Long Term Care Trends

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Altarum’s Center for Value in Health Care detailed the spending decline in nursing homes this year in a new report. Spending for nursing home care dropped 7.2% from April to May despite other healthcare sectors showing signs of recovery amid the ongoing coronavirus pandemic. Analysts said they expect a gradual decline through at least the end of the year. Overall, nursing home care spending is down 12.7% from February.

The ongoing coronavirus pandemic has the skilled nursing industry in a challenging state right now after new data revealed occupancy at SNFs dropped to 78.9% by the end of April. In March, SNF occupancy had dropped to 83.4%, which were the lowest levels since 2012.

Rhyan also noted that employment in the sector fell 3% and 4% in April and May, respectively, when compared to last year. He added that though the industry is likely seeing increased spending in patients who require care for COVID-19, that’s being offset by a reduction in other types of care. He expects to see a continued decrease in spending as COVID prevalence increases across the country.

“Nursing homes did not have as near of a steep drop that in April, but we are seeing now this persistent decline into May,” senior analyst and report co-author Corwin Rhyan explained that the sector has seen a more “moderate decline” when compared to the other healthcare industries during the pandemic.

The ability for spending in the sector to rebound will depend on the “extent to which nursing homes get the virus under control,” added George Miller, report co-author, fellow and Research Team Leader for Altarum’s Center for Value in Health Care. “That’s a little hard to predict,” Miller said.

The findings also revealed that Medicaid revenue patient per day increased by $10.53, or 4.9%, when compared to April 2019.

“It is way past time to have nurses in nursing homes.”

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Nursing homes need to be a priority when personal protective equipment (PPE) is being distributed, and these facilities also need to be required to have a nurse on staff 24 hours a day.

“It’s absolutely critical to have registered nurses 24 hours a day in nursing homes,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, in Washington. “Right now, the only federal requirement is a registered nurse for 8 consecutive hours a day, but people get sick in the middle of the night.” Without a nurse on duty for nursing home workers to consult, “we’re not going to get good care for people,” she said. “It is way past time to have nurses in nursing homes.”

“The federal government, whose prompt response was so desperately needed, failed to surmount the challenge and make PPE a priority for nursing homes,” said Michael Wasserman, MD, a geriatrician and president of the California Association of Long Term Care Medicine. The nursing home industry “had the ability to leverage their assets to acquire PPE, but many chose to wait for a government response which didn’t happen … As a clinician, I don’t care who takes responsibility for the acquisition of PPE, but without PPE, COVID-19 cannot be stopped.”

Wasserman and Edelman were speaking at a roundtable hosted by the House Democratic Caucus Task Force on Aging and Families. Task force members also heard from Chris Brown, a certified nursing assistant working at a nursing home. “I find the work to be very rewarding but to be truthful, I face many challenges on the job, and many of these challenges existed before COVID-19,” said Brown.  Brown said nursing home workers are being paid “poverty wages” and often don’t get sick leave. “If I become sick, how can I take care of somebody? And who will take care of me? I have to choose between having the lights on and protecting my health.”

Wasserman worried about nursing homes allegedly dumping vulnerable residents in order to make room for more profitable COVID-19 patients. “I was worried that this type of behavior could and would occur, so when the story came out, it didn’t surprise me,” he said. “The bad apples highlight a couple of fundamental problems in the industry …. Surveyors can only do so much after the fact; we need to work to prevent this type of behavior” from occurring in the first place.

In addition, “medical directors have been kept out of medical management and decision making. We need to make sure the medical director is fully engaged,” said Wasserman. They’re critically important because “unless you have clinical leadership in the building calling this out, the facilities manage to come up with reasons and excuses for why they’re doing it. We need to be calling it out and recognizing that staff and facilities are under tremendous financial pressure and that drives a lot of this type of behavior.”

SavaSeniorCare and COVID

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Congress launched an investigation into the ongoing COVID-19 crisis in nursing homes, requesting information from both the federal government and five national for-profit operators in the industry. The action comes after the subcommittee held a hearing on COVID-19 in nursing homes in which both frontline workers and academics described the problem as systemic.  The probe focuses on five major nursing home owner/operators: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare. (Data indicates over 500 deaths of caregivers and residents at SavaSeniorCare facilities, including in one facility where 98 percent of residents were infected).

“The only thing COVID did was rip the doors open,” Chris Brown, a CNA working in Chicago, said during the hearing, testifying that staffing and PPE shortages were a problem in nursing homes prior to the pandemic. “It blasted the doors open of a system that was already failing.”

Atlanta-based SavaSeniorCare is targeted in the congressional investigation because of their long history of problems including a pending Medicare Fraud case in Tennessee.  Rubin Schron expanded his interests with the $1.3 billion acquisition of about 175 nursing homes from Mariner Health Care, Inc., which were subsequently leased to and operated by SavaSeniorCare.  SAVA operates 209 SNFs and five ALFs in 21 states with a total of 24,908 beds as of December 31, 2017, making it one of the largest SNF operators in the United States. Mr. Schron effectively owns most of the equity in Sava through Cammeby’s outstanding loans to Sava.

The former Mariner properties are master leased to SAVA subsidiaries and each property, in turn, is subleased to separate entities, subject to an operating lease. After Tony Oglesby’s sudden death, Jerry Roles took over as the CEO of SAVA. The rest of the management team includes Tim Schindler (President and Chief Operating Officer since May 2017) and Kevin Seramur (Executive Vice President and CFO)
and Stefano Miele (Executive Vice President, General Counsel and Secretary).

SavaSeniorCare is a named party in ongoing litigation focused on violations of federal law. Cases of note include United States ex
rel. Hayward v. SavaSeniorCare, LLC, alleging that SAVA knowingly and routinely submitted false claims to Medicare for
rehabilitation therapy services that were not medically reasonable or necessary. In addition, SAVA and related entities were defendants in a previously settled lawsuit alleging that SAVA and other parties took illegal kickbacks to refer their residents to Omnicare for pharmacy services. The United States entered into a settlement agreement with SAVA, and other related parties. The settlement agreement required the defendants to pay a sum of $14.0 million to the United States. Somehow they keep operating…

Annaliese Impink, corporate counsel for the national for-profit chain said:

“While we will likely cooperate, we are weighing our options and will determine our next steps.”

Sava has 13 nursing homes across Georgia and 4 in South Carolina. At Roselane Health and Rehabilitation Center in Marietta, 99 residents have tested positive for COVID-19 and 14 died. At Sandy Springs Health and Rehabilitation, 66 have tested positive and 13 have died, according to the Georgia Department of Community Health. Sava nursing homes in other states have also had major outbreaks and large numbers of deaths, including almost all of its facilities in Maryland and Michigan, according to federal data. At one Pennsylvania facility, 173 residents were infected, and 48 died.

“We know that this is an unsettling and scary time for our residents and the community,” SavaSeniorCare Consulting LLC Chief Experience Officer Annaliese Impink wrote in a statement emailed to 7 On Your Side. “We understand and greatly appreciate family members’ concern for their loved ones and are doing everything in our power to keep our residents safe and protected.”

SavaSeniorCare Administrative Services LLC, the company that issued the statement, provides management services to nursing homes, and is based in Atlanta.

The Industry is a Moral Failure

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Charles C. Camosy teaches bioethics and moral theology at Fordham University.  He wrote an op-ed for the New York Times. Below are excerpts.

We knew it from the beginning. A nursing home in Washington State was the center of the first known coronavirus outbreak in the United States. We knew that institutions caring for the elderly and disabled in close quarters would be particularly vulnerable during the pandemic.

But we did not act. Personal protective equipment, special training and extra staff went almost exclusively to our critical care facilities. Nursing homes got virtually nothing. Well, that’s not entirely true. In New York and other places we gave them patients, and even nurses, infected with the virus.

The result has been a raging wildfire of infection and death. We don’t have full reporting of anywhere close to all the deaths at this point, but the best estimates right now are that about half of those who have died from Covid-19 have been nursing home residents. In some places, it’s much more: Connecticut reported that nearly 90 percent of its Covid-related deaths between April 22 and April 29 occurred in nursing homes.

We tend to see this as a public health failure, but it is also a moral failure. That fact hit me recently, after I went on Fox News’s “Tucker Carlson Tonight” to talk about the plight of nursing homes.

Even before the pandemic, these were places where what I call “throwaway culture” was thriving. The staff aren’t paid a living wage, often have poor training and are hopelessly overworked. The residents face elder abuse, and large percentages of them are desperately lonely. A good number get no visitors at all, which pushes rates of dementia among residents to unbelievable levels.

I suggested to Mr. Carlson’s audience that it was no surprise that throwaway culture kicked into hyperdrive in nursing homes during our current moment. I was excited to be able to make my case to a national audience; afterward, I was exhausted. All I wanted to do was help my wife get our 2-year-old to bed and go to sleep myself.

But that’s when the messages started coming in. Email. Facebook messenger. LinkedIn. Twitter. One after the other after the other. And they were horrifying.
It is one thing for a professor of bioethics to cite abstract numbers and trends and offer a theoretical explanation for them. It is another thing to get message after message detailing the human toll of what you had just discussed.

One of the most moving — and frightening — was from a nursing home staffer. She said she was given inadequate P.P.E. and training, and had likely been exposed to the virus. Her communications with management were ignored. Staff members at her facility were not being tested. She decided to quit her job rather than risk infecting her residents. “I don’t know if you can help me,” she said. “I feel that what you said is true; the elderly need a voice by someone that cares.”

Another correspondent, who had worked in health care administration, said that she was “not surprised in the least that the hospitals were trying to discharge their Covid-19 infected patients” back to long-term-care facilities because, in her experience, this has “been happening for quite some time.” It got worse: Agreeing with me about the radical understaffing of nursing homes, she said that it is “increasingly common is to discharge high cost and difficult patients to homeless shelters … Yep, you heard me right … HOMELESS SHELTERS.”

Not every story was coronavirus-specific. One man told me the story of the fatal neglect of his father — after which the nursing home falsified his father’s records and hid behind state laws that nursing home lobbyists had written.

A former director of nursing at a long-term-care facility said that given her terrible professional experiences, she had refused to put her 78-year-old husband, who was suffering from dementia, anywhere outside her own home. Another clearly frightened woman explained that she had just had a horrible experience with her mother in a nursing home; she even gave me, a complete stranger, her phone number, in the desperate hope that I could raise the alarm about how bad things were.

We need to listen to people like this and act on what they are saying. The pandemic doesn’t have many silver linings, but as the number of nursing-home deaths piles up, the news media is being forced to cover a world many of us would prefer to ignore.

It is understandable that we would. Part of the price we pay for living in a death-denying, consumerist, throwaway culture is that we must push these kinds of grim realities to unseen places that afford us plausible deniability. The pandemic forces us to look. If we want to understand the current phase of the coronavirus pandemic, we can no longer look away.

After receiving this waterfall of messages, I expected to fall into despair. But while I do have my bad days, I also have hope. Times like this have produced major cultural changes in our past. If we do take a hard look, we may change more than just the way we treat older Americans. We may, along the way, find a way to push against throwaway culture in all its forms.

Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us? To honor the moral and social equality of every human being, regardless of their mental or physical status?

Why not? Many of us are staying home and practicing physical distancing, not primarily for ourselves but for the benefit of our elders and others who find themselves at risk. Let us build on that good and decent impulse by challenging a throwaway culture that, right up until this very moment, has marginalized these populations and made the nursing-home crisis a tragic inevitability.

Leadership During Crisis?

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Under normal circumstances, state surveyors only visit individual facilities on behalf of CMS about once per year, or perhaps in response to a specific credible complaint. However, new federal guidelines released require all states to perform a “targeted” infection-control survey or risk losing some CARES Act funding, while instituting mandatory follow-up inspections after new outbreaks are reported.

Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said “At the end of the day, the ultimate responsibility, really, for the health and safety of residents is on the nursing home,” during a phone press conference. “The role of the state and the federal government — we set regulations, we do inspections.”

Verma was answering a question about nursing homes with outbreaks of COVID-19 despite receiving deficiency-free surveys even during the pandemic, a conclusion that questions the integrity and efficacy of the inspections.

Just 3% of the more than 5,700 surveys conducted since the start of the pandemic revealed infection-control citations, prompting the Center for Medicare Advocacy to call the results “not credible.”  Especially since 84% of all facilities have had at least one deficiency related to infection control in the last five years! Deficiencies include insufficient hand-washing and lax attitudes around separating COVID-positive residents from those without the virus, as well as appropriate use of personal protective equipment (PPE).

“It is simply not plausible, during the pandemic, when at least 32,000 residents have died of COVID-19 and large proportions of deaths from COVID-19 nationwide are residents and staff, that facilities have no problems in their infection prevention and control practices,” the advocacy group said. “Problems cannot be fixed going forward if they aren’t even identified and acknowledged.”

Verma pointed to limitations, however, in the inspection system.

“When you go into the nursing home, the staff know that they’re being observed — particularly on that day. They go in, and they’re looking for things, and they may not see it in that particular visit,” Verma said. “But when the inspector leaves the nursing home, things can change.”

“It just could be at that particular day, [surveyors] didn’t observe anything, and they showed that they had the appropriate policies and procedures in place,” she said. “But when something actually happens — does the staff follow those policies and procedures? May have happened on that particular day, may not happen every day.”

Will COVID-19 Change the Industry?

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As a nursing home lawyer who has represented hundreds of families, I am constantly thinking of ways that the industry can improve.  The one issue that has remained a problem for decades is the failure to provide safe, sufficient, and competent staff.  The only way to do that is invest in training, benefits, competitive wages, and enough staff to prevent burnout.

The stunning death toll from the industry’s failure to prevent and contain the coronavirus has brought new scrutiny to an industry that is due for a major overhaul. Questions about reimbursements, staffing levels, adequate training for staff, effective regulations and oversight all are raging as states battle to control the ravages of the pandemic.

There have long been ideas among people who study nursing homes — or work in them — for ways to make them safer, increase quality, and be more humane.  The pandemic exposed the weaknesses of the nursing home system. Facilities were short of PPE. Tales abounded of nursing home staff wearing rain ponchos and goggles from hardware stores because they couldn’t get proper gowns and face shields.

“There’s lots of hubbub” around nursing homes, says Dr. Louise Aronson, a geriatrician, professor of Medicine at UC San Francisco, and author of Pulitzer Prize finalist Elderhood. And it’s important, she says, that the public keep that focus. “The way we’ve created nursing homes,” she says, “they’re so separate from real life that it’s altogether too easy for people to go back to their lives and just kind of forget about it and not make a difference.”
Infection control is the most frequently cited deficiency by health inspectors. Annually, well over a million nursing home residents contract preventable infections and as many as 400,000 die from them. Even after the pandemic began, nursing home inspectors found that 34% of nurses and nursing assistants did not wash their hands properly and at least 25% were using personal protective equipment (PPE) incorrectly.  Good grief.
Expert Charlene Harrington, a professor of Nursing and Sociology at the University of California San Francisco says that “The fines are so small that they don’t really have an impact on the nursing home. It’s just the cost of doing business.”

Professor Charlene Harrington of the University of California, San Francisco, says a “better way” would be to refocus the inspection system on the fundamental problem of nursing homes, which she says is inadequate staffing.  Nursing assistants, she says, are “running from one resident to the other without hand washing,” which she says is one of the main reasons that nursing homes are so often cited for poor infection control.

So many of the citations that nursing homes receive — from poor infection control, to patients with bed sores, to nutrition problems — can all be traced back to insufficient staff, says Harrington, but it’s something they’re almost never cited for directly.

Harrington blames nursing home owners for the low staff levels.

“Over 70% of nursing homes are for-profit,” she says, contending they reduce staff to lower their costs. “That’s the primary way that for-profit companies can save money.”

“The financial interests of for-profit nursing homes are too often in conflict with their mission to care for older adults,” Harrington says. And the only way to fundamentally change that is to change the ownership structure, she says, regulating them like a utility.

“You would have very tough financial requirements, you would have stricter requirements of who could become an owner. Only owners with good track records would be allowed,” Harrington says. “And you would have very strict standards around their staffing and the way they pay their staff and treat their staff.”

People never picture themselves in a nursing home, Harrington says. But they should. And they should think about what they would like for themselves.

“Until we start doing that,” she says, “we’re going to allow them to continue to operate on a sub-par level.”

“I’ve been teaching nursing homes and studying this area for 20 plus years,” says David Grabowski, professor of Health Care Policy at Harvard School. “I would really think about smaller home environments where we value the caregivers and we value the residents,” Grabowski says. He imagines houses with just eight to 12 residents living together. “I think in general, we’ve had way too much focus in terms of regulation on quality of care and not enough on the quality of life in these homes.”

“There’s under-investment in care generally and in staff in particular,” Grabowski says. “And why can’t we pay more for these services and value the people that provide care for all of us in these settings? You know, we’re getting what we pay for right now. And it’s unfortunately not a very good outcome.”

Limiting occupancy can also help control the spread of infection, says Daniel Ruth, CEO and president of the San Francisco Campus for Jewish Living.

“I absolutely believe that all rooms should be single rooms,” Ruth says. Currently, many nursing homes house residents two or three or even four to a room, all sharing one bathroom, making it easier for infections to spread.

There might be better outcomes if most nursing homes weren’t designed to make money, says Daniel Ruth of the Jewish Home. “If I was the king of the world, there would be a much greater proportion of nursing homes run by not-for-profits.”

Money for Nothing

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The Department of Health and Human Services announced last week that another $15 billion in coronavirus relief funding to Medicaid providers will be provided. The additional funding will be distributed to eligible Medicaid and Children’s Health Insurance Program providers. Additionally, the agency announced that an enhanced portal is available for providers, starting today, that allows them to report their annual patient revenue, which determines their payment amount. About 62% of all Medicaid and CHIP providers have received relief funding and this distribution is expected to cover the remaining 38%, according to the agency.

“HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins,” the agency explained.

The American Health Care Association/National Center for Assisted Living applauded the federal government for distributing the additional funding to Medicaid providers. In May, in a separate payout, the federal government disbursed $5 billion to nursing homes. The funding equates to about $50,000 per facility. That’s a baseline $50k per facility, plus another $2,500 per bed.

“These nursing home, assisted living and intermediate care facilities for individuals with intellectual disabilities urgently need these resources from the federal government to acquire testing, equipment and staffing to protect their residents,” AHCA/NCAL President and CEO Mark Parkinson said.

Now They Want Immunity!

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Nursing homes operated by Life Care Centers of America, one of the largest chains in the industry, violated federal standards meant to stop the spread of infections and communicable diseases even after outbreaks and deaths from Covid-19 began to sweep its facilities from the Pacific Northwest to New England, inspection reports show.  To experts and advocates, the size of the outbreaks reflects profound flaws in the company’s management and the treatment of patients, which have been documented for years in lawsuits by families, former employees and federal prosecutors. Time and again, they described a company beset by staffing shortages and compromised care, deficiencies that critics say probably worsened as covid-19 infected hundreds of residents and caregivers.

As the nationwide death toll among the elderly soared, government inspectors discovered breakdowns in infection control and prevention at at least 10 Life Care nursing homes that underwent covid-19 inspections overseen by the Centers for Medicare and Medicaid Services. That does not include deficiencies found at the Life Care Center of Kirkland in Washington state, which suffered the country’s first reported outbreak of the novel coronavirus in February.

At other Life Care nursing homes, inspectors have since then discovered staff members who did not wash their hands or enforce social distancing guidelines, according to the inspection reports. At one home in Denver on May 5, staffers left open the door of an isolation room, allowing a patient with covid-19 to slip into the hallway without a face mask and sit next to a room with two healthy residents. At another home in Colorado, a nursing assistant hovered 12 inches from the face of a coughing patient who was not wearing a mask. In Kansas, inspectors found a nursing home’s infection control log failed to include two patients with fevers — one was sent to the hospital with a 103-degree fever and died. In a home in Michigan, a nursing assistant rolled a blood pressure machine out of an isolation room and into a non-covid-19 room without sanitizing the equipment. At another Michigan home, inspectors found residents in a hallway who were not wearing masks and an aide who delivered meals without wearing gloves or a gown, even though the residents were at risk of respiratory infection.

“These deficient practices resulted in the high liklihood of spreading coronavirus and harmful pathogens among five residents . . . second floor residents that received direct care from staff, second floor residents that interacted with each other, residents that resided on the first floor that received food from the kitchen and nine residents that transferred to the hospital testing positive for covid-19,” the inspector wrote.

Life Care President Beecher Hunter said “Life Care Centers of America and its affiliated facilities are not perfect; no organization is because it is made up of people, and people are imperfect human beings,” Hunter said in an email to The Post. “. . . Our healthcare heroes will from time to time unfortunately fall below our standards for resident care.”

In the past three years, dozens of Life Care homes received below-average staffing ratings or were flagged during inspections for not having enough nurses to properly care for patients, according to CMS. Forrest Preston, the son of a Massachusetts pastor, settled in southeastern Tennessee in the 1950s to help his brother create booklets and public relations material for hospitals. Over time, he developed an interest in long-term care. Preston and his partners opened the first nursing home in 1970. From his Tennessee headquarters, the company would grow to more than 200 nursing homes, one of the largest networks in the country.

The Justice Department in recent years accused the company’s billionaire owner of leaving Life Care “severely undercapitalized” while engaging in a “systematic scheme to maximize its Medicare billing.” Prosecutors say Life Care subjected patients to excessive, unnecessary and “sometimes even harmful” rounds of rehabilitation therapy to draw Medicare dollars and chastised or punished those who complained the practice undermined the judgment of therapists at the expense of patients.

The company settled with the Justice Department in 2016 for $145 million — the largest settlement with a skilled nursing chain in the department’s history. Life Care also entered into a five-year corporate integrity agreement with the inspector general of the Department of Health and Human Services, which required an independent annual review of the company. Life Care was in its fourth year of the agreement when the coronavirus struck the United States.

Families, lawmakers and former and current employees say Life Care, after years in operation and amid intense scrutiny, should have done far more to protect patients and caregivers as the pandemic intensified.

“We kept waiting and waiting for them to do something, and they never did,” said Diane Crowley, who worked at the front desk at the nursing home, wiping her hands with a cloth soaked in bleach that she said she kept in a plastic bag in her pocket. She eventually quit. “I was literally surrounded by covid,” she said. “I just told my kids, ‘Please never put me in one of those places. These people live their whole lives — there are teachers, poets and everything else — and this is what they’re ending their lives with?’ ”

Accepting Responsibility

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In the aftermath of Hurricane Katrina in 2005, the inspector general for the U.S. Department of Health and Human Services found that nursing homes were unprepared for emergencies. The watchdog recommended strengthening the federal requirements to be more specific about the elements that must be in a disaster plan and encourage more coordination with state and local emergency management officials.  The nursing home industry spent millions fighting the recommendation.

In 2009, the Government Accountability Office examined preparedness for a flu pandemic and recommended that the federal government do more to advise health care providers on emergency plans and monitor their performance. The industry fought back arguing that it was not necessary. The shortcomings were underscored by an outbreak of swine flu that year, which sickened nursing home residents nationwide.

In 2013, the concerns over infectious outbreaks increased. The Centers for Medicare and Medicaid Services, or CMS, proposed updating the emergency preparedness requirements for all health care providers that participate in Medicare and Medicaid, including nursing homes. Nursing home owners and operators objected to the new requirements, arguing they would be costly and burdensome. Over the next three years, they repeatedly voiced their concerns as CMS finalized the new rule.  CMS eventually rejected the appeals, issuing its final rules in September 2016. Nursing homes and other facilities had to implement the changes in 2017 but then Trump took office.

On Dec. 15, 2016, the nation’s largest nursing home lobby wrote a letter to Donald Trump, congratulating the president-elect and urging him to roll back new regulations on the long-term care industry so they can increase profits. Trump’s election, the American Health Care Association, or AHCA, wrote, had demonstrated that voters opposed “extremely burdensome” rules that endangered the industry’s profit margins. The letter continued the industry’s fight against regulations designed to increase safety and quality of care including preventing diseases like COVID-19 from devastating elderly residents of the nation’s nursing homes.

One item on the wish list was the emergency preparedness rule. It required nursing homes to draw up plans for hazards such as an outbreak of a new infectious disease. The lack of pandemic plans helps explain why nursing homes have been caught unprepared for the new coronavirus, patient advocates and industry observers said. Across the country, more than one in four nursing homes have registered an outbreak, according to media reports.

Emergency plans help facilities train their staff ahead of time and guide tough decisions during a crisis, said Ted Goins, the president and CEO of Lutheran Services Carolinas, a nonprofit based in Salisbury, North Carolina. “COVID-19 is a perfect example of why we have emergency plans in our facilities, and I’m sure that’s why it’s a requirement,” Goins said.

More than 30,000 nursing home residents and workers have died of COVID-19. That figure is likely an understatement of the true scope of the harm. Nursing home advocates say that detailed plans accounting for expected staff and equipment shortages would have likely resulted in fewer deaths and illnesses at nursing homes stricken by the coronavirus.

“Facilities should have been better prepared for this,” Melanie McNeil, Georgia’s long-term care ombudsman, said. “The cost is human lives. That’s the cost of not being prepared. We know that people in long-term care are vulnerable.”

“It’s just a river of grief, and it could have been prevented,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

The American Association for Justice is pushing back against politicians giving immunity to nursing homes for abuse, neglect, and malfeasance. The group, which represents trial lawyers, and a coalition of other groups sent a letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer urging them not to make it harder for nursing homes to be sued over coronavirus deaths.

“As a nation, we cannot tolerate rewarding nursing homes for years of cost cutting and profit maximizing by relieving them of responsibility,” they wrote.

The American Association for Justice is battling the proposals by pointing to “the facts and the data make clear that there is no wave of litigation” threatening businesses, Julia Duncan, a spokeswoman for the group, said. While the Chamber and other groups have warned about the threat of potential lawsuits, she said such groups are only trying “to gin up fears so they can get out of being held accountable.”

Industry Demands Slush Fund

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Meanwhile, despite the continued profitability of the nursing home industry AND the millions the industry received from the Trump bailout, the nursing home industry lobbyists continue to ask for legal immunity and a $10 billion slush fund. The $2.2 trillion federal stimulus package included $175 billion to be distributed by the Department of Health and Human Services to healthcare providers.

Lobbyists are now demanding the federal government create a dedicated fund for skilled nursing operators — like it did for hospitals — to aid them in their coronavirus response.  The American Health Care Association/National Center for Assisted Living is specifically calling for the federal government to set aside $10 billion in relief funding for skilled nursing facilities.

Do they really need it?

The Ensign Group (Nasdaq: ENSG) has logged another record quarter to start 2020.  The San Juan Capistrano, Calif.-based operator saw a 28.3% increase in its per-share earnings over the fourth quarter of 2019 — which itself represented another record — earnings figure was also a 92.5% increase over the same time last year.