Nursing home companies accused of misusing federal money received hundreds of millions of dollars in pandemic relief

Nursing home companies sued for Medicare fraud in recent years received more than $300 million in coronavirus relief payments. The allegations include putting elderly residents into unnecessary therapy services and delaying patients' release to reap higher Medicare payments. (N/A/Getty Images)

By Debbie Cenziper

For-profit nursing home providers that have faced accusations of Medicare fraud and kickbacks, labor violations or widespread failures in patient care received hundreds of millions of dollars in “no strings attached” coronavirus relief aid meant to cover shortfalls and expenses during the pandemic, a Washington Post analysis of federal spending found.

More than a dozen companies that received federal funding have settled civil lawsuits in recent years with the Justice Department, which alleged improper Medicare billing, forged documents, substandard care and other abuses.

The companies repaid the government a total of more than $260 million and nearly all are under active corporate integrity agreements with the inspector general of the U.S. Department of Health and Human Services — the same department that distributed the payments under the Coronavirus Aid, Relief, and Economic Security Act, or Cares Act. The five-year agreements require independent audits, employee training and other enhanced reporting protocols.

One nursing home provider is still embroiled in active litigation with the government, which has accused the company in federal court in Tennessee of putting elderly residents into unnecessary therapy services and delaying the release of patients to reap higher Medicare payments. SavaSeniorCare, whose homes received more than $65 million in pandemic relief aid, has denied wrongdoing.

All told, nursing home companies sued for Medicare fraud in recent years received more than $300 million in relief payments.

Millions more went to nursing homes with widely publicized breakdowns during the pandemic. Among them: a facility in Pennsylvania cited by the state for giving more than 200 residents the experimental anti-malarial drug touted by President Trump and a home in New Jersey under investigation by the state attorney general for lapses in infection control and patient care during a lethal coronavirus outbreak earlier this spring. After an anonymous tip, police found the bodies of 17 residents in a makeshift morgue; another had been stored in a shed.

The money was distributed through the $175 billion Provider Relief Fund, which since April has directed federal stimulus payments to hospitals, nursing homes and other health-care providers. In May, HHS announced a targeted nursing home distribution of $4.9 billion.

The payments, for expenses or lost revenue related to covid-19 — the disease caused by the novel coronavirus — came with few spending restrictions. Agreements between the providers and HHS include language prohibiting nursing homes from using the federal money for abortions, gun-control lobbying and the purchase of chimpanzees, but do not require homes to spend on such things as personal protective equipment or hazard pay for nurses and aides caring for covid-19 patients.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, told nursing home companies and other health-care providers in April that coronavirus relief payments came with “no strings attached.” (Drew Angerer/Getty Images)

“The president wants us to accelerate getting those dollars out,” Seema Verma, administrator for the Centers for Medicare and Medicaid Services (CMS), announced in April during a news briefing with the White House coronavirus task force. “There are no strings attached, so the health-care providers that are receiving these dollars can essentially spend that in any way they see fit.”

Watchdog groups and some independent experts say the government should have assessed the financial needs of the nursing home industry, scrutinized the track records of providers and attached some spending restrictions before distributing the payments. They say they are most concerned about for-profit companies, some owned by private equity and other investment firms, that in the past have slashed costs and cut staff to boost profit.

Two publicly traded nursing home companies that regularly pay dividends to shareholders announced they continued to do so in the first two quarters of this year, The Post found.

Rep. James E. Clyburn (D-S.C.), who chairs the House select subcommittee on the coronavirus crisis, launched a congressional investigation in June focused in part on grant spending by five nursing home chains.

Rep. James E. Clyburn (D-S.C.), chairman of the
House select subcommittee on the coronavirus
 crisis, said that the panel will conduct oversight
 to make sure nursing home companies are spending
 funds as Congress intended. (Salwan Georges/The
Washington Post)

“Our committee intends to conduct rigorous oversight to ensure that nursing home companies that received funds in order to deal with the crisis spend those funds as Congress intended,” he said in a statement to The Post. “Nursing home companies that received funds after committing fraud warrant particularly close scrutiny.”

HHS said that providers will be required to undergo audits and submit spending documents, and those unable to show that money went to expenses or lost revenue attributed to the coronavirus could be forced to return some or all of the funds.

“HHS will have significant anti-fraud monitoring of the funds distributed, and the Office of Inspector General will provide oversight as required in the CARES Act to ensure that federal dollars are used appropriately,” according to HHS.

The American Health Care Association (AHCA) and National Center for Assisted Living, which represents 14,000 long-term-care providers, said the federal money was badly needed. The group has reported that both nonprofit and for-profit nursing homes had been “on the verge of collapse” during a deepening health crisis, faced with the increasing costs of supplies and personnel expenses and the loss of existing and potential residents.

The industry group said it expects reporting and tracking protocols.

“For several months, all health care providers have been waiting for guidance on reporting and HHS’ approach to auditing and are anticipating significant oversight in the coming months,” Mike Cheek, AHCA senior vice president of reimbursement policy, said in a statement to The Post. “We support reasonable efforts to ensure this federal aid has been properly directed to providers to cover costs associated with addressing COVID-19 and potential losses."

Whether that oversight prompts the government to flag irregular spending — or demand the return of stimulus money — is not yet known.

As the money became available, LeadingAge, an industry group that represents nonprofit providers, put out a primer for providers with detailed instructions about how to access and use the payments.

“HHS or Congress could clawback some portion of the relief funds from non-COVID areas,” the document says. “But in an election year, there is low probability of this occurring.”

Those familiar with the industry say they fear some companies will simply absorb the money without investing in patient care or compensation for front-line workers.

“This has been one of my concerns from the moment the government passed the Cares Act — the money is not ending up where it needs to be,” said Michael Wasserman, medical director of a Los Angeles nursing home and president of the California Association of Long Term Care Medicine. “The help has to go specifically to the front line.”

To better understand where stimulus money was distributed, The Post used public records and provider websites to untangle the ownership structure of individual homes and then determine the total funding for homes within the same parent company. The calculations may be low. In some cases, The Post was unable to link the names of individual nursing homes with ownership records maintained by HHS or CMS.

The analysis captured more than 2,000 homes within some of the largest chains in the United States. The Post also looked at several publicly traded nursing home companies as well as smaller companies and individual facilities scrutinized for improper business practices or patient care before or during the pandemic. The Post could not independently verify how the relief payments, only recently distributed, were spent.

More than $35 million went to homes operated by the for-profit Brius, with dozens of nursing homes in California, federal data shows.

In 2016, officials at four Brius homes acknowledged in federal court that employees used corporate credit cards to buy massages, tickets to sporting events and excursions on the 222-foot mega yacht Inspiration Hornblower for hospital planners who provided patient referrals. The officials, who struck deferred prosecution agreements with the government, said at the time that Brius management was unaware of the scheme to maximize Medicare revenue.

The four homes repaid $6.9 million through a settlement.

Last year, the state threatened to fine one Brius home $156,000 after inspectors noted that a resident who had trouble swallowing choked on a honey bun and died, and another resident needed two surgeries after she fell out of her wheelchair while unattended. The home’s administration withheld records and instructed staff not to cooperate, according to the state inspection report.

In 2014, then-California Attorney General Kamala D. Harris called the company’s owner, Shlomo Rechnitz, a “serial violator of rules within the skilled nursing industry” in an emergency court motion to stop Brius from buying homes through a bankruptcy sale.

Shlomo Rechnitz, right, with Steve Rechnitz and their wives at a 2012 event in Beverly Hills, Calif., is the owner of Brius Healthcare, the largest nursing home provider in California. In 2014, then-California Attorney General Kamala D. Harris called Shlomo Rechnitz a “serial violator of rules within the skilled nursing industry.” (David Livingston/Getty Images)

Speaking for Rechnitz, company attorney Mark Johnson said Rechnitz does not have any role in the day-to-day operations of Brius homes. Johnson said the Justice Department settlement stemmed from allegations from 2006 to 2012 and “clearly has nothing to do with the CARES Act or the current pandemic.” The company, he said, cooperated with investigators and terminated the individuals involved.

Johnson denied allegations that facility employees failed to cooperate last year with state inspectors and said the company appealed the state’s findings. He added that Brius has faced rising expenses from increased wages, the cost of supplies and other needs during the coronavirus crisis.

“While we certainly cannot project the end of this pandemic, at present it seems unlikely that the relief funding will be sufficient to meet the increased expenses related to this pandemic,” Johnson said in an email.

In New York, two homes that are part of the for-profit SentosaCare received more than $2 million in pandemic relief payments, federal records show. In October, a federal judge ruled that the owners of the company were liable for violations of human-trafficking laws after Filipino nurses brought to the United States to work in the two homes said they were overworked, improperly paid and threatened with $25,000 fines if they quit before their contracts ended.

Elliot Hahn, a lawyer for SentosaCare, said nurses were not threatened and were paid an hourly rate of $29 or more. The company has appealed the ruling.

“This is not a case where employees were mistreated or ‘trafficked’ in any sense of the word,” Hahn said in an email.

Nursing homes that have drawn significant scrutiny during the pandemic also received relief payments, The Post found.

The Life Care Center of Kirkland in Washington state, the site of the country’s first known coronavirus outbreak, received nearly $320,000 in pandemic relief. After the outbreak, CMS inspectors found the home did not properly care for sick residents or alert authorities to the spread of illness. The state banned the home, linked to more than 40 deaths, from accepting new residents until changes were made.

The Life Care Center of Nashoba Valley outside of Boston drew $300,000 in federal funds. After 17 people died of covid-19, including a nurse at the home, Sens. Elizabeth Warren (D-Mass) and Edward J. Markey (D-Mass.) and Rep. Lori Trahan (D-Mass.) appealed to CMS to provide more oversight of Life Care and other for-profit chains. The Massachusetts Attorney General is investigating the home.

Tim Killian, public information liaison for the Tennessee-based chain, said the company continues to work with government regulators to “provide the best care and to safeguard both residents and staff.”

“We have lost both residents and staff members to this horrible contagion,” he said in an email. “Our staff members engaged in heroic efforts to provide the best care possible at great risk to their own health and well-being."

Life Care, with more than 200 nursing homes, is being monitored by federal authorities for financial compliance with Medicare rules. In 2016, Life Care, without admitting liability and arguing the government did not prove its case, agreed to the oversight and to a $145 million settlement to resolve allegations by the government that the chain and its billionaire owner had engaged in “a systematic scheme” to maximize Medicare billing.

Homes within the Life Care network received more than $48 million in pandemic relief payments, federal data shows.

“I asked Seema Verma to increase oversight of these for-profit chains, not hand out hundreds of millions of dollars with no strings attached,” Warren said in a statement to The Post. “CMS needs to make sure this money goes to responding to the virus and protecting vulnerable residents and staff, not padding profits and bottom lines.”

Billions distributed with few restrictions

The nursing home industry has pressed for financial relief since the start of the pandemic, when hundreds and then thousands of elderly residents fell ill during coronavirus outbreaks that swept homes from New York to California. More than 45,000 residents have died since March, along with several hundred nurses and other caregivers.

For months, the industry has asked Congress and the Trump administration to provide testing supplies, protective gear and money to cover expenses as well as lost revenue from beds left empty by patients who died of covid-19 or potential residents who decided to live elsewhere. Congress complied, allowing nursing homes to use stimulus money to cover shortfalls in revenue or expenses attributed to covid-19.

In May, Health and Human Services Secretary Alex Azar, talking with President Trump, announced $4.9 billion in targeted pandemic relief to nursing homes. Homes were given broad flexibility on use of the money. (Jabin Botsford/The Washington Post)

Nursing homes received about $2.7 million in initial, general distribution payments for hospitals and health-care providers. In May, HHS Secretary Alex Azar announced a targeted $4.9 billion distribution to nursing homes.

“This funding secured by President Trump will help nursing homes keep the seniors they care for safe during the COVID-19 pandemic,” Azar said at the time.

HHS opted for a simple distribution formula: Nursing homes would receive a $50,000 lump-sum payment, along with an additional allocation of $2,500 per bed. The average distribution was $315,000, with some larger facilities receiving $3 million or more, according to HHS.

The money, HHS said in guidance to the industry, did “not need to be specific to providing care for possible or actual coronavirus patients.” Providers could use the grants for a range of expenses, including health insurance, rent or mortgage payments, and equipment lease payments. Providers would have to comply with unspecified future audits and reporting requirements.

“They should have specified that the money couldn’t just be used for administrative costs and profits,” said Charlene Harrington, a nursing home researcher and professor at the University of California at San Francisco. “There was no reason that CMS couldn’t have put more restrictions on the money."

Some say the government also should have assessed the finances of nursing homes and their parent companies before distributing the payments.

In 2018, nursing homes in the United States received $28.5 billion from Medicare, which covers short-term stays and pays a far higher rate for services than Medicaid.

As the coronavirus crisis spiraled, CMS waived a rule that required patients to spend three consecutive days in a hospital before becoming eligible for skilled nursing care funded by Medicare. The idea was to free up hospital beds for covid-19 patients — and protect the elderly from exposure. But the change also allowed nursing homes to convert existing, long-term-care patients on Medicaid to higher-paying Medicare as long as the homes determined the residents needed skilled care under CMS guidelines.

David Grabowski, a professor of health-care policy at Harvard Medical School, called the change a “huge revenue bump.”

“That’s where all of the high margins are associated with nursing home care,” Grabowski said. “You can quadruple your revenue overnight for those residents.”

CMS also extended the time that patients were eligible for Medicare-funded skilled nursing, doubling the pre-pandemic 100-day limit if patients affected by covid-19 needed more care. At the same time, states including Massachusetts and Connecticut have directed aid to nursing home providers.

Then came the stimulus money.

Homes within the publicly traded Genesis HealthCare, which reported $33 million in net income in the first quarter of this year, received about $180 million in pandemic payments. States provided an additional $27 million.

“It goes back to this issue of whether or not there were shortfalls,” Grabowksi said. “You would want them to be able to make payroll, to buy all the supplies. … But I think there are a lot of concerns, especially with private equity and others, are you making the payments to a private-equity group or are you paying your staff? Greater accountability here on the financial side would be a good thing.”

The American Health Care Association said the money came at a critical time: Medicaid for years has covered only 70 or 80 percent of the cost of care in nursing homes, leaving some companies even before the pandemic with razor-thin margins. Struck by higher costs and lower occupancy rates during the crisis, the industry faced the loss of billions of dollars in revenue, the group has reported.

Money flows to troubled chains

On the front lines of nursing homes, the needs are clear. Last month nearly 3,000 reported shortages of nurses, aides or both, according to CMS data. More than 1,700 reported that they lacked a week’s supply of N95 masks; 1,500 said they lacked surgical gowns.

Hundreds of nursing homes ran short on staff, protective gear as more than 30,000 residents died during pandemic

But lawmakers and watchdog groups worry that with few safeguards, nursing home companies will seek to grow profit rather than direct money to patients and caregivers. Some providers have affiliated entities, such as medical supply companies, that could charge related nursing homes above-market rates for goods and services to justify expenses.

“There are owners in the industry who have related parties,” said Wasserman, the California doctor and industry representative. “Now the facility is paying five to 10 times the amount for PPE. That is not how Cares Act money should be spent.”

Watchdog groups say they are particularly concerned about companies that have faced allegations of Medicare abuse.

Nursing homes within Ohio-based Saber Healthcare, with facilities in seven states, received more than $45 million in pandemic funding only weeks after the company and related entities settled a 2016 government lawsuit, agreeing to five years of compliance monitoring and repaying $10 million to the government, court records show.

Government lawyers alleged in federal court in Virginia that nine of Saber’s homes submitted false claims to Medicare in recent years for rehabilitation therapy services for residents that were not reasonable, necessary or skilled.

“Our office is committed to investigating and stopping health-care fraud,” U.S. Attorney G. Zachary Terwilliger, of the Eastern District of Virginia, said in April. “Billing Medicare for higher-than-necessary levels of care exploits our senior citizens and undermines trust in the health-care system.”

Saber did not admit liability when settling the case.

“Saber disputes the allegations and has the utmost confidence that its facilities have acted in compliance with applicable laws and regulations in providing the best possible care to each and every patient,” the company said in a statement to The Post. “During this critical time for healthcare providers, our resources are better spent in serving our patients’ needs and supporting our employees rather than continuing to litigate these issues.”

In federal court in Tennessee, the Justice Department is currently pursuing a case against SavaSeniorCare, arguing that the nursing home company, among the largest in the U.S., pressured its homes to meet “unrealistic” financial goals by submitting false claims to Medicare for rehabilitation therapy.

Homes within the Sava network received more than $65 million in pandemic relief, federal spending data shows.

Patte Packey, whose 83-year-old father died of covid-19 at a Sava nursing home in Bethesda, Md., said she worries the money will not be spent on patient care.

“Who’s responsible for the oversight?” she said.

A spokesperson for Sava declined to comment on the government’s case, saying the litigation is ongoing. In court records, the company disputed the allegations, arguing the government failed to prove its case.

“The government hinges its entire case on five patient examples that demonstrate, at most, the government’s subjective clinical disagreement — and even then, a disagreement that wholly ignores the high standard to which [skilled nursing facilities] are held in the delivery of therapy services,” the company said.

Nursing homes flagged by government inspectors for lapses in care during the pandemic also drew millions of dollars, including Andover Subacute and Rehabilitation Center in New Jersey, where 17 bodies were found in a makeshift morgue.

Hundreds of nursing homes with cases of coronavirus have violated federal infection-control rules in recent years

The facility, which along with a sister property received about $3 million, failed to follow infection-control standards or properly screen visitors, according to a state inspection in April. Inspectors also found staff members who did not use proper protective equipment, wash their hands or separate sick patients from healthy ones.

The home, under investigation by the New Jersey attorney general, said every effort was made to keep residents safe.

“Despite all our efforts, the virus made its way into our facility, as it did in the majority of long-term care facilities across New Jersey,” owner Chaim “Mutty” Scheinbaum said in a statement. “We took every possible step to handle this crisis internally while simultaneously making dozens of outreaches to local, state, and federal agencies for help. … The facility has made a strong recovery since the height of the pandemic.”

Industry appeals for more

In recent weeks, state and federal lawmakers have ramped up calls to track the money. Clyburn is investigating Sava, Genesis and Life Care, among other nursing home chains, to determine how the stimulus money was spent.

In Pennsylvania, state Sen. Katie Muth (D) is pushing a measure that would require providers to track and report their spending.

“All these things that we hoped the feds would do, they haven’t,” Muth said.

The nursing home industry, meanwhile, is lobbying for more money. Last month, the Trump administration announced an additional $5 billion in funding for nursing homes and state veterans homes.

The American Health Care Association is asking for $100 billion, much of it directed at nursing homes. In early June, the group announced a $15 million fundraising effort to launch a public awareness campaign.

“Our profession faces its greatest challenge in history,” Mark Parkinson, the former governor of Kansas and AHCA’s president, wrote in a letter to the industry. “This isn’t like the usual fight we have in D.C. over a two percent increase or cut, or over some crazy regulation. Instead, this is a battle for the lives of our residents, our staff, and the very survival of our sector.”

Jacobs and Mulcahy are graduate students in journalism at Northwestern University’s Medill Investigative Lab. Post researcher Alice Crites and staff writer Douglas MacMillan contributed to this report, along with Michael Korsh, Ellie Eimer, Chloe Hilles, Cadence Quaranta, Catherine Buchaniec, Daniel Rosenzweig-Ziff and Alexa Mikhail with the Medill Investigative Lab.

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Nursing home companies accused of misusing federal money received hundreds of millions of dollars in pandemic relief

Alzheimer's patient beaten, wedding ring stolen off her finger at West Bloomfield nursing home

CANTON, Mich. (FOX 2) - A male orderly has been arrested for beating and stealing from a 69-year-old Alzheimer's resident inside a West Bloomfield nursing home.

The attack allegedly happened just days after the woman moved into the facility. (Warning: the video contains images of the assault that may be distressing to some.)

Man charged with beating, stealing from Alzheimer’s patient at West Bloomfield nursing home

An employee at the Villa at Green Lake Estates in West Bloomfield is facing multiple charges after a patient there was badly beaten and robbed.

Kristine Tracy's husband, Stan, says her wedding ring was stolen. The two have been married for nearly 50 years.

"It' the longest memory the two of us have. She never took it off," he said. "Honestly, I would've liked to of gone in there and grabbed people by the throat and shaken them."

On July 11, Stan could no longer take care of Kristine's Alzheimer's so she was placed in a nursing home at Villa at Green Lake Estates in West Bloomfield. But days later, she was beaten.

"What goes through someone's mind to take advantage of an Alzheimer's victim, 67 years old, tear off a ring that's been on her finger since 1971," said Greg Rohl, the attorney suing Villa at Green Lake Estates.

Stan says the nursing home told him Kristine's injuries were because she fell.

"They don't let them fall on their [expletive] on their head. They don't do that," Stan argued. But police said videotape showed Kristine was assaulted by an orderly who worked at the nursing home.

FOX 2 put in a call to the facility but did not receive a call back.

Meanwhile, the suspect, Tirrell Mercer, Jr. was charged with armed robbery, a felony, and elder abuse, a misdemeanor.

"When you run an organization like that and you abuse people that come out bruised, you are not doing any standard of care," Stan said.

The police do have video of the beating but are not releasing it at this time. Meanwhile, Kristine's ring is still missing.

"I would've liked to have given it to my granddaughter; I'd have liked to have worn it on a chain. I would just like to have it," Stan said.

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Alzheimer's patient beaten, wedding ring stolen off her finger at West Bloomfield nursing home

Nursing home residents offer weekly words of wisdom amid the pandemic: 'You can’t take your money with you, so spend it at the pub'

by Megan Sims

These seniors at Waratah Lodge are sharing their thoughts on various topic, much to the delight of social media. (Photo: Orbost Regional Health)

With the global health pandemic putting countless lives on pause, Waratah Lodge, a senior living facility in Australia has been keeping their residents busy providing words of wisdom on social media. The commentary has ranged from relationship advice to money-saving tips, often served with a dash of wit.

In the photos shared on social media, seniors at the home in Orbost, Victoria can be seen holding up dry erase boards that show the topic, their name, age and the advice they have decided to share. In one photo, Tom, 88, offers this financial tidbit: “You can’t take your money with you, so spend it at the pub.”

In another photo, Aileen, 90, offers marriage advice: “Try before you buy.” Meanwhile, 89-year-old Lora warns, “Don’t do it.”

Jo Marshall, the director of clinical and aged care services at Orbost Regional Health, tells Yahoo Life that the project started off as a one-off opportunity for seniors to impart words of wisdom for younger generations. But with their first post on June 16 getting thousands of shares and comments, they decided to make it a weekly activity.

“The residents have loved the activity and get very excited when shown the comments that they have received,” Marshall says. “They have a sense of pride that they are contributing to some positivity in an otherwise fairly stressful time. [And] the reactions have been wonderful, with comments such as ‘please keep these coming, they are the only brightness in a dull world,’ and ‘these guys are so inspiring.’”

Marshall says that they have had to put restrictions into play at Waratah Lodge, along with their other senior care facility, Lochiel House. Some of these restrictions include only allowing residents to leave for essential reasons and limiting access to visitors. Employees have also been required to wear masks and have been vaccinated for influenza.

“The care needs of the elderly in each facility are different and this means that the activities they do are tailored to their needs, interests and abilities,” Marshall says. “We have tried to discuss the pandemic but not constantly. Our staff have worked with family members to connect with residents in other ways including Skype and FaceTime.”

In the meantime, Marshall says that they hope to continue the weekly words of wisdom project until the residents no longer enjoy doing it, or they run out of questions. She adds that the “very resilient” seniors even have inspiring words about the current state of the world: “They comment that this pandemic isn’t so bad, they have lived through worse!”

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Nursing home residents offer weekly words of wisdom amid the pandemic: 'You can’t take your money with you, so spend it at the pub'

Florida nursing home residents ‘dying of failure to thrive’ as state debates visitation

by Kate Santich

In this July 13 photo, Mary Daniel and husband Steve sit together in his room at a Jacksonville memory care center. Daniel took a part-time job washing dishes at the facility to see him after a 114-day absence. (AP)

After five months of physical separation from their loved ones, Florida’s nursing home residents are dying of loneliness and isolation, the wife of an Alzheimer’s patient said Friday as she pleaded with a state task force to speed up the process of allowing at least one visitor per resident.

“There are people dying today, right now ... from failure to thrive,” said Mary Daniel, who took a job washing dishes at a Jacksonville memory-care center so she could see her 66-year-old husband there. “I am begging for urgency. ... Why am I allowed to touch my husband as a dishwasher, but I am not allowed to touch him as his wife?”

Daniel’s comments came during an initial meeting of the task force, created last week by Florida Gov. Ron DeSantis to map out a “safe and limited reopening” of the state’s long-term care facilities to visitors. DeSantis ordered them closed in mid-March to prevent the spread of COVID-19, which has killed at least 68,000 residents and workers at facilities across the country.

In Florida, nearly 3,900 people have died of the virus in nursing homes, assisted-living centers and group homes as of Thursday night. But in recent weeks the number of infections among residents has begun to flatten, and it is now declining for workers.

Daniel’s claim that residents are dying from the despair of separation, she said, comes from anecdotal evidence. Members of her Facebook group, Caregivers for Compromise, now over 8,000 strong, describe distraught loved ones who stopped eating and seemed to lose the will to live after months of isolation — a scenario also recounted by gerontologists and long-term care ombudsmen in other states.

While some states have allowed outdoor visits or limited indoor visits, Florida’s facilities have remained largely shuttered — although state officials said confusion over the governor’s order has kept out some visitors who should have been allowed in.

“We have certainly allowed facilities to consider it as optional” to allow visitors who previously served as regular caregivers for their loved ones, said Mary Mayhew, secretary of Florida’s Agency for Health Care Administration, which oversees the industry. “It’s either confusion or a decision” by the facility not to continue that.

Daniel also said that “compassionate” visits — for nursing home residents who are nearing death, grieving or recovering from surgery — are also being blocked.

“That [visitation] is not happening,” Daniel said. “A lot of what I’m asking are little things [including] clarification of what the rules are.”

Mayhew said she agreed with the need to act urgently and planned a second meeting for Tuesday, when the group will debate specific requirements to help facilities prepare for visitation.

Dr. Scott Rivkees, Florida’s surgeon general and a task force member, said federal guidelines spell out such requirements already, including that the facility be free of new COVID cases for 28 days. They also recommend outdoor visits when possible, the use of masks and other personal protection equipment for visitors and residents, maintaining a 6-foot buffer between visitors and loved ones, and having a designated employee “monitor” the visits to ensure compliance.

The Florida Health Care Association, which represents most of the state’s nursing home owners and operators, has its own task force that has recommended all facilities allow outdoor visits for residents who are COVID-negative.

“Preference No. 1 [is] outside areas protected from weather elements, such as porches, patios and other covered areas — or tented areas,” said Emmett Reed, the association’s executive director. “In-facility visits should be limited to the compassionate care situations ... and also facilities that have no new-onset cases for 28 days.”

Facilities also should have no staffing shortages; adequate supplies of masks, gowns and gloves; sufficient testing supplies and room in local hospitals to transfer residents if they become ill, Reed said.

But he also called for the resumption of beauty salon and barber shop services within nursing homes for COVID-negative residents, provided they follow certain safety protocols.

“This is a little outside the purview,” he admitted. “We think beauty salons and barbers help quality of life and make residents feel good about themselves.”

Other task force members did not comment on his suggestion.

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Florida nursing home residents ‘dying of failure to thrive’ as state debates visitation

See Also:
Wife takes dishwashing job at nursing home to visit husband with Alzheimer's

State investigates death at Harris Hill nursing home

by Mike McAndrew

Harry Scull Jr.

The State Department of Health is investigating a death at Harris Hill Nursing Facility in Lancaster, a spokesman said Wednesday.

The death of the resident was reported by the nursing home staff to the Health Department.

“Protecting people in nursing homes is a top priority of the Department of Health. Immediately upon learning of this incident at Harris Hill, the Department opened an investigation. As this is an ongoing investigation we cannot comment further," said Jeffrey Hammond, the Health Department spokesman.

A spokeswoman for the McGuire Group, which operates Harris Hill, declined to provide any details about the resident's death.

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State investigates death at Harris Hill nursing home

Caregivers Are More Likely To Develop Alzheimer’s Due To Stress

By A. Stout

Watching a loved one’s cognitive capabilities deteriorate is a heart-wrenchingly painful process, rife with stress. My grandma has dementia, so I know that firsthand. You do what you can to help them, but when it comes down to it, there’s little you can do. You are forced to watch as they slowly slip away from you. And if you double as their caregiver, you may find yourself even more stressed due to the daily challenges the disorder poses.

But science has found that this process is more than just stressful for caregivers; it’s also deadly.

Studies from John Hopkins University, Duke University, and Utah State University have found that caregivers of people with Alzheimer’s are six times more likely to develop the neurodegenerative disorder themselves. This may be the case for several reasons:  

• Social isolation
• Stress
• Poor diet and lack of exercise (due to a lack of time or energy)

These things can lead to clinical depression, brain inflammation, and general poor health — factors that raise your risk of developing dementia.

So this just proves it: caregivers need to care for themselves, too.

If you are a caregiver, a big part of this involves getting help. You don’t have to — and shouldn’t have to — face the challenges of Alzheimer’s care alone. There are a wealth of resources to help you, like adult daycare centers and home care services. If you can’t or prefer not to turn to these services, ask family and friends for help. You can also join a support group for caregivers, where you can learn how to better help your loved one, as well as gain emotional support.

If the thought of asking for outside help makes you feel guilty, remember that your own physical, mental, and social health is critical — not just for yourself, but for your loved one, too; by meeting your own needs, you’re better able to meet theirs.

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Caregivers Are More Likely To Develop Alzheimer’s Due To Stress

A Quarter of the Residents at This Nursing Home Died From COVID-19. Families Want Answers.

Scott Morrow visits his mother, Claudette Stasik, at the Bria of Geneva nursing home in the western suburbs of Chicago. Since mid-April, 75 of the nursing home’s 91 residents and 37 of its 120 workers have tested positive for the coronavirus. (Anjali Pinto for ProPublica)

Within three weeks, the Bria of Geneva nursing home went from one case of COVID-19 to two dozen residents dead and at least 75 infected. Delayed testing and gaps in nursing home data obscures the true toll of the crisis.

by Jodi S. Cohen and Haru Coryne

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Standing outside a window at the Bria of Geneva nursing home one morning last week, 2-year-old Rosa Morrow tried to get her grandmother’s attention. She held her palm to the screen. She blew kisses. She counted slowly, “1 … 2 … 3 …”

On the other side, 71-year-old Claudette Stasik, who has tested positive for COVID-19, sat in her reclining wheelchair, her eyes closed and her arms crossed against her chest, her gray hair braided to one side. A nurse, wearing gloves, gently rubbed her hand.

“Can you say hi? Wake up, honey. You have visitors.”

Separated by the glass — and by a devastating outbreak of the coronavirus at this facility in the western suburbs of Chicago — Stasik’s son Scott and his family can only attempt to communicate with her through a FaceTime call.

“Hi, Mom. We’re over here. Can you look over this way?” her son said. Stasik opened her eyes, but only for a moment.

It’s been a brutal few weeks at Bria of Geneva, which has experienced one of the largest and deadliest outbreaks of the coronavirus in the state, according to a ProPublica Illinois analysis of Illinois Department of Public Health data.

Since mid-April, 75 of the nursing home’s 91 residents and 37 of its 120 workers have tested positive for the virus. Twenty-four residents have died from COVID-19, the most recent on Monday, according to Bria of Geneva and the coroner’s office in Kane County, where the facility is located.

While other Illinois nursing homes may have seen larger overall numbers of cases and deaths, almost none have experienced an outbreak on the scale of the one here, with more than two-thirds of the residents infected with the virus and one-fourth killed by it. The situation at Bria of Geneva illustrates the price of insufficient and delayed testing and how a lag in public reporting of cases and deaths in nursing homes obscured the breadth of a crisis that has disproportionately hit the state’s vulnerable elderly population.

The first resident at Bria of Geneva tested positive April 17. At the time, Illinois public health officials had instructed nursing homes that they did not need to test everyone when there were positive cases. That guidance changed soon after, when state officials acknowledged that more testing was needed in nursing homes to identify asymptomatic residents and staff members and prevent large outbreaks. Still, it took another week for Bria to obtain enough supplies to do widespread testing.

State public health officials first released coronavirus case data on nursing homes April 19. It showed no cases at Bria of Geneva, even though the outbreak was underway. In some of the Public Health Department’s weekly updates since, the number of deaths has been undercounted or becomes outdated almost as soon as it’s released, according to a comparison of state data with a tally from the Kane County coroner’s office.

Some family members have blamed Bria officials for being unprepared for the virus and for failing to communicate with them about their family members. The county coroner, who has been performing posthumous COVID-19 tests, also has expressed frustration with the handling of the outbreak.

“I don’t feel that it should be my responsibility at this point running around testing [dead] people that should have already been tested,” Coroner Rob Russell said.

Philip Branshaw, the medical director at Bria of Geneva, said that the last few weeks have been “trying” and “heartbreaking” for the medical staff, family members and residents, but that he is confident that patients are well cared for. As of this week, 43 residents and staff members have either recovered from the virus or are asymptomatic, according to the nursing home.

“I likened it to following all the rules, and when you get ready to cross the street and look at the lights and you step out and get run over by a truck,” Branshaw said.

At least 1,500 residents of Illinois nursing homes or other long-term care facilities have died from the virus — roughly half of all COVID-19 deaths in the state, although residents of such facilities make up less than 1% of Illinois’ population. The crisis is most apparent outside Cook County. In these areas, long-term care centers account for two-thirds of all deaths, according to a ProPublica Illinois analysis of data from the state Department of Public Health.

Across the state, more than 400 out of about 1,700 facilities have reported at least one positive case among residents and staff, and about 20 facilities have had 100 or more positive cases.

The 75 cases among residents at Bria of Geneva, located about an hour west of Chicago, include Claudette Stasik, who has Parkinson’s disease and dementia, her family said. Although she hasn’t displayed a high fever, cough or other symptoms of the virus, her health has declined in recent weeks as she has been confined to her room.

Patricia Yanni, 78, had lived at Bria of Geneva for eight years. “The doctor called me and said, ‘I’m not sure she will make it out of this,’” said her daughter, Kristin Davison. Yanni died several days later, on May 1.

Susan Borowiak knew her mother, Lucille James, had been tested for the virus, but nobody from the nursing home told her the results, she said. James died May 1, hours before Yanni. The death certificate listed the cause of death as COVID-19 and noted she was last seen alive in the late hours of April 30. “The hardest part is knowing there was nobody there with her,” Borowiak said.

“Somehow the virus got in there and went like wildfire,” Borowiak said. “You scratch your head over the whole thing.”

A Dire Situation

Left: Patricia Yanni had lived at Bria of Geneva for eight years. She died May 1. (Courtesy of the Yanni family); Right: Lucille James was tested for the virus but her daughter says no one from the nursing home informed her of the results. James died May 1, hours before Yanni. (Courtesy of the James family)

When Branshaw discusses the timeline of the outbreak at Bria of Geneva, he starts with the morning of April 17. That’s when the first resident, sent to Northwestern Medicine Delnor Hospital in Geneva a day earlier, tested positive for the virus.

“We did not have any testing available to us, which unfortunately is pretty common,” Branshaw said. “Once we got our first patient, it was a landslide.”

Three more Bria of Geneva residents were admitted to Delnor that day. Others have been admitted since. Some of the first residents to test positive were transferred to a facility in Palos Hills that Bria of Geneva’s parent company, BRIA Health Services, operates. At the time, staff members thought they could contain the virus by transferring them to a coronavirus-designated wing at the Palos home.

“We were still trying to figure out the scope of the issue,” Branshaw said.

He was hamstrung, he said, because he couldn’t get testing supplies. At the direction of the Kane County Health Department, Bria of Geneva eventually obtained 10 tests from a state lab, the amount supplied to facilities at the time, county health officials said. Branshaw secured an additional 60 tests after asking, in a group chat with medical professionals, if anyone could help; top health officials from Northwestern’s Central DuPage and Delnor hospitals supplied them.

On April 23 and 24, Branshaw and a nurse practitioner went from room to room at the nursing home. “We swabbed everyone we could,” he said.

Russell, the coroner, said he was frustrated by the difficulty nursing homes had in obtaining tests. “The biggest disappointment to me is why aren’t long-term facilities testing folks? There are things they could do to mitigate the spread,” he said last month, as the outbreak was just beginning. He tested some nursing home residents after they died, both to provide answers to family members and to build a more accurate public accounting of the disease.

Only four nursing homes in Illinois had more deaths than Bria of Geneva when the state updated its count last Friday. All of them are larger facilities, with more beds and a higher average number of residents. Meadowbrook Manor of Bolingbrook has had at least 26 deaths, the most in the state, but it has three times the capacity of Bria of Geneva. Symphony of Joliet, with twice the capacity of Bria of Geneva, has had 24 deaths.

Pat Comstock, the COVID-19 response director for the Health Care Council of Illinois, an industry group that represents about 300 nursing homes, criticized state public health officials for not providing nursing homes with personal protective equipment early enough. Hospitals obtained gear directly from the state, but nursing homes initially had to go through county health departments or secure it on their own, she said.

“Not prioritizing nursing homes early enough created some challenges across the board,” she said. “At the beginning, even if facilities went out and tried to find their own test kits, the supply just wasn’t available. Help was needed from the state.”

Gov. J.B. Pritzker has said that the state provided protective gear to all county health departments and made clear that the long-term care facilities are “priority recipients” for distribution. Kane County health officials provided masks, gloves, gowns and other gear to Bria of Geneva, a spokeswoman said.

On April 20, state officials said they would send teams to nursing homes to test residents and staff — including at facilities with no confirmed cases to try to isolate cases and avoid major outbreaks. It’s unclear how many sites they’ve visited, and the Illinois Department of Public Health did not respond to a request for that number.

“We are working to test all residents and all staff at those homes,” Pritzker said in April, adding that the state would prioritize homes serving minority populations. State officials also said staff members should be tested more regularly instead of relying on “wellness checks” that don’t detect asymptomatic carriers.

In response to questions from ProPublica Illinois, an Illinois Department of Public Health spokeswoman said the agency has sent 30,396 test kits to 129 long-term care facilities and Quest Diagnostics, a private company, has sent at least an additional 2,653 test kits to eight facilities.

“This effort continues daily,” IDPH spokeswoman Melaney Arnold said. “Early in the pandemic when testing capacity and PPE were limited, and asymptomatic transmission was thought not to occur, isolating residents and restricting staff could be done with symptoms alone.”

Arnold said the state releases data on nursing home cases and deaths only once a week because public health officials are currently “stretched” and their focus is on responding to outbreaks to limit the spread and protect residents and workers.

“Without widespread testing and without frequent release of the data, there are undoubtedly buildings across the state that have outbreaks that we don’t even know about or don’t know as much about as others,” Comstock said.

Troubling Reports

At the front door of Bria of Geneva, it’s as if time stopped before the coronavirus arrived. A sign at the front door still reads: “Visiting hours are only a suggestion. Visitors are welcome any time.”

But no visitors have been allowed inside since mid-March. Messages in the windows signal the fight that’s going on inside: “#WeGotThis.” “#BriaStrong.” “#AllforOne.” “GenevaProud.”

BRIA Health Services operates nine facilities in Illinois, all in the Chicago area and near St. Louis. Five of them have had deaths from COVID-19.

The Centers for Medicare and Medicaid Services, which inspects and regulates nursing homes, gives Bria of Geneva an overall rating of four stars, which is above average, and its top rating, five stars, for the care of long-term residents. But in its most recent health inspection report, in July 2019, the federal agency cited the facility for having insufficient staff to meet residents’ needs and for some workers not using proper hygiene, among other concerns, and gave it just two stars in that report.

The report described residents waiting so long for workers to respond to them that they soiled their clothes or were essentially confined to their rooms. “We just don’t have enough staff,” one resident told inspectors last year, according to the report. “I have waited up to 2 hours to get my call light answered.”

Inspectors also watched a nursing assistant change a resident’s soiled underwear without changing her gloves. The same worker, 45 minutes later, changed another resident’s soiled underwear and then, still wearing the same pair of contaminated gloves, transferred him back to his wheelchair, wiped his face with a wet washcloth and combed his hair.

“Staff should wash their hands and change their gloves after caring for residents to prevent the spread of infection,” the report states. Inspectors concluded residents did not face immediate harm but there was potential for it. Bria of Geneva was not fined.

Some family members whose relatives died from the virus told ProPublica Illinois they were left in the dark as COVID-19 spread through the home.

Kristin Davison’s mother returned to Bria of Geneva after being treated at a hospital for COVID-19 symptoms around April 25. Davison said she spent hours repeatedly calling the nursing home to get updates, but nobody answered the phone. She FaceTimed with her mother on Wednesday, April 29. The next day, she couldn’t reach anyone at the facility.

“They either didn’t pick it up, I was hung up on, I was transferred. It took forever for someone to call me and most people would not return your calls,” Davison said. “I had to hound them. It was ridiculous. You shouldn’t have to do that.”

Bria of Geneva (Anjali Pinto for ProPublica)

On Friday evening, May 1, she got a phone call that her mother had died. “The director said, ‘We did our rounds and when we came around she was gone,’” Davison said. She called the nursing station to ask what had happened and why she wasn’t contacted. She said a nurse replied: “We are very busy here. I didn’t know she was going to pass, so I didn’t know to contact you.”

“What hurts me the most is my mother was alone,” Davison said. “I would have loved to have been able to FaceTime her one more time to say goodbye, and I didn’t have that option.”

Susan Borowiak said she’s also concerned about the care that her mother, Lucille James, received in the weeks before she died. When Borowiak last saw her mother through a window, she “looked really rough,” she said. Her hair was long and unkempt. Food was stuck on her shirt.

“The nurses we did know there, we liked. They were very caring. Once the staff all got sick, it was a rolling boil there,” she said. “I don’t think they were as prepared as they should have been and didn’t have the proper protective equipment.”

She also expressed frustration at not getting updates about her mother’s declining health after learning through a mass email from Bria of Geneva on April 24 that residents and staff had tested positive. The next evening, she emailed the nursing home with a plea for an update on her mother’s health, saying she had been trying to reach someone there for two days. “I understand it’s insane there. I’ll even take a text or email,” she wrote. “Thank you for being there and taking care of my mom.”

Administrators allowed Borowiak’s sister, Donna James, to visit her mother the night before she died, and she held her hand for the last time. As she walked into the home, James said, a resident was wheeled out on a stretcher and into an ambulance. The nursing home workers did not have face shields or medical-grade masks as they went from room to room, James said.

Lucille James died on her husband’s birthday. They had been married for 59 years. Borowiak, who had said goodbye to her mother on FaceTime, went to Bria of Geneva one last time and watched as the funeral home arrived to pick up her mother’s body, draped in purple velvet, her favorite color.

When Stasik’s family visited last week, the nurse by her bedside wore a face shield, gown, mask and gloves. But during visits before that and since, the family said, workers didn’t wear gloves and one nurse assistant wore his mask below his mouth.

“He was touching her and everything,” said Stasik’s daughter-in-law, Maria. “No wonder it is spreading so fast.”

Rosa Morrow blows kisses at her grandmother, who has tested positive for COVID-19. (Anjali Pinto for ProPublica)

Branshaw said that Bria of Geneva has been “more than adequately staffed” by nurses working longer shifts or through pulling in employees from other BRIA homes. He said the nursing staff has been “heroic” and that it has had sufficient protective gear.

Bria of Geneva resident Debbie Jacobs, who tested positive for the virus but is asymptomatic, has lost many of her friends in the past few weeks. She learns the disease has taken another life when the nursing home plays the hymn “How Great Thou Art” over the intercom to mark each death.

She said the outbreak was “like a bomb went off.” Two days after residents met with the Bria of Geneva administrator to discuss preemptive lockdown procedures, the first resident tested positive, Jacobs said. “Nobody expected it,” she said. She said workers have been supportive during the crisis and have kept residents informed through flyers and one-on-one meetings.

“I have never met a [nursing home] administrator that cares so much for her building,” Jacobs said.

Other families, including whose loved ones died, have sent letters, emails and food to thank the nurses and other workers for their courage to keep coming to work. Community members provided lunch from Panera Bread Co. and the Geneva library staff sent a letter of thanks.

Difficult Visits

During the 90 minutes that Stasik’s family visited her last week, at least two other residents had windowside visits from their families.

Mary Niceley dropped off homemade fudge and pumpkin-date bread for her 95-year-old mother, who has also tested positive for the virus but is doing well, she said.

“I love you mom,” Nicely said, during a brief windowside visit. She cried as she walked away, waving her hands in front of her eyes to try to stop the tears.

Noel Corral saw his 89-year-old father, Alfredo, who had tested positive for COVID-19 a week earlier and was moved to a room on the first floor so his family could visit. Corral tapped on the window and told his father he wasn’t alone. He told him not to worry anymore.

“Every day he is getting weaker and weaker,” Corral said, choking up. His father died the day after that visit. Nursing home workers escorted Alfredo’s body outside when the funeral home came to pick him up. “The staff did everything possible to make us feel like we were there with our dad,” he said.

Alfredo Corral’s wife, Tina, 81, visited her husband last week to say goodbye. They were married for 62 years. (Courtesy of the Corral family)

During last week’s visit, Stasik’s son shared small talk and asked questions he knew his mother, who can no longer speak or feed herself, would not answer. “I haven’t seen you in a few days? Anything new and exciting?”

“You have to eat a little more, OK?” Morrow said. “It will make you feel better.”

Stasik occasionally opened her eyes. Once, she wiggled her fingers, as if she were waving. “Grandma’s ’wake!” shouted her 2-year-old granddaughter.

The end of the visits are always the hardest. “We all love you,” Morrow said through the window.

As he drove off in his minivan, he had the same thought he has every time. “Will she be OK the next time I see her?”

Ash Ngu contributed reporting.

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A Quarter of the Residents at This Nursing Home Died From COVID-19. Families Want Answers.