Hard-hit Georgia nursing home industry seeks $347 million in COVID-19 relief

By James Salzer

With more than 3,500 COVID-19 deaths, a big drop-off in occupancy and rising costs, nursing home officials say their industry has been financially hammered by the pandemic, and they’re looking for federally funded relief.

The Georgia Health Care Association is requesting nearly $347 million from the state’s $4.8 billion portion of the COVID-19 relief fund Congress approved in March.

The Atlanta Journal-Constitution reported Wednesday that the state has delayed announcing which businesses, governments and nonprofits will be awarded grants from the fund until early next year to give them more time to apply.

Nursing homes and other care facilities have received hundreds of millions of dollars in state and federal help since COVID-19 hit the state in March 2020, but officials say they need more.

“Long-term care providers across the state have responded to this crisis heroically, all while facing significant operational challenges and financial losses,” said Tony Marshall, president and CEO of the Georgia Health Care Association.

“The current financial conditions are simply not sustainable for our state’s long-term care communities, and a number of providers are facing difficult operational decisions that include limiting admissions and even closure at a time when Georgia’s senior population is set to grow exponentially,” Marshall said.

The COVID-19 recovery bill President Joe Biden signed in March was designed to help states — and the economies of those states — hard hit by the coronavirus.

Gov. Brian Kemp has set up committees to review applications to spend the state’s share of the money in three areas: expanding high-speed internet services to areas that lack them; improving water and sewer infrastructure; and providing relief to people and businesses impacted by COVID-19.

The money could be used to make direct payments to Georgians, provide aid to small businesses, give extra pay to “essential workers,” fund job training and placement services, or assist hard-hit areas of the economy such as the hospitality and travel industries.

For instance, Kemp, who gets to make the final decision on how the money is spent, announced Thursday that he was giving the state’s tourism division $5.8 million to promote the industry.

Georgia has received half of the $4.8 billion it is expected to get. It is scheduled to receive the second half next year.

The first round of applications would allocate about $875 million of the $2.4 billion the state has received so far, according to the Office of Planning and Budget.

The $347 million request from the nursing home industry would eat up a sizable chunk of the fund.

When asked whether one industry will wind up getting that much, House Appropriations Chairman Terry England, R-Auburn, a member of the committees, said: ”I have no idea. But I think they are building a pretty good case.”

The nursing home industry said the COVID-19 grants would help financially stabilize their business and could end when occupancy rates match or surpass pre-pandemic levels for two consecutive months.

It said occupancy in homes dropped from an average of 84.5% in December 2019 to just below 70% in February. While the occupancy rate improved to 72.2% in July, more than one-quarter of the homes are less than two-thirds full. Some, much less. There were about 28,500 people residing in nursing homes in Georgia in July, down from just under 34,000 in December 2019.

England said, “A lot of folks are saying, ‘We are going to keep granny at home.’ ”

Marshall said the drop in occupancy in homes has resulted “in a devastating loss of revenue.”

“Revenue losses of $31 million or more per month, as seen during the second half of 2020, continue to this day,” Marshall said.

Deborah Meade, CEO of Health Management in Warner Robins, the third generation of her family to operate a small nursing home company, said her average occupancy at her facilities is 59% as the delta variant outbreak hits Middle Georgia hard this summer.

“We are taking admissions, and five days after they are admitted, they are testing positive,” she said. “And they were fully vaccinated.

“The additional strain on the staff to see this all over again after seeing this during 2020 is unimaginable,” she said, noting that she has lost workers because of it.

Meade, who is also chairwoman of the American Health Care Association, said her father died of COVID-19. She had hoped her daughter would follow her in running the company, but “I am for the first time afraid that she is not going to have that opportunity — it is that dire.”

Industry officials said they have seen greatly increased costs for things such as COVID-19 prevention and mitigation, and for staffing. Often workers are only available through staffing agencies.

Some of those higher costs were picked up by taxpayers.

The state sent in National Guard troops to help the homes, and $113 million in CARES Act COVID-19 funding approved at the beginning of the pandemic paid for staffing and pandemic response.

The industry is heavily reliant on payments from Medicaid and Medicare, the taxpayer-funded health care programs for the poor, disabled and elderly. For some facilities, that reliance has only increased since the pandemic began.

But the fact that so much of its revenue is tied to state and federal funding means the industry is also by necessity politically active, which puts it in a strong position to lobby for more COVID-19 relief.

The Health Care Association and nursing home giant PruittHealth have well-connected lobbyists at the Capitol.

The association has contributed more than $400,000 to state leaders, lawmakers and partisan state political action committees in the past five years. The Pruitt family and its companies have donated at least $950,000 in that time, including about $107,000 to Kemp’s campaigns and $250,000 to Republican caucus funds and the state GOP.

But beyond the money and lobbying, the General Assembly is run by lawmakers from rural Georgia, which is a key voter base for Kemp and the Republican majority. Rural lawmakers say while the nursing home giants may be able to hang on through the pandemic, small local facilities in their areas may not make it without further aid.

“With these small, independent homes ... the cash flow has disappeared,” England said. “It’s really putting them in a quandary.”

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Hard-hit Georgia nursing home industry seeks $347 million in COVID-19 relief

Kirsten Gillibrand: Prosecute owners of nursing homes who allowed abuse, neglect

U.S. Sen. Kirsten Gillibrand, D-N.Y., arrives at the Capitol in Washington on Feb. 10, 2021. Joshua Roberts | Pool via AP

By Mark Weiner

U.S. Sen. Kirsten Gillibrand wants the federal government to probe problems in the nursing home industry and start prosecuting owners of nursing homes who put profits ahead of patient care.

Gillibrand, D-N.Y., said she read a series of reports by syracuse.com revealing numerous cases of horrific abuse and neglect at the Pontiac Nursing Home in Oswego.

Federal and state regulators this week added the for-profit, 80-bed facility to a list of the nation’s worst nursing homes.

Gillibrand said it’s part of a nationwide problem that needs urgent oversight and a full government review of the industry.

“There needs to be prosecution of the owners of these nursing home facilities who did cut costs, who did cut corners,” the senator said Thursday at an editorial board meeting of syracuse.com | The Post-Standard.

“I think the fact that we give a pass to all white-collar crime in this country is a serious problem,” Gillibrand said. “And I’m very concerned about the private equity firms that have owned nursing homes and have cut costs that resulted in the death of people.”

Gillibrand, a member of the Senate Special Committee on Aging, said she will use her position on the panel to push for more oversight and accountability of nursing home operators.

In Oswego, Pontiac Nursing Home has been cited for failing to protect residents from sexual abuse, not sending gravely ill residents to the hospital for emergency care and letting water from a leaky roof drip into residents’ rooms for years.

Federal and state officials designated Pontiac as a “special focus facility” because of its “persistent record of poor care,” a state Health Department spokesman said Thursday.

Pontiac is owned by Cosimo Mastropierro of Long Island, who owns three other nursing homes in New York state.

Gillibrand said the coronavirus pandemic has helped expose the structural problems of for-profit nursing homes. She’s particularly concerned about nursing homes owned by private equity funds as investments.

“Those private equity firms, they want profits over anything,” Gillibrand said.

In January, Sen. Elizabeth Warren, D-Mass., slammed a privately-owned nursing home chain for paying a $5.2 million bonus to its CEO during the coronavirus pandemic. Genesis Healthcare had 2,812 patients die from Covid-19 across its 350 locations, Warren said.

At an Aging Committee hearing Thursday, Gillibrand also brought up the issue of the undercounting of nursing home deaths from Covid-19, an issue in New York and other states.

Gillibrand last month confirmed that federal authorities are investigating Gov. Andrew Cuomo’s handling of nursing homes during the coronavirus pandemic.

New York Attorney General Letitia James issued a report Jan. 28 that found the state was undercounting Covid deaths in nursing homes by about 50% during the pandemic. The attorney general’s findings were similar to those of a syracuse.com investigation published independently on the same date.

Cuomo’s top aide later admitted the state intentionally kept the data from the public over fears former President Donald Trump would use the information to launch politically motivated investigations.

The governor faced criticism for his order in March 2020 that required nursing homes to accept Covid-positive patients discharged from hospitals.

Cuomo rescinded the order in May. He has said repeatedly that his earlier order was based on federal guidance.

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Kirsten Gillibrand: Prosecute owners of nursing homes who allowed abuse, neglect

Investigation finds massive fraud in Indiana nursing home industry

The FBI, treasury and other law enforcement officers conduct an investigation at the Carmel home of then-American Senior Communities CEO James Burkhart in 2015. (IndyStar Photo Charlie Nye)

A secret internal investigation of fraud at Indiana’s largest nursing home system alleges more schemes, more conspirators and far greater financial losses than anything previously disclosed.

After the FBI raided the office and Carmel home of then-American Senior Communities CEO James Burkhart in 2015, Burkhart and four associates were charged. They pleaded guilty in 2017.

Federal prosecutors said the five men set up shell companies to inflate costs and pay themselves kickbacks on vendor contracts for landscaping, food, medical supplies and more. In all, $19 million was stolen, prosecutors said.

Health & Hospital Corp. of Marion County, the county’s public health agency and owner of the homes managed by ASC, recovered $15.5 million and says it was “made whole.”

But there’s more to the story. Here’s what you need to know:

Company launched secret investigation

After the FBI raided Burkhart’s office and home, American Senior Communities quietly hired a team of Chicago attorneys that included former federal prosecutors.

What the public never knew was that ASC’s internal investigation turned up far more fraud allegations. IndyStar obtained a copy of the company’s confidential 277-page presentation to federal prosecutors, which was produced in 2016. It describes more than half a dozen schemes that were not included in the criminal case and identifies 20 alleged conspirators or “key players” who were never prosecuted. It also estimates far greater losses of at least $35 million.

ASC would not comment on its investigation. The office of U.S. Attorney Josh Minkler also declined to comment.

Alleged participants included Indiana Attorney General’s relative

Among those identified in ASC’s internal investigation was Rob New, a former Fishers businessman who coached boys basketball at Scecina Memorial High School. The company’s analysis claimed he participated in alleged schemes that resulted in millions of dollars in losses. And in court filings last year in its civil lawsuit against Burkhart, the company again accused New of participating in fraud schemes with Burkhart. New is not a defendant in the case.

New has never been charged with a crime. He denies any wrongdoing and his attorney called the allegations in the lawsuit against Burkhart “meritless and spurious.” Last year, New sold his Fishers mansion for $3 million to NBA star Gordon Hayward and now lives in a luxury high-rise condo near the beach in Naples, Florida.

Another person named in the company’s investigation is Gretchen Zoeller, the cousin of then-Indiana Attorney General Greg Zoeller. His agency was part of the criminal investigation and he accompanied prosecutors when charges against Burkhart and others were announced. He told IndyStar he was unaware his cousin was involved in the nursing home scandal at the time.

ASC is now suing Gretchen Zoeller for her alleged role in the schemes. She, too, has not been charged with a crime, and denies participating in any fraud.

Public agency quietly settled fraud claims

Although the nursing home buildings are privately owned, and managed under contract by ASC, the businesses are technically owned by Marion County’s public health agency and funded mostly with Medicaid and Medicare tax dollars.

The leader of that agency, the Health & Hospital Corp. of Marion County, is Matthew Gutwein. He knew about the findings from ASC’s internal investigation but quietly signed an agreement with the company in 2017 that allowed it to keep operating the homes.

The agreement, which was never publicly announced, recovered only $15.5 million — far short of the estimated losses identified in ASC’s own investigation. It also contains several secrecy provisions that helped keep a lid on the suspected scope of the fraud, IndyStar found.

A lawyer for HHC defended the deal, arguing that it made the government whole and outweighed the cost and uncertainty of additional litigation. HHC said ASC’s secret report was preliminary and the estimated losses it claimed were inflated because not every allegation could be substantiated.

Concerns about federal money loomed over fraud case

Gutwein’s decision to quickly settle the fraud allegations came at a time when he was deeply concerned that the scandal could threaten a much larger source of money for his agency.

As IndyStar reported in March, HHC and more than 20 other county hospitals across Indiana have bought up nearly every nursing home in the state, at least on paper, to take advantage of a program that provides extra Medicaid funds to government-owned facilities. The money is intended to provide care for vulnerable nursing home residents, but HHC and others exploited rules that allowed them to legally divert much of it to their hospitals instead, leaving Indiana with the worst elder care system in America, according to AARP.

The fraud case represented a major threat to the program, which provides about $180 million a year for HHC. In a victim impact statement, Gutwein wrote, “just as fraud and abuse erode the public’s trust, they can also affect the views of legislators and policymakers who, in response, could choose to cut back or even eliminate the federal supplemental program.”

HHC said its decision to settle with ASC had nothing to do with protecting the lucrative Medicaid funds. “Any suggestion that HHC chose to settle with ASC to avoid scrutiny is both offensive and meritless,” HHC said in a statement.

Public left in the dark

ASC has settled outside of court with at least five individuals or companies it suspected of fraud. But because of its agreement with the county agency, those settlement agreements — including the amount of money recovered — remain a secret.

As a result, the public may never know how much taxpayer money was recovered.

Meanwhile, HHC continues to do business with at least one of the people identified in ASC’s investigation. The agency pays New about $5.5 million a year to lease nine nursing homes and an assisted living facility.

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Investigation finds massive fraud in Indiana nursing home industry

US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Family members of residents at the Life Care Center home, in Kirkland, Washington, where some patients have died from Covid-19, at a press conference on 5 March. Photograph: Jason Redmond/AFP via Getty Images

The US nursing home industry is clamoring for legal immunity during the coronavirus pandemic, even as horror stories from hard-hit facilities enrage families, consumer advocates and the American public.

Healthcare organizations insist liability protections are essential for under-resourced nursing homes fighting against Covid-19, while an already staggering death toll continues to climb.

Tricia Neuman, senior vice-president of the Henry J Kaiser Family Foundation, said: “The liability issue is exposing a longstanding tension between consumer advocates, who want to see the standards enforced, and owners, who are worried about the financial implications of a lawsuit.”

The US “ground zero” for the virus was a nursing home outside of Seattle. Once the country became a global hotspot, elderly Americans suffered. In some states, nursing homes have accounted for a majority of Covid-19 deaths as facilities scrambled to adapt.

Critics say the virus has ravaged nursing homes “like a brushfire”, partly because of the industry’s disastrous track record with infection control, but also because of staffing and resource deficiencies that long predate Covid-19.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, said: “It’s a population at risk, but this industry has a lot of serious problems that led to these enormous outbreaks in nursing homes. So I don’t think they can just say: ‘It’s not our fault, we didn’t have equipment.’

“They were supposed to have that equipment. This isn’t new.”

Some nursing homes have also faced criticism for their responses to Covid-19 that have only fanned the outbreaks’ flames.

Mike Dark, a staff attorney at California Advocates for Nursing Home Reform, said: “Facilities mostly don’t want to flag that they have the virus even when it’s killing residents, because it’s such a publicity problem, it’s such a business problem, and they are for-profit enterprises.”

Cheyenne Pipkin (left) with her mother Loraine Franks visits her grandfather Jerry Hogan, a Vietnam veteran, at Lindsey Gardens in California. Photograph: Barcroft Media/via Getty Images

Nearly 70% of US nursing homes are for-profit, and the industry has a reputation for lackluster performance around infection control. In all longterm care facilities, which include nursing homes, somewhere between 1m and 3m serious infections are contracted annually, according to the Centers for Disease Control and Prevention.

Hundreds of thousands of people die from infections each year, even when not in the grip of a pandemic.

“Our members are working hard to do the right thing and are focused on their missions of providing care. They are on the front lines of fighting coronavirus and are full partners with hospitals and other providers,” Katie Smith Sloan, the president and CEO of LeadingAge, an association for nonprofits providing services to older people, said.

“Regulations about standards of care evolve and change rapidly; providers’ access to needed personal protective equipment and testing is limited and often insufficient.”

State officials have been quick to let nursing homes off the hook for decisions made in the midst of the public health emergency. Through a hodgepodge of laws and executive orders, at least 21 states have granted some form of civil immunity to healthcare providers, according to a tally sent to the Guardian by National Consumer Voice for Quality Long-Term Care – though in a few cases it is not clear if the immunity extends to nursing homes.

Smith Sloan wrote: “States recognize that providers require legal protection as a result of actions related to combating the Covid-19 pandemic. LeadingAge … is pursuing protections on the federal level with a coalition asking for uniform and consistent relief as well.”

Some states are including immunity from criminal liability, but policies do generally make exceptions for especially egregious treatment, including willful misconduct or gross negligence.

Richard Mollot, executive director of the Long Term Care Community Coalition, said: “To basically take away the one area of potential accountability when residents are most vulnerable to me is dumbfounding and dangerous.”

For some public health experts, however, the issue is not so cut and dried. They describe nursing homes as a sector in chronic need of reform that is nevertheless “the safety net of the safety net” for vulnerable people.

Experts acknowledge that the industry is filled with deficiencies, and is based upon a broken business model that struggles in the face of a pandemic. But they also say nursing homes have been under-prioritized by officials in a public health crisis that has disproportionately targeted their patient populations.

Michael L Barnett, a professor at the Harvard school of public health, said: “Putting a nursing home out of business because somebody died is really punishing at the wrong level, because certainly there are nursing homes that probably did not act responsibly, or they may have ignored the threat. But so did many government agencies.”

Instead of lawsuits, experts are advocating for immediate reinforcements in testing, personal protective equipment (PPE) and staff, followed by permanent fixes for longterm care. They suggest payment reform, so nursing homes are not dependent on fickle revenue streams to subsidize their Medicaid patients.

Mildred Solomon, president of the Hastings Center, warned against the “blitzkrieg of lawsuits” that these immunity measures mean to avoid.

She said: “I think we have to hold our fire, not put our energy into finger-wagging and blaming. And put more emphasis on stronger regulations, with teeth.”

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US nursing homes seek legal immunity as Covid-19 spreads ‘like brushfire’

Nursing home industry demands higher wages, more patient care

DETROIT (FOX 2) - As all eyes are on Detroit for the Democratic debate Tuesday and Wednesday, folks with the largest union of nursing home workers in the state, SEIU Healthcare Michigan, used that spotlight to voice their concerns dangerously short staffing issues and poverty wages.

"It's hard to go to work and not know if you have enough staff," said Trece Andrews, a nursing home employee. "It's hard to face the residents daily because they need our help. It's all about the residents really."

Fast food employees and security guards are joining the fight as well.

"I take home between $400 and $500 a month working at McDonald's," said Jamika Ruffin. "I have two beautiful children at home and we are barely surviving in the wages that McDonald's pays me."

With 73,000 cases of elder abuse each year, Michigan Attorney General Dana Nessel traveled across the state and stopped by Tuesday after launching a payroll fraud task force and an elder abuse task force.

"When these facilities are understaffed and employees underpaid, that creates situations where you have neglect of seniors," Nessel said.

Everyone there is asking presidential candidates to put working people front and center.

"We want presidential candidates to wake up every day and figure out what they are going to do to make it possible for millions of workers to have a better life," said Mary Kay Henry, the SEIU International president.

"We are shouting out, we are doing everything we can to get some politicians in office to hear us now," Andrews said.

The fight for change continues Wednesday, as security workers from across Michigan and the Midwest plan to rally in downtown Detroit.

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Nursing home industry demands higher wages, more patient care