House Hammers Governors Over Nursing Home Admission Orders Amid COVID-19 Pandemic

As a leading House Democrat demands information about the response to COVID-19 in nursing homes from the federal government — and a quintet of top operators — his Republican counterparts have targeted governors whose states required facilities to take in patients with COVID-19.

Rep. Steve Scalise, the Louisiana Republican who serves as the ranking member on the House’s Select Subcommittee on the Coronavirus Crisis, led a group of GOP lawmakers in sending letters to five state governors, all Democrats, asking for detailed information about their COVID-19 policies for nursing homes.

“The ongoing COVID-19 pandemic has disproportionately affected the elderly, especially those living in nursing homes and other long-term care facilities,” the U.S. representatives wrote in the introduction to each letter. “We write seeking information, at a granular level, about the science and information used to inform your decision to mandate nursing homes and long-term care facilities admit untested and contagious COVID-19 patients from hospitals.”

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The letters, dated June 15, were sent to Gov. Andrew Cuomo of New York, Gov. Phil Murphy of New Jersey, Gov. Gretchen Whitmer of Michigan, Gov. Gavin Newsom of California, and Gov. Tom Wolf of Pennsylvania.

In each one, Scalise and his fellow Republican lawmakers asserted that the governors’ response to COVID-19 “likely contributed to the thousands of elderly deaths” in their respective states.

Scalise — along with co-signatories Rep. Jim Jordan of Ohio, Rep. Blaine Luetkenmeyer of Missouri, Rep. Jackie Walorski of Indiana, and Rep. Mark Green of Tennessee — asked for a host of information from each state governor, including:

  • A chronological list of all orders regarding hospital discharges to nursing homes and other senior living facilities
  • Data on nursing home deaths due to COVID-19
  • Communications among the governors’ offices, state health departments, and long-term care facility operators
  • Communications from nursing home administrators to government officials

At the heart of the GOP lawmakers’ objections are controversial edicts, issued early in the coronavirus crisis, that required nursing homes to take patients regardless of their COVID-19 status — which in general meant they could not deny residents because they had either tested positive for the novel coronavirus or had an uncertain status.

The mandates reflect the top concern of state health departments at the time: The fear that a sudden spike in COVID-19 cases among the general public would overwhelm acute-care hospitals, making post-acute beds a vital resource reserved only for those in need of the most urgent attention.

That same urge also manifested itself in the conversion of non-medical facilities — such as New York’s Jacob K. Javits Convention Center and Chicago’s McCormick Place exhibition complex — though such properties were lightly used in the end, as well as federal waivers allowing for reimbursements at non-licensed sites of care.

New York’s Cuomo has borne the brunt of the criticism over the mandatory-admission edicts, although he and Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma have sparred in the media over whether the mandates were in line with federal recommendations.

The Scalise letters point out that CMS guidance from March directed nursing homes to accept residents “that they would normally admit to their facility,” but only if they could meet coronavirus containment recommendations from the Centers for Disease Control & Prevention (CDC).

“Just about the worst possible thing to do is knowingly introduce coronavirus to the most vulnerable populations, yet that’s exactly what several states did by mandating nursing homes accept infected patients,” Walorski said in a statement. “These misguided policies deserve close scrutiny, and the leaders who put them in place have a lot of tough questions to answer.”

In New York, Cuomo asserted that any facility that could not safely handle COVID-19 patients should have contacted the state health department to make alternative arrangements for placement. The Empire State seemingly reversed the mandate in mid-May, and a spokesperson for Cuomo dismissed the Scalise letter as coming from a group of “craven political hacks,” according to the New York Post.

“Nothing can cover for the fact that the federal government failed, specific federal guidelines were issued and followed by more than a dozen states, and that present state law … states that a nursing home shall accept and retain only those residents for whom it can provide adequate care — specifically outlawing nursing homes from accepting patients they cannot care for,” the spokesperson told the publication.

Across the country, shortages of personal protective equipment (PPE), lack of access to testing, and occasionally conflicting guidance from various authorities all conspired to accelerate the spread of the disease in nursing homes — coupled with persistent issues around infection control and the vulnerable nature of long-term care residents.

The letter comes as the Democratic chairman of the House’s coronavirus panel, Rep. Jim Clyburn of South Carolina, issued a similarly exhaustive demand for information from the Centers for Medicare & Medicaid Services (CMS) and five top nursing home providers: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare.

Clyburn criticized CMS’s strategy for COVID-19 in nursing homes, accusing the agency of failing to use its power and instead deferring oversight to state and local authorities.

“CMS has issued guidance for nursing homes, but this guidance has often been unclear, and CMS failed to take adequate steps to ensure that nursing homes comply with its recommendations,” Clyburn wrote. “Deregulation and lax enforcement of infection control violations by CMS — both before and during the pandemic — may have contributed to the spread of the virus.”

The subcommittee chairman also requested sheafs of information from the five providers, including detailed information about their current and projected levels of PPE, total Medicare and Medicaid revenue stretching back to 2018, and all complaints regarding COVID-19 in their facilities.

“We are writing to seek documents and information regarding the deaths of men and women in your company’s nursing homes during the coronavirus outbreak, the conditions that may have contributed to these deaths, and any steps taken to protect residents and workers from further tragedy,” each letter, addressed to each company’s CEO, reads in its introduction.

The Clyburn letters gave CMS and the five operators until June 30 to comply. Scalise requested the data and a remote briefing by this Thursday.

The Select Subcommittee on the Coronavirus Crisis, according to Clyburn’s office, was created in the mold of the Truman Committee, a Senate group launched to root out corruption and profiteering during World War II.

The subcommittee sits under the larger House Oversight Committee, which Scalise said “has broad authority to investigate ‘any matter’ at ‘any time’ under House Rule X.”