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| A nursing home patient is loaded into an ambulance in Brooklyn, N.Y. |
Nearly 18 months after covid-19 began to cut a broad swath through the nation’s nursing homes — killing 184,000 elderly and disabled residents and care workers — the U.S. Senate is weighing a bill to update federal policies and oversight of such facilities.
The bill, dubbed the Nursing Home Improvement and Accountability Act, was introduced by six Democrats, including Ron Wyden of Oregon, chair of the Senate Finance Committee, and Bob Casey of Scranton, chair of the Senate Aging Committee.
It comes as covid-19 infections across the country surge, fueled by the highly contagious delta variant.
Stunning death tolls
The initial surge in infections in early 2020 focused a bright light on continuing staffing deficiencies and infection control issues in nursing homes such as the Brighton Rehabilitation and Wellness Center in Beaver County. Eventually, Pennsylvania Gov. Tom Wolf sent in the National Guard to assist staff at the massive 589-bed facility. More than 70 residents died. Officials eventually said everyone in the nursing home had been infected with the coronavirus.
While Brighton had more covid-19 deaths than any nursing home in Western Pennsylvania, few facilities escaped unscathed before vaccines were released late last year. Recent reports detail how more than half of the 27,957 covid-19 deaths in Pennsylvania occurred in long-term care facilities — 13,434 among nursing home residents and 1,894 in personal care and assisted-living facilities.
Such numbers were the rule rather than the exception in many states.
In June, the New York Times reported that while only 4% of the nation’s covid-19 cases occurred among nursing home patients, the frail and often disabled residents of those facilities accounted for 31% of the nation’s covid-19 deaths.
Casey, who highlighted continuing health and safety violations at hundreds of nursing homes a year before the pandemic, was among those who have vowed to bring increased scrutiny and reform to nursing home operations.
The stunning death toll the pandemic claimed among nursing home residents underscored the need for such action, he said.
Only when vaccines became available and officials prioritized nursing home residents as the first to receive them did covid-related deaths in such facilities begin to subside.
“The profound loss of life in nursing homes from covid-19 was a tragedy within the broader tragedy of the pandemic,” Casey said, announcing the new bill. “The residents, workers and families who suffered through it are owed solutions, to ensure we prevent such tragedies in the future. This legislation provides the transparency and accountability that families deserve, expanding staffing, technical assistance and oversight efforts across the board.”
The bill would bump up staffing requirements. Among the new regulations, each facility would be required to have a full-time infection control and prevention specialist. It also requires that a registered nurse be available 24 hours a day at each facility.
The federal legislation would provide additional funding to underwrite such changes and raise wages. A recently proposed state regulation to increase minimum staffing requirements for nursing care at such facilities did not.
Where nursing homes stand
It’s an important issue, said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, a trade group that represents more than 200 Pennsylvania nursing homes and 200 assisted-living and personal care homes. He said Casey has been a friend to the sector, and they hope to have continuing dialogue with him.
Nonetheless, his group has concerns about parts of the bill. A provision banning requirements that patients sign agreements waving their right to sue when they are admitted to nursing homes struck the trade group as unreasonable.
“To ban arbitration agreements in Pennsylvania, one of the most litigious states in the country on long-term care, would result in more and more dollars going to trial attorneys instead of bedside care,” Shamberg said. “And funding for staffing would last for six years. But on the seventh year, the money runs out and it becomes another unfunded mandate.”
State regulators also are demanding that nursing homes improve infection prevention by requiring that workers be vaccinated.
On Thursday, Keara Klinepeter, executive deputy secretary of the Pennsylvania Department of Health, said nursing homes should plan to have at least 80% of their staff vaccinated for covid-19 by Oct. 1. She said current reports show only 12.5% of the state’s nursing homes have reached that vaccination level.
The vaccine mandate — met with skepticism in an industry already plagued by a shortage of workers — is needed to prevent future outbreaks in those facilities, Klinepeter said.
The controversy underscores an increasingly contentious relationship between nursing homes and those who regulate them.
Shamberg said the industry has been working to educate workers and residents on the benefits of the vaccine ever since it became available.
“Instead of proposing solutions to increase vaccine acceptance
rates in long-term care, the Department of Health threatened providers
and issued a punitive mandate on nursing homes if 80% vaccination rates
are not achieved,” he said.
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