State…

Just days ago,the latest update of the AARP Nursing Home COVID-19 Dashboard, released by AARP’s Public Policy Institute, unveiled a new report in a series on improving the care of care provided in the nation’s nursing homes. “Rhode Island’s nursing homes continue to face alarming trends,” says the AARP report.

Using data released by the Centers for Medicare & Medicaid Services—which is self-reported by nursing homes—the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff. The dashboard will continue to be updated every four weeks.

In the four weeks analyzed, from October 19 to November 15, AARP’s dashboard reports that Rhode Island nursing homes had a dramatic increase in resident and staff cases, and a higher percentage of facilities reporting they are without a 1-week supply of PPE.

“With coronavirus surging across the country, nursing home residents and staff remain in grave danger as the virus reenters nursing homes and other facilities at an alarming pace,” said AARP State Director Kathleen Connell.  “Facilities continue to have shortages of the staff and PPE needed to keep residents and workers safe and stop the spread. Our state leaders must act now to save lives,” she said.

Connell added, “AARP will continue fighting to protect nursing home residents now and offering solutions to improve our long-term care system for the decades to come.”

For copies of Senate reports go to: https://www.aging.senate.gov/imo/media/doc/The%20Cost%20of%20Inaction.%2019%20Deaths%20and%20Hour%20and%20Rising.pdf

https://www.finance.senate.gov/imo/media/doc/SFCNursingHomesCOVIDMajorityStaffSFCReport23Sep2020FINAL.pdf.

The complete dashboard is available at aarp.org/nursinghomedashboard.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

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