NBC News reported that front-line workers are fearful of retaliation for notifying families of positive coronavirus test results. Most caregivers believe nursing home owners, operators, and managers have not done enough to protect and compensate the staff as they face life-threatening risks on a daily basis, sometimes for minimum wage. Certified nursing aides are in close physical contact with residents all day, lifting them in and out of bed, helping them use the toilet and brush their teeth, and feeding them meals.

Service Employees International Union have supported caregivers asking for higher pay, more hires to relieve staffing shortages, and more personal protective equipment. In response, the nursing home management threatens to call the police and fire the staff.

Long before nursing homes became a breeding ground for the coronavirus, aides have faced harsh working conditions for low wages with staffing shortages, according to nursing home workers, advocates and industry experts.

Despite promises to protect these workers and the vulnerable residents they care for, the federal government does not require nursing homes to inform staff members about coronavirus infections or deaths, and the Department of Labor does not require any workplaces to follow coronavirus guidelines from the Centers for Disease Control and Prevention.

Nursing homes have struggled for months to provide enough personal protective equipment for employees and COVID-19 tests for both residents and staff members, often getting second priority to hospitals.  According to data collected by NBC News, at least half of the 100,000 known coronavirus deaths in the United States are linked to nursing homes and other long-term care facilities.

Several workers who spoke to NBC News say their management has been unresponsive to their concerns — in some cases allegedly retaliating against staff members for speaking up, which would violate federal labor law — and has withheld the most basic information about coronavirus cases and deaths.

Federal oversight of these hazardous workplaces is limited. New federal rules do not require nursing homes to inform their own staff members about cases — even though employees have the most direct and potentially dangerous contact with infected residents. And the data reported to the federal government won’t be posted publicly until June, according to the agency.

CMS said in an email that all nursing homes are required to have infection control plans and “would inherently need to inform staff about cases of COVID-19 in the facility” to implement them effectively. The agency’s inspectors are currently focused on infection control and problems that place residents in “immediate jeopardy.”

“OSHA has disappeared — nobody has these workers’ back,” said Debbie Berkowitz, a former OSHA official under the Obama administration. “They are not enforcing the CDC guidelines. Employers can follow them or ignore them, and there are no consequences.”

OSHA had received more than 310 complaints about staff exposure to COVID-19 in nursing homes as of April 28. The agency also received reports of 47 staff deaths from the coronavirus in nursing homes, as well as 120 whistleblower complaints from nursing home employees since mid-February, the Labor Department said.

CNN reported disturbing evidence that nursing home managers were intentionally misleading and blatantly lying to caregivers about the risks of cornavirus.  Employee accounts of more than 500 complaints filed with the federal government’s Occupational Safety and Health Administration (OSHA) show ignorance and indifference.  A CNN review of these records, along with reports made to other government officials and interviews with employees, show that long-term care workers across the country feel their own lives are at risk as they work on the frontlines in facilities that have become hotbeds for Covid-19 — with more than 30,000 deaths nationwide.

In the worst examples, employees reported that managers hid positive cases from staff, meaning caregivers had no way of knowing for sure whether they were treating a patient with the disease. They expressed concerns over a lack of preparation, training and supplies to prevent them from contracting and spreading the virus. Employees have also reported staff being forced to work while symptomatic for Covid-19.

Supervisors told workers that a flu shot will protect you from coronavirus.  No need to tell authorities, a worker reported being told about the Covid-19 related deaths of colleagues at a Missouri nursing home.  Keep working, an employee who was vomiting and running a temperature at an Ohio long-term care facility was instructed, according to another worker complaint.

Worker complaints allege dangerous conditions in which staff members are deprived of basic protective gear and have been told to use coffee filters as masks and wear garbage bags or rain ponchos as medical gowns. The employees say they have been kept in the dark about outbreaks in their own facilities as they care for elderly and frail residents who are particularly susceptible to the disease.

 

The NY Times had an incredible article explaining why the nursing home industry’s emphasis of profits over people caused thousands to die. No nursing home could be completely prepared for a pandemic as devastating as Covid-19, but some for-profit homes were particularly ill equipped and understaffed, which undercut their ability to contain the spread of the coronavirus, according to interviews with more than a dozen nursing home workers and elder-care lawyers. The article explains how private equity firms and REITs have siphoned funds away from the facility causing many nursing homes to look unprofitable, falling into disrepair, and struggling to attract new occupants.  Their troubled state was years in the making.

Ownership by private equity and other private investment firms left nursing homes with large mortgage debt and razor-thin margins. Even so, many of their owners still found creative ways to wring profits out of them, according to an analysis of federal and state data by The New York Times. In many cases, investors created new companies to hold the real estate assets because the buildings were more valuable than the businesses themselves, especially with fewer nursing homes being built. Sometimes, investors would buy a nursing home from an operator only to lease back the building and charge the operator hefty management and consulting fees. Investors also pushed nursing homes to buy ambulance transports, drugs, ventilators and other products or services at above-market rates from other companies they owned.

These strategies paid off handsomely for investors, but they forced nursing homes to skimp on quality. For instance, for-profit nursing homes — roughly 70 percent of the country’s 15,400 nursing homes and often owned by private investors — disproportionately lag behind their nonprofit counterparts across a broad array of measures for quality, The Times found. Also, they are cited for violations at a higher rate than nonprofit facilities.

The pandemic “has brought a lot of these issues to the forefront,” said David Grabowski, professor of health care policy at Harvard Medical School. “With this huge health crisis and economic downturn, we are all of a sudden seeing how risky it is to have the ownership split between the real estate side that has the most valuable asset and the operator, who is left with much less.”

Controlling the real estate gives investors, including real estate investment trusts, leverage to raise rents. Separating the real estate from the operating business can also help limit liability in wrongful-death lawsuits, because the latter typically has little cash and few assets.

“The structure is designed to keep liability on the company that has the fewest assets and the most debt,” said William Murray, a plaintiffs lawyer who specializes in suing nursing homes.

Private equity firms and other investors first gravitated to nursing homes more than a decade ago, betting that aging baby boomers would create demand irrespective of economic cycles and counting on a steady stream of Medicare and Medicaid reimbursements.

A recent report on private equity buyouts of nursing homes, which studied 119 transactions from 2000 to 2017, said private equity owners tended to put “high-powered profit maximizing incentives” first. The researchers found that after private equity stepped in, nursing staff hours per patient fell 2.4 percent, and staff quality as measured by federal regulators fell 3.6 percent.

The quality of care declines after the private equity buyout, which seems to reflect staffing cuts,” said one of the report’s authors, Sabrina T. Howell, assistant professor of finance at New York University’s Stern School of Business.

 The nursing home industry is pushing for broad immunity in the wake of the pandemic. So far, 16 states, including New York, New Jersey, Michigan, Georgia and Illinois, have already approved measures granting immunity from lawsuits — a development that worries longtime critics of the industry.

A lot of these nursing homes are trying to get immunity because of Covid, and that is really scary because some of these companies are so negligent,” said Charlene Harrington, a professor emerita of nursing at the University of California, San Francisco. Many for-profit nursing home operators report meager profits only because income is “drained off in their management contracts,” she said.

Not all nursing home buyouts have worked well for private equity firms. In 2018, HCR ManorCare, which was the nation’s second-largest nursing home operator, filed for bankruptcy protection — a decade after the Carlyle Group, a big private equity firm, acquired it. When it filed, ManorCare had $7.1 billion in debt, and its facilities had racked up numerous citations for failure to treat infections and properly monitor residents’ medications, records show.

Years before ManorCare declared bankruptcy, Carlyle sold the homes for $6.1 billion to a real estate investment trust, a move that largely wiped out the debt of the nursing homes. ManorCare then rented many of those facilities.

 

 

“I’ve been a nurse for 20 years. I’ve never seen an illness [work] the way this disease works,” says a nurse currently employed at the Kirkland facility. “It’s all unprecedented. We are the landlocked cruise ships.” This nurse says the staff has been doing everything they can to remain virus-free, and to prepare for “the new normal.” She still hasn’t been tested for the virus, however, since she doesn’t have any symptoms. The Kirkland location had 108 residents before the outbreak and is now down to 32 patients, due to deaths, infected individuals being transferred to hospitals and residents being discharged.

In early April, a nurse named Maria Krier spoke out about the conditions at the Littleton, Massachusetts, Life Care Centers of America (LCCA) facility and accused the company of negligence during the coronavirus outbreak, according to a local news report. Krier, 59, died from COVID-19 reportedly on April 10, 2020, shortly after making her remarks. “We are deeply saddened by the passing of one of our own associates. Our sympathy goes out to her family and all of those who are close to her. If you need to talk, we are here for you. Our thoughts and prayers go out to her family,” the company said in a message to employees that was reviewed by Forbes.

The industry blames others.  The virus’ entry into long-term care facilities was inevitable, according to the American Health Care Association, which represents over 14,000 nonprofit organizations, including nursing centers and assisted living communities. Yet the devastating effects of the virus are exacerbated by long-term care providers not having adequate access to testing, personal protective equipment (PPE) or staffing. “Just like hospitals, we have called for help. In our case, nobody has listened,” a spokesperson for the AHCA tells Forbes.

LCCA is the biggest privately owned chain of nursing homes and assisted living facilities in the country and the only one in the U.S. to have minted a billionaire. The $3.2 billion (2018 sales) company is entirely owned by Tennessee billionaire Forrest Preston, who built it from scratch over the last half-century. The 87-year-old businessman, worth $1.7 billion, is LCCA’s chief executive; his longtime aide Beecher Hunter is the president and the public face of the company. Neither Preston nor Hunter responded to Forbes’ requests for an interview, but nearly half a dozen people who have spent time inside LCCA facilities during the coronavirus crisis did.

It now runs nursing homes as well as assisted living facilities and retirement living communities in 28 states. The company drew notice in 2016, when it agreed to pay a $145 million settlement with the Department of Justice for Medicare fraud. The federal government alleged that LCCA had provided unreasonable and unnecessary therapy to its clients as well as longer-than-needed therapies regardless of the therapists’ suggestions to end treatment.

 

Florida’s largest lobbyist for nursing home owners and operators are requesting immunity and other protection from accountability or responsibility for neglect and abuse during the COVID-19 outbreak.  Gov. Ron Desantis, who refused to close the beaches during Spring Break and mocked the concerns of people warning him in February and March about the pandemic, is now considering giving a windfall to his campaign contributors.  The Florida Health Care Association sent a letter to Gov. Ron DeSantis earlier this month requesting “immunity from any liability, civil or criminal” for nursing homes, hospitals and other facilities.  Why should they have immunity for criminal abuse and neglect?

The group is the most recent in a series of health care associations seeking legal immunity for being ill-prepared, short-staffed, and poorly trained.   A recent USA TODAY analysis of federal inspection data found that a majority of U.S. nursing homes (75%) have been cited for failing to properly monitor and control infections in the last three years – a higher proportion than previously known.Brian Lee, executive director of Families For Better Care, a non-profit group advocating for nursing home residents, said the letter was the equivalent of “asking for forgiveness in advance.”

“It just got my blood boiling. I was shocked by the temerity of the industry to ask for blanket immunity from lawsuits… and to do it during the middle of this crisis. It’s appalling, and it’s a total slap in the face of families,” Lee said. “All of their focus should be on saving our families lives, but it shows that, at the end of the day, they care more about their own protections. It’s gross.”

Incredibly, nursing homes are still not prepared to meet the needs of residents.  In California, nursing homes are so unprepared that the supply of the safety masks are gone, replaced by face covers fashioned from pillowcases. In lieu of sterile isolation gowns, staffers at the Los Angeles Jewish Home for the Aging are sewing sleeves onto the cloth garments typically used by patients. Underneath, workers don a trash bag for heightened protection.  They are using raincoats as PPE.  Cleaning supplies are dwindling.

“This is just one raincoat that we have to keep reusing,” Lim said last week between shifts at the Healthcare Center of Orange County, a 100-bed nursing facility in Buena Park. “A lot of people are using it.”

In thousands of facilities that are home to California’s elderly and infirm, this failure to plan and be prepared are placing them at risk for death.  Nursing homes and assisted living centers are fast becoming a locus of outbreaks, driving up mortality rates and straining public health resources. Yet institutions and public health officials said shortages abound: of protective gear, testing kits and, increasingly, of staff, who are sick or afraid to show up to work. With family visits halted, workers — many of whom shuttle between multiple facilities — are a potential source of infection in nursing homes but are essential to feeding, bathing and caring for the state’s vast aging population.

“This is an infectious disease that moves quickly,” said Matt Feaster, the epidemiologist for the Pasadena Public Health Department who is leading the city’s response to confirmed cases at nine residential care facilities. “A small problem can become a big problem.” Nationally, outbreaks in nursing homes and assisted living centers have propelled the crisis. Long-term care facilities have accounted for at least 221 deaths in Washington, or about half of the deaths in the state. In New York, more than half of nursing homes have positive cases, and more than 1,700 people in such facilities, about a third of nursing home residents with COVID-19, have died.

“The speed at which our elderly patients go into respiratory failure is staggering,” said Sydnie Boylan, a registered nurse at Hollywood Presbyterian Medical Center. “The patients go downhill so quickly, and once they go on a ventilator, most of them don’t come off.” Prevention is the key.  Proper staffing with adequate safety interventions with well-trained staff can keep the residents safe and healthy.  With most facilities essentially on lockdown — ending family visits and new admissions — focus has turned to the staff, the one group that circulates through a nursing home, sometimes several.

“Everyone is anxious,” said a certified nursing assistant at a South Pasadena nursing home. Her concerns centered on colleagues who work at multiple facilities, scraping by at $14 or $15 an hour. Her boss has begun scrutinizing their employment lest they inadvertently bring the virus with them.

“We do not make enough with just one job,” she said. “You need a good two full-time jobs, working seven days a week.”  Many employees stopped showing up for work after becoming disillusioned and panicked by the industry’s handling of the outbreak.

 

People are separated from their families, friends and jobs, lives disrupted to maintain social distancing and follow stay-at-home orders.  Residents of nursing homes are isolated, prohibited from seeing loved ones and neglected by short-staffing and ill-prepared facilities. Because of the coronavirus, the lives of the normally active and engaged residents have drastically changed. Visitors are now restricted, group activities are on hold and dining together has been replaced by take-out meals or meals served in their rooms.

“Our residents have been through a lot,” said Tara Ober, vice president of communications and resident life at the Brethren Village. “Many were born in the Depression, have fought in wars, lived through presidential assassinations, and emotionally, they are very tough. It’s unfortunate that they are also among the most physically vulnerable to this virus.”  “There is a heavy emotional toll,” Ober said. “It’s not only the families who have lost loved ones, but our team members have grown very close to our residents, and it’s a loss for them, too.”

In Philadelphia, where most of the state’s cases have been reported, nursing homes have already pivoted from trying to keep the coronavirus out to working like crazy to keep it from spreading, The Philadelphia Inquirer is reporting.
As an advocate, the main concern we are hearing from residents is what appears to be a lack of communication. Residents see staff members in gloves and masks. They see wings of their nursing homes being quarantined off. But they don’t necessarily know what’s going on – or they feel like they’re being kept in the dark about the spread of the virus. The association asks nursing homes to stay in touch with the loved ones of their residents, and if there is a positive case, keep them informed of how they are handling it.  Everyone knows how short-staffed nursing homes are and now with the staff sick or not showing up, staffing becomes even a bigger issue with the expectation that residents will suffer from preventable conditions like bed sores and falls.

Nursing homes are not doing a good job preventing or containing COVID-19. so far, more than 3,500 deaths nationwide have been linked to coronavirus outbreaks in nursing homes and long-term care facilities, an alarming rise in just the past two weeks, according to the latest count by The Associated Press. Because the federal government has not been releasing a count of its own, the AP has kept its own running tally based on media reports and state health departments. The latest count is up from about 450 deaths just 10 days ago.  But the true toll among the 1 million mostly frail and elderly people who live in such facilities is likely much higher, experts say, because most state counts don’t include those who died without ever being tested for COVID-19.

Experts say nursing home deaths will keep climbing because of chronic short-staffing, unprepared facilities, poorly trained caregivers, and a shortage of protective supplies and available testing.  Why won’t the Trump Administration do something for the nursing home residents besides give the for-profit corporate entities legal immunity? Finally, the Centers for Medicare and Medicaid Services issued “recommendations” urging nursing homes to use separate staffing teams for residents, and to designate separate facilities within nursing homes to keep COVID-19 positive residents away from those who have tested negative.  That seems obvious.  Why wasn’t that being done earlier?

Dr. Deborah Birx, who leads the White House coronavirus response, suggested this past week that as more COVID-19 tests become available, nursing homes should be a top priority.  “We need to really ensure that nursing homes have sentinel surveillance. And what do I mean by that? That we’re actively testing in nursing homes, both the residents and the workers, at all times,” Birx said.

 

As Alameda County health officials warned of a growing outbreak of coronavirus infections at two senior care facilities, Gateway Care & Rehabilitation Center in Hayward and East Bay Post-Acute Healthcare Center in Castro Valley,  but are demanding that workers return to work even if they tested positive for the virus.  Health officials confirmed new infections among staff and residents at Gateway Care & Rehabilitation Center in Hayward and East Bay Post-Acute Healthcare Center in Castro Valley, leading to six deaths.  Gateway currently has 59 people infected with COVID-19, 35 residents and 24 staff, according to Alameda County Public Health Department spokesman Neetu Balram. Six of those infected residents have died.  East Bay Post-Acute currently has nine residents and 17 staff members who have contracted the novel coronavirus.

Two men told KPIX 5 that their wives, both staffers at Gateway who tested positive for COVID-19, were told by their bosses that they had to come back to work.

Dinesh Kumar alleged his wife’s supervisor told her she could return to work even after testing positive and warned her repeatedly she would be fined if she didn’t return to work.

“My wife got diagnosed positive and she’s now fully isolated at home and I’m taking care of her,” said Kumar. “After she got diagnosed positive the employer called. A supervisor told my wife, ‘Oh you can still come to work.’ I said, ‘No we’ve been told you’re supposed to be isolated.’”

In addition, Kumar alleged the management told employees they did not need to wear masks on the job unless they were sick.

Guadalupe Tafolla told a similar story. “They told my wife, ‘You can come back to work. Just have to wear a mask and be careful,’” Tafolla said. “She’s positive! Of course, she’s never going to come back to work.”

“They’re not just residents here. They’re somebody’s grandmother, somebody’s mother,” said Jaime Patino. He is a Union City councilmember and the grandson of a resident at Gateway, and he says his family was told his grandmother was healthy, but no one at the facility said anything about the number of coronavirus cases. He wants answers.

“The protocols put in place by the CDC and state officials is they do not come in if they test positive. So that’s ridiculous!” Patino said.

 

A California nursing home where dozens have tested positive for the novel coronavirus was forced to evacuate recently after a majority of its staff failed to show up to work for the second consecutive day, according to public health officials.  On Tuesday, only one certified nursing assistant out of the 13 scheduled to work showed up. The staffing problem persisted into Wednesday morning,  People decked out in masks, gloves and protective gowns could be seen wheeling residents of the Magnolia Rehabilitation & Nursing Center  one by one on stretchers to ambulances that would take them to other care facilities in the area.  At the time of the evacuation, the center was looking after more than 80 patients, 34 of whom have tested positive for the coronavirus,  Five employees have also contracted the virus.

“We have a large vulnerable population at any of our long-term-care facilities, and we want to make sure those people are taken care of,” he said.

Riverside County officials say they do not yet know why many of Magnolia’s staff members stopped reporting for duty.   But no matter how justified the reasoning, the employees’ actions rise to the level of abandonment.  “Nationwide, all of our health-care workers are considered heroes, and they rightly are,” he said. “But implicit in that heroism is that people stay at their posts.”  Since the coronavirus reached the United States, reports of nursing homes and eldercare facilities being ill-prepared and poorly trained making the facilities overwhelmed by outbreaks.  “We are in immediate need for help to care for our most vulnerable patients,” he said. “We will provide full PPE. We will pay you and provide malpractice. The facilities you work in will be clean. We have an amazing team that is working on this night and day. Please come join us.”