After the New York Times editorial board published a piece criticizing the nation’s response to the effects of COVID-19 on nursing homes, the head of the Center for Medicare & Medicaid Services (CMS) raised several objections on behalf of the Trump administration.
“The administration took early, rapid action: We issued infection control guidance to prepare facilities, restricted visitors, required staff testing and distributed $10 billion for testing, staffing and personal protective equipment,” Seema Verma, the administrator of CMS, wrote in a letter published in the Times on September 11. “We developed a national training program for nursing home staff and directed states to inspect all facilities.”
Verma also touted the requirement that SNFs report COVID-19 infection data to the Centers for Disease Control and Prevention (CDC), and the fact that the government “deployed federal strike teams made up of medical personnel.”
She also reported that each week since May, “at least 90 percent of American nursing homes have reported adequate access to PPE [personal protective equipment], contrary to the editorial’s alarmism.”
A study released in August in the journal Health Affairs reported that more than one in five nursing homes reported “severe” shortfalls of PPE and staffing, with 20.7% of nursing homes with submitted data reporting a week or less of available supplies of PPE during the first reporting period used by the study. At the end of the second reporting period, 19.1% of nursing homes reported shortages of PPE.
“Despite a slight decrease in facilities with any PPE shortage driven by higher availability of gowns, overall PPE and staff shortages have not meaningfully improved since late May 2020,” the researchers wrote.
In the original piece, the paper’s editorial board argued that testing mandates issued by the federal government, and the rules surrounding the use of PPE, needed financial and logistical support, particularly as facilities have to bid against each other to secure equipment.
“The federal government’s attempts to address these problems have been belated and clumsy: unusable gloves and gowns, a testing initiative that didn’t begin until midsummer and that remains far too meager, and unenforceable mandates,” the NYT editorial said, citing widespread reports of equipment that was faulty or defective sent to nursing homes by the Federal Emergency Management Association (FEMA).
Verma specifically defended FEMA, saying the agency’s “supplies satisfied all safety standards.”
She also pushed back on the editorial’s argument that the Trump administration has given the long-term care industry a break on fines, noting that “total fines increased 21% between fiscal years 2016 and 2019” and that the agency has issued millions in fines for infection control violations since the pandemic.
The Times editorial also covered a long-standing issue in the SNF world: low Medicaid reimbursement. The paper argued that federal officials should consider revising rates so they can support salaries above the minimum wage, and changing policies to allow for at least some Medicare coverage of long-term care.
The criticism of Medicaid have some validity, according to Verma, though she put the blame on state priorities — and concluded with a veiled reference to a controversial New York State policy that forbade nursing homes from requiring a negative COVID-19 test for new admissions, by now a hardened partisan talking point for supporters of the Trump administration.
“The editorial’s criticism of Medicaid reimbursement is justified, but many states have expanded Medicaid to able-bodied adults while ignoring nursing home payments, worsening resource shortages,” she wrote. “Finally, the editorial overlooked the outright scandal in its own backyard: governors’ failure to heed the administration’s early call to focus testing and supplies on nursing homes while forcing ill-equipped facilities to admit infectious patients.”