House Briefing: COVID-19 in Nursing Homes ‘Blasted the Doors Open of a System that Was Already Failing’

The COVID-19 pandemic has devastated the nursing home sector and exposed endemic flaws in the long-term care system in the U.S., several witnesses testified before members of the House of Representatives’ Oversight Committee in a video briefing held Thursday.

The Select Subcommittee on the Coronavirus Crisis heard testimony from a range of witnesses on the effect of the pandemic on nursing homes in the U.S., including a certified nursing assistant (CNA) from Chicago, a professor at Harvard Medical School, and the family member of a resident who passed away due to COVID-19.

Though nursing homes face an array of challenges in combatting COVID-19, including a shortage of personal protective equipment (PPE), and must improve their practices in communication and benefits for workers, the need to improve the infrastructure of the long-term care system was a common theme among the witnesses.

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“The only thing COVID did was rip the doors open,” Chris Brown, a CNA working in Chicago, told the committee, stressing the fact that staffing shortages and PPE shortages were a problem in nursing homes prior to the pandemic. “It blasted the doors open of a system that was already failing.”

The toll COVID-19 has taken on nursing homes has been mounting steadily ever since the first outbreak at the Life Care Center of Kirkland in Kirkland, Wash., but the exact numbers and estimates have varied by source. The federal government’s early figures indicate that almost 32,000 have died from COVID-19, with more than 88% of facilities reporting as of June 4.

Numerous reports of shortages of testing and PPE across the country have led to a patchwork response, with containment strategies for COVID-19 varying from state to state.

That has led to devastation for nursing homes across the U.S., according to Dr. David Grabowski of Harvard Medical School.

“Much of the negative impact of COVID in nursing homes could have been avoided. However, rather than prioritizing the safety of the 1.3 million individuals who live in nursing homes and the staff that care for them, we failed to invest in testing, PPE and the workforce,” Grabowski told the subcommittee in his opening remarks. “We allowed a problem that could have been contained to grow into a national crisis. Now that we are here, it is time for the federal government to make the necessary investment to mitigate the spread of COVID across all U.S. nursing homes.”

COVID-19 outbreaks in nursing homes tend to be correlated to racial demographics and location, among other factors, according to early research — but not ratings or profit status.

The subcommittee members took turns — mostly along party lines — pointing at different causes to blame for the severity and scope of COVID-19’s impact on the nursing home setting, including the lack of a strong federal response, the low wages paid to the frontline workers in nursing homes, and the orders by various governors mandating that nursing homes accept COVID-19 patients.

New York Gov. Andrew Cuomo and Michigan Gov. Gretchen Whitmer — both Democrats — came under particular criticism for orders mandating that nursing homes take in COVID-19 patients; the March 25 order in New York requiring that SNFs take in patients without requiring a negative COVID-19 test was reversed in May.

Rep. Carolyn Maloney, a New York Democrat, pushed back on the “unfounded attacks” on the way New York handled the COVID-19 crisis, emphasizing the nationwide scope of the pandemic and the fact that nursing home residents have died in all states.

“This is not a red-state or a blue-state problem; it is a national problem,” she said. “And we urgently need a national solution.”

Grabowski agreed with Maloney on the need for federal leadership and support for securing testing and PPE into nursing homes. Though the Centers for Medicare & Medicaid Services (CMS) issued recommendations on reopening nursing homes that include aggressive testing plans including weekly testing for nursing home staff, it largely left states to decide how to execute those recommendations.

It’s the opposite of what the federal government should be doing now, according to Grabowski.

“I’ve actually called it non-guidance guidance, in that there was no teeth or dollars behind it,” he told Maloney when asked if the guidance was sufficient. “If you don’t put logistics, if you don’t put costs into this guidance, if it’s simply a theoretical set of guidance for the nursing homes and for the states, it’s not actually going to happen. And we’ve seen incredible variation in what states are doing.”

This includes Ohio using the National Guard, New Jersey requiring testing while pushing the logistics of testing to SNFs, and Alabama “not doing anything in terms of these requirements.”

Nursing homes in several states cannot secure testing fast enough, Grabowski said, and the federal government should have put testing in place and paid for it, given how many workers have fallen between the cracks in terms of having their COVID-19 tests covered, he added.

That means the federal government should pay for the tests and ensure testing in all nursing homes, he said.

“Nursing homes have been underfunded for years and have struggled with staffing and other issues prior to COVID,” Grabowski said in his opening remarks. “In many respects, COVID is, to quote a colleague, ‘a crisis on top of a crisis.'”

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