COVID-19 in Nursing Homes: What Went Wrong and Next Steps

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On September 23, 2020, the Senate Finance Committee released a 67-page report.  The purpose of the report is summed up in the Introduction and the last paragraph of the Executive Summary:

This report discusses the findings of the majority staff of the United States Senate Committee on Finance, following a review of nursing home performance during the first eight months of the COVID-19 pandemic.  Nearly 1.4 million individuals reside in approximately 15,600 Medicaid-enrolled nursing facilities and Medicare-enrolled skilled nursing facilities nationwide.  Some of these facilities, which are the subject of this report, have provided exemplary care to their residents, while others became overwhelmed, during the COVID-19 outbreak.  Data indicates that over two out of five deaths due to COVID-19 in the United States are linked to nursing homes and other long-term care facilities, leading critics to dub these facilities “death traps” or “death pits.”

This report incorporates a three-part analysis.  First, it identifies the issues and challenges confronting all nursing facilities during the pandemic.  Second, it focuses on the reasons why this novel coronavirus had an especially deadly impact on some facilities, but not on others.  Third, it seeks to identify the best practices among facilities in which the virus apparently had no, or only a limited, impact.  Such an analysis could help elucidate what works best, and what does not work, in mitigating, or at least slowing the extent of COVID-19 transmission in these vulnerable facilities in the coming weeks and months.  This report concludes by making recommendations for policymakers on next steps to promote the quality of life and safety of nursing home residents and frontline workers in these facilities, across the United States.

The Committee’s Conclusion statement:

This report offers members of this Committee some additional background on the challenges that many nursing homes have faced, and continue to face, during this year’s public health emergency period. It makes specific recommendations for Congress, based on best practices that these facilities and some public officials adopted during the pandemic to protect nursing home residents and personnel. It includes additional recommendations to better protect the nation’s older Americans from elder abuse, neglect, and exploitation.  Many of these recommendations are embraced in legislation previously filed by Chairman Grassley or other members of the United States Senate. (The recommendations in this report do not substitute for official guidance, issued by CMS and the CDC during the pandemic, to reduce the transmission of COVID-19 nursing homes.)

I’m still working my way through this lengthy document (there are lots of references to other documents).  In between the Introduction and the Conclusion, you’ll also find:

  • What Went Wrong: Factors Fueling COVID-19 Fatalities in Many Nursing Homes
  • Challenges Common to Virtually All Nursing Homes
  • Additional Challenges Confronting Selected Nursing Facilities
  • Differences in Nursing Home Preparedness and Response
  • Differences in State Governments’ Response to COVID-19
  • Lessons Learned: What Worked Best Before and During COVID-19 Pandemic
  • Recommendations for Congress

I find it most interesting that what I’ve read to date indicates that the pandemic is over.  It is not done with us yet!!  Did this Committee review the National Commission’s report released to the public on September 16th?  CMS had this report in their hands as of September 1st.  I have yet to find any comment on the rule the current Administration played in what went wrong nor next steps for this and the next Administration other than the following statement on page 4:

Any suggestion 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.  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.

 I’ll keep reading but perhaps the elected-to-office critics of the pandemic – TO DATE – need to remember that we’re not out of the woods yet.  Hold your “applause” til the show is over, as they say.