COVID-19 in Nursing Homes Became a Partisan Football. Leaders Must Accept That Crisis Had Countless Causes

In 1968, Japan Air Lines Flight 2 from Tokyo touched down on its belly in San Francisco Bay, a little more than two miles short of the airport.

Thankfully, everyone on board survived the unintentional landing in the bay’s shallow waters. The NTSB eventually determined that the pilots failed to follow the proper procedures for an instrument landing in San Francisco’s notoriously foggy weather, partially due to their unfamiliarity with specific aircraft systems.

But when asked by federal investigators about what happened, captain Kohei Asoh reportedly gave a much more succinct explanation for the crash.

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“As you Americans say, I [screwed] up,” the pilot said, actually using a slightly stronger word to indicate the depths of his mistake.

The captain’s frank admission of fault, and willingness to publicly own up to his error with a touch of self-deprecating humor, has endured in analyses of crisis management and professional mishaps for more than a half-century as the “Asoh defense.”

Far from going down in history as a bungling pilot who nearly killed a plane full of people, Asoh’s difficult choice to accept full responsibility for his actions earned him immortality as an oft-cited case study of how good leaders admit when they’ve made mistakes — even potentially catastrophic ones — without trying to pass the buck.

Asoh’s honesty also may have helped him save his job: After a temporary grounding for more training and a demotion from captain to first officer, he returned to the skies and continued safely flying cargo routes until he reached retirement age.

As a chorus of voices tries to sort out blame for our current COVID-19 catastrophe, America’s elders, and the people who care for them in nursing homes, could use a lot more Asoh defenses from leaders around the country.

Instead, they can only watch as COVID-19 deaths in nursing homes become a political football for Democrats and Republicans to spike in each other’s faces ahead of a presidential election in the fall, with lawmakers seemingly more interested in scoring points against the other team than getting to the root causes of the disaster.

Perhaps the highest-profile example of this dynamic has been the public sparring between New York Gov. Andrew Cuomo and Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma, who each have blamed the other for a controversial state order requiring nursing homes to accept COVID-19 patients. Cuomo says his state was just following federal guidelines; Verma has said the federal guidelines recommended no such thing.

But a little more quietly in Washington, away from the airwaves, this past week brought the most stark example of the partisan divide in deriving lessons from the COVID-19 crisis in nursing homes: the dueling letters from the House Select Subcommittee on the Coronavirus Crisis.

Rep. Jim Clyburn, the Democratic chair of the subcommittee, issued a series of blistering letters demanding detailed information from the Centers for Medicare & Medicaid Services (CMS) and the CEOs of five prominent nursing home chains: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare.

In short, Clyburn argued that CMS had failed elders by leaving guidance largely up to the states and the nursing home operators themselves to interpret, while also taking shots at the industry.

Across the aisle, subcommittee ranking member Rep. Steve Scalise and four of his GOP colleagues wrote a similarly scathing set of letters to five governors — all Democrats — asking for an explanation of their states’ controversial orders to require facilities to take COVID-19 patients, all but directly blaming them for the death counts in their jurisdictions.

Both sides put out splashy press releases, portraying themselves as the sole protectors of the nation’s elderly against the big, bad federal government, state governors, or nursing home lobby — depending on which one you read. Scalise’s statement even emphasized that the Democrats on the subcommittee declined to sign onto his letters.

This partisan bickering belies a fundamental reality about COVID-19’s impact on nursing homes: Few things in life are truly binary, and more than one thing can be true at the same time.

This concept seems to be lost on many leaders who have weighed in on the coronavirus crisis in nursing homes.

If you’re in the Trump administration or one of its allies, it’s the fault of bumbling state governors. If you’re a Democratic state governor, it’s the fault of the Trump administration. If you’re an outspoken resident advocate, it’s solely the fault of the nursing homes, and no amount of material support could have changed their incompetence.

So, for the record, let’s put it in writing. The federal government should have developed a specific pandemic plan and more effectively distributed resources to nursing homes ahead of the crisis, as early as January or February, before it reached the point of no return.

FEMA’s attempt to distribute PPE to operators, already nowhere near up to the insatiable demand for masks and gowns, has descended into something like a dark comedy, with operators receiving only fractions of what they were promised in unmarked boxes — along with masks clearly not approved for medical use.

State governments should have more strategically managed their often substantial emergency resources. There is no reason that people with the novel coronavirus should have been sent to nursing homes instead of to the vast — and, ultimately, vastly underutilized — temporary acute-care centers built at sites such as the Jacob K. Javits Convention Center in New York City and Chicago’s McCormick Place exhibition hall.

Early COVID-19 hotspots focused on hospital capacity at the expense of long-term care, perhaps revealing where elder care typically ranks on most officials’ list of concerns.

Long before the spring of 2020, the federal and state governments should have developed a more robust and equitable funding mechanism for this care than the taped-together landscape of Medicare, Medicaid, and private-pay sources that exist today. Simply put, Medicaid was never designed to be the primary funding source for nursing homes, and it certainly shouldn’t be going forward in its current form.

It’s true that in general, the media holds nursing homes to a much higher — and almost always by default critical — standard than any other health care setting.

But that doesn’t mean that nursing homes don’t have problems of their own. The subset of operators that put profits over resident care should obviously never have been allowed to remain in business, and any providers deemed to have made deliberately negligent decisions during the crisis should face consequences.

The industry as a whole should continue striving toward the highest standards achievable, with the full financial support of a government that primarily funds it; any increases in Medicaid or Medicare funding should be dedicated solely toward beefing up infection control protocols, developing detailed pandemic preparedness strategies, significantly raising frontline caregiver salaries, and performing capital improvements to aging physical plants.

Lest you think I’m taking the opportunity to lash out at everyone, allow me to invoke the Asoh defense for myself. I’m not in a position of power over any policy or operational decisions, but I should have accepted earlier that this crisis would last longer than a few weeks in long-term care, and been more eager to cover the issue in January and February.

As I read the early news reports coming out of China, I didn’t want to incite panic or appear to overhype something that, at least in the early going, seemed to be isolated and distant; for that reason, SNN didn’t publish a story on COVID-19 until February 29, after the first reports of the outbreak in Kirkland, Wash. that would serve as ground zero for the eventual crisis.

By the time I ran a piece calling on operators to realize that there would be no excuses for preventable lapses in care, it was March 15 — three days after the NBA suspended its season, a watershed moment that triggered the wave of lockdowns and closures that eventually spread nationwide. I was already under a mandatory order to work from home when I pressed “publish,” and the cascading series of failures was in deadly motion.

As we Americans say, I [screwed] up.

I wasn’t so naive to think that this wouldn’t become a political issue. As both a trained journalist and a regular person with political beliefs, it can be challenging to cover the post-acute and long-term care industry from a strictly “neutral” perspective, since the mechanisms that drive it are inherently political: Medicare, Medicaid, state and federal regulations, labor issues, and managed-care models are all shaped by the political winds out of Washington and state capitols.

I vote, I donate money to national and local political candidates whose policies I want to see implemented, and I take a vested interest in electoral and organizational politics.

But I do my best every day to present a balanced look at the issues in long-term and post-acute care, because ultimately I know my job is to keep stakeholders in the industry informed of the trends and policies that will affect them — and, in turn, hopefully help them provide better care to our most vulnerable neighbors.

That’s why it’s so distressing to see tens of thousands of deaths in America’s nursing homes treated like nothing more than the latest inflammatory presidential tweet or hot-mic gaffe, a cudgel to whack the members of the other side and inflict as much damage as possible as we careen toward another divisive summer and fall campaign season.

As I’ve said repeatedly throughout this crisis, we will never avoid a repeat of the devastating spring of 2020 unless we openly admit where mistakes were made, work together to define what justice looks like for those who died, and implement real changes based on science and research.

We can’t do that by pointing fingers at the nearest target with the wrong letter next to his or her name. Yes, nursing home funding and regulation are political issues that require political solutions — but everyone needs to come to the table in good faith, with the shared goal of preventing harm and establishing a better way forward.

If we all invoke the Asoh defense for the things that we could have done better, we can start the process for real.