Incredible. After the nursing home industry was too greedy to be prepared to prevent or contain the spread of COVID-19 in their facilities, and refused to disclose the number of residents with coronovirus, the nursing home lobbyists are demanding Congress give them additional windfall including a dedicated $100 billion emergency fund for nursing homes.  The demand is a part of a new campaign, “Act For Older Adults,” launched by lobbyists to put pressure on politicians up for re-election.

The organization is also requesting that lawmakers do the nursing home’s job by providing supplies and appropriate personal protective equipment, accurate and rapid testing, funds to cover testing costs, “hero” pay, paid sick leave and healthcare coverage for frontline workers.

Meanwhile, an investigation into the ongoing COVID-19 crisis in nursing homes has started including demanding information from both the federal government and five prominent operators in the space. House committee’s probe focuses on five major nursing home operators: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare.

“We are writing to seek documents and information regarding the deaths of men and women in your company’s nursing homes during the coronavirus outbreak, the conditions that may have contributed to these deaths, and any steps taken to protect residents and workers from further tragedy,” each letter, addressed to each company’s CEO, reads in its introduction.

The subcommittee’s requests span 10 separate categories, from basic data on bed counts and resident demographics to the exact amounts of personal protective equipment (PPE) at each facility operated by the chains — along with estimates of when those supplies would be exhausted and plans for replenishment.

Clyburn also asked for Medicare and Medicaid revenue data stretching back to 2018, all documents and communications regarding COVID-related complaints, and data on any CARES Act relief they may have received.

“The Trump administration’s distribution of the funds to long-term care facilities and other companies under the CARES Act and other programs has been marked by a lack of transparency,” Clyburn asserted. “Recipients must agree to use the funds for certain purposes related to the outbreak, but there has been little public reporting on how nursing home operators have actually used the funds.”

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 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.”

In the letters, Clyburn’s said the subcommittee’s mission is “‘to conduct a full and complete investigation’ of the ‘efficiency, effectiveness, equity, and transparency of the use of taxpayer funds and relief programs to address the coronavirus crisis,’ the nation’s ‘preparedness for and response to the coronavirus crisis,’ and ‘any other issues related to the coronavirus crisis.’”

As President Trump moves to resume indoor campaign rallies, his campaign has added a twist to his optimistic push to return to life as it was before the pandemic: Attendees cannot sue the campaign or the venue if they contract the virus at the event.

“By clicking register below, you are acknowledging that an inherent risk of exposure to Covid-19 exists in any public place where people are present,” a statement on Mr. Trump’s campaign website informed those wishing to attend his June 19 rally in Tulsa, Okla. “By attending the rally, you and any guests voluntarily assume all risks related to exposure to Covid-19 and agree not to hold Donald J. Trump for President, Inc.; BOK Center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors or volunteers liable for any illness or injury.”

The Centers for Disease Control and Prevention still recommends that people avoid mass gatherings and stay out of crowded places. But of the four states that the president announced this week as sites for rallies, three of them — Florida, Arizona and North Carolina — are seeing rising virus caseloads.

Forbes published an article by Patricia Barnes about the nursing home industry’s demand for blanket immunity.  Judge Barnes writes:

“Granting broad immunity to nursing homes that failed to put in place reasonable protections for vulnerable residents during the pandemic represents an appalling abuse of the rule of law.

About 20 states already have granted nursing homes immunity from civil lawsuits stemming from the coronavirus pandemic and now the U.S. Congress is poised to do so. What’s the rush?

There has been no serious investigation into how nursing homes performed in the pandemic and there is plenty of reason for concern.

The Centers for Medicare & Medicaid Services reported Friday that 31,782 nursing home residents have died from COVID-19 as of May 31, which is about 33% of the nation’s known coronavirus deaths. The highest number of deaths occurred in New York, New Jersey and Connecticut, which were among the first to grant civil immunity to nursing homes.

A grant of immunity effectively eliminates civil legal redress for and on behalf of nursing home residents who died due of COVID-19 due to negligence and abuse.

Nursing home immunity makes it difficult, if not impossible, for family members of the ability to find out what happened to a loved one who died during a lockdown, alone and behind closed doors.

Worse still, society is left without the means to hold bad nursing homes operators accountable for patient abuse and neglect. It’s the equivalent of signing a blank check with no name and no ending date.

A waiver under the present circumstances is the equivalent of signing a blank check. Who is the beneficiary?

The AARP reports that approximately 70 percent of the nation’s 15,600 nursing homes are for-profit corporations. In recent years, corporate nursing home owners have been criticized for using business models that squeeze profits out of nursing homes by leaving facilities poorly staffed and under-resourced. These corporations likely will be the primary beneficiaries of an immunity waiver.

The Canadian Armed Forces in April dispatched 1,675 troops to more than 30 hard hit nursing homes in Ontario and Quebec to provide humanitarian relief.  In some homes the Army found:

  • COVID-19 positive residents wandered freely among non-positive patients.
  • Staff wore the same protective equipment in COVID-19 positive and non-positive units.
  • “[A] general culture of fear to use supplies because they cost money.”
  • Expired medications apparently were dispensed for weeks.
  • Rotten food and cockroach/fly infestations.
  • Some patients didn’t get three meals a day.
  • Patients left for hours in soiled pads and diapers.

The New York Times recently investigated deaths at the Isabella Geriatric Center in New York, where more than a 100 residents died. Two nurses said employees there wore the same personal protective equipment to handle both Covid and non-Covid residents, thus “creating avenues for the virus to spread.”

It is common sense and costs little money to segregate COVID-19 patients and non-positive patients. Failure by a health care facility to do so could easily rise to the level of neglect.

Some states have adopted nursing home immunity laws and executive orders that go far beyond protecting front-line doctors and nurses.

The definition of health care provider in New York, Massachusetts, and North Carolina includes “a health care facility administrator, executive, supervisor, board member, trustee,” or other corporate managers.

Connecticut’s waiver is so broad that it could be characterized as a “blanket.” Gov. Ned Lamont’s executive order grants protection from civil liability to any “health care professional or health care facility” for “any injury or death” sustained as a result of an “act or omission” in the course of providing medical services in support of the state or federal government’s response to  COVID-19 outbreak.”

Given the circumstances, it seems ironic that Republicans are rushing to protect nursing home corporations during an election cycle where they are dependent upon the support of older Americans.”

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.

Chris Coons, a Democrat, is a U.S. senator from Delaware. William Kristol, former editor of The Weekly Standard, is director of Defending Democracy Together. They wrote an editorial for USA Today.

One of us is a Democratic senator, who, though certainly willing to seek common ground across the aisle, has been a loyal Democrat all his adult life. The other voted Republican in every presidential election of his adult lifetime until 2016, and came to Washington to serve in the Reagan administration.

But we agree on this: We both want this nation to deal with the coronavirus as well as possible. We both want an economic recovery as soon as possible. And we both see proposals in Congress that would set back these goals.

Too many members of Congress, following the lead of President Donald Trump, continue to engage in coronavirus denialism. They also rush to embrace short-sighted and counterproductive policies that are particularly dangerous in the midst of a global pandemic. Today, these lawmakers seem to believe that by simply wishing for the country to be “open for business,” but without any real plans or safeguards, that all will go well. It won’t. We’ll lose tens of thousands of more Americans to the virus, and we won’t get the economy going again.

In the last week, President Trump and Senate Majority Leader Mitch McConnell have seemed to balk at providing financial assistance to states — though it is the states who have shown real leadership in fighting COVID-19, even as their revenues evaporate.

It gets worse. McConnell, upon announcing the Senate’s return this month, said that giving businesses immunity from lawsuits would be his priority, perhaps a condition for the states to receive aid. At the same time, some Republican governors have said employees who are wary of returning to work once businesses reopen, fearing for their health and even their lives, will lose access to unemployment benefits. In short, the position of today’s Republican Party seems to be that employers should get a waiver of liability if their workplace turns out to be unsafe, but employees should lose unemployment benefits if they won’t return to that unsafe workplace.

In other words: No liability at all for businesses, absolute liability for workers. This is unfair and, indeed, offensive.  And we would say, as a Democrat who’s been an advocate for the legitimate interests of businessmen and women in his state, and as a Republican concerned for the future of democratic capitalism, this is the worst possible message about capitalism to send to young people, or to anyone, in America. No wonder the polls show support for democratic capitalism falling.

And unfortunately, the list goes on. Republicans don’t want to provide funding to the postal service because Trump is obsessed with Jeff Bezos, the founder of Amazon (despite the fact that the Postal Service has profited significantly from Amazon’s business). And they do not want to provide funding for safe and secure elections because they fear (with no evidence) that making it easier to vote absentee or by mail will help the other party. Again, if you want to discredit the American democracy in the eyes of our fellow citizens, this is the way to do it.

We urge responsible Republicans to rise above the divisive rhetoric of Donald Trump and the cynical political maneuvering of Mitch McConnell, and join with Democrats in advancing legislation in this crisis that’s good for our country. Let’s get through this crisis responsibly, and then the two of us can get back to arguing again!

 Connecticut Gov. Ned Lamont (D) issued an emergency order granting nursing homes immunity from most lawsuits during the coronavirus pandemic. Similar to recent measures in about 20 other states, the Connecticut order has sweeping implications, depriving potential plaintiffs of the ability to uncover an accounting of their relatives’ last days in nursing homes. The demand for information during the crisis has become particularly urgent: Since March, federal officials have curtailed routine inspections and restricted visitors in homes, leaving families to peer through windows or beg for information over the phone.
“Even with a history of these nursing homes having problems, why was immunity put in place?” Anagnos, who lost her mother, said. “I’m not looking for money. I’m looking for somebody to be held accountable.”
The Health Coalition on Liability and Access represents 36 associations, including the American Health Care Association. The lobbyists argue that nursing homes are entitled to immunity from accountability because medical equipment and tests are in short supply.  They want to use their lack of preparation as a reason they need immunity now—incredible.

For weeks, well-paid industry lobbyists have pushed governors for immunity from lawsuits, in some cases offering specific language for emergency orders, according to letters, public statements and media accounts. The groups also have promised campaign assistance to flailing Republican Senators only after Senate Majority Leader Mitch McConnell (R-Ky.) promised on the Senate floor  to extend additional immunity and tort reform to everyone in the health-care industry.

McConnell spins taking away a victim’s right to a jury trial or be compensated for abuse and neglect as a necessary measure to protect “health-care heroes” — doctors, nurses, researchers — from “nuisance” lawsuits.  Then why give immunity to management companies and corporate owners who are not licensed health care providers?

The protection comes as the industry continues to lobby for even more federal aid after the Trump Administration released over $5 billion to the country’s 15,000 Medicare-certified nursing homes.

Patient advocacy groups and legal organizations counter that even before the pandemic, many homes had been unable or unwilling to meet basic health, safety and staffing standards set by the federal government. Nursing homes, critics say, could use immunity to evade long-standing liabilities. Consumer advocates and experts assert that substandard facilities ought to remain subject to litigation resulting from life-threatening failures in infection control and patient care, and families need an opportunity to unravel the layers of secrecy that surround the thousands of unexpected or unexplained deaths during the pandemic.

Since the start of the pandemic, more than 30,000 nursing home residents have died of covid-19, state data shows. Through the discovery process in civil litigation, family members would have an opportunity to obtain medical and company records and the sworn depositions of caregivers and company officials.

The industry seized on this crisis to try to get a get-out-of-jail-free card,” said Steve Levin, a lawyer in Chicago. “I’ve never seen anything like it.”

Although nursing homes are the deadliest of all group settings during the pandemic, the disparity in coronavirus cases is still a medical mystery: Why have some homes, such as Kimberly Hall North, had dozens of deaths while others have been able to contain the outbreaks? By helping to stave off scrutiny, legal immunity makes it less likely that the public will ever fully know, lawyers and patient advocacy groups say.

Watchdog groups say the industry used the coronavirus emergency to push a longstanding agenda to limit liability and lawsuits. For decades, nursing homes have lobbied to set legal limits for damage payments and to compel nursing home residents to forgo the courts and take their cases to arbitration, where homes more easily prevail, lawyers said.

Even without immunity, proving how the coronavirus slipped inside a home is difficult, plaintiffs’ lawyers say.

“This so-called flood of litigation is simply not going to materialize,” said Robert Sachs, past chairman of the nursing home litigation group at the American Association for Justice. “These are going to be very difficult cases to prove on a number of levels. The hurdles are high.”

“My mother could have beat covid. I know it in my heart of hearts,” she said, adding: “No one cared or paid much attention. I just feel like someone should be held accountable.”

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?’ ”

The United States officially entered a recession in February 2020 prior to the shutdown caused by the coronavirus.  The National Bureau of Economic Research said that the economy hit its peak in Januarary and has since fallen into a downturn, as pandemic-related shutdowns decreased activity and brought an end to a record-long expansion — one that had lasted since Obama’s presidency.  This is the first economic downturn since the Bush Recession in 2008.

 

 

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.

 

 

 

ProMedica saw improvement in its HCR ManorCare nursing home business line during the first quarter of 2020 because of the bail out money.  The Toledo, Ohio-based ProMedica pulled in $17.1 million in income compared to $7.7 million in the first three months of 2019 associated with its ManorCare business to start 2020.  ProMedica so far has landed a total of $158 million in federal support under the CARES Act stimulus package, $89 million of which went to its senior care division.

ProMedica and fellow Toledo-based company Welltower (NYSE: WELL) acquired ManorCare in a complex joint venture back in 2018, with the health system buying the operations outright and entering into a 20-80 partnership with the REIT to purchase the real estate.

Combined with ProMedica’s home health and hospice business lines, the ManorCare assets helped the system log income of $27.5 million in its senior care division, up $9.5 million from the year-ago quarter — and representing a plurality of the system’s overall revenue.

The non-profit also received extensions on some of its debt obligations, deferred payroll taxes, froze non-essential hiring and spending, and temporarily furloughed 900 employees — mostly from acute-care settings that were temporarily shut down amid bans on the provision of non-essential care.

“I will tell you that ProMedica is in fine shape,” Welltower chief operating officer and chief investment officer Shankh Mitra said, emphasizing that the business line was “very, very low” on his list of COVID-19 concerns.