After fighting COVID-19 in their facilities for 18 months, many nursing home operators were frustrated when they were informed in mid-August that a vaccine mandate would be coming into effect only for nursing home workers in the health care space. While that mandate has since been expanded to include all health care workers, the feeling of being singled out has been felt by operators since the pandemic first struck.

“Nobody was helping us and everybody was celebrating the hospitals, and trust me, I love hospitals and I love hospital health care workers, but as they still celebrate the hospitals, we’re still vilified in long-term care,” Joyce Humiston, president and CEO of Colorado-based C&G Healthcare Management, an independent operator with seven SNFs throughout southern Colorado, told Skilled Nursing News.

American Health Care Association President and CEO Mark Parkinson echoed those sentiments during the association’s annual conference last week.

He said that no matter what nursing homes did to prepare for COVID-19 they were going to be blamed just like the Kirkland, Wash., facility, the site of the first COVID outbreak, was.

“[CMS] should have sent in a team of workers to help … but instead they sent in huge survey teams that spent 400 hours of Kirkland’s time on surveys when everyone was trying to figure out what was going on,” Parkinson said. “They collected thousands of pages of documents and they issued over $600,000 in civil monetary penalties [CMPs]. That is when I knew we were in real trouble.”

The average CMP steadily increased from $8,000 in January 2016 to over $16,000 in July 2019, according to a note published over the summer by the National Investment Center for Seniors Housing & Care (NIC). However, once the pandemic hit the average CMS penalties declined to just under $12,000 for SNFs by October 2020.

CMPs are on the rise again, with the average SNF penalties up to $15,000 by April, NIC data shows. Fines collected through per-incident penalties increased more than eight-fold from 2016 to 2020 and were projected to continue to rise in 2021.

Humiston felt that CMPs cause more harm than good at a time when she’s looking for the government’s support.

“I think what was so disturbing to me is instead of the federal government reaching out … it turned into a let’s send surveyors in, CMS gave [the Kirkland facility] over $600,000 in fines. Nobody was helping us,” Humiston said. “There wasn’t enough PPE, no masks, no testing. There was nothing.”

In her view, the long-term care industry has had to fight for every single thing it has gotten since the pandemic first started.

“I feel like we have to beg the government,” she said. “CMS is very proud of themselves for their CMPs but they’re not helping us.”

She said she’s seen CMPs issued due to minor violations such as a nurse aide not wearing a mask correctly or there being masks on the floor.

“I’m not saying what the surveyors found was wrong … but right now we need the support of our government rather than the atmosphere that we have right now, which is one of penalizing and pointing fingers,” she said.

As Dr. Arif Nazir, chief medical officer for Signature HealthCARE, put it during SNN’s Clinical Executive Summit last week, accountability in the nursing home industry needs to evolve beyond carrot and stick systems only.

Humiston felt that CMPs have become “demoralizing” and a “slap in the face” for her facilities as they face obvious financial challenges brought on by fewer hospital referrals and staffing shortages.

A recent AHCA and National Center of Assisted Living (AHCA/NCAL) survey shows that 58% of nursing homes are limiting admissions due to staffing shortages and 78% are concerned about having to shut down their facility due to workforce challenges.

“None of her buildings have been running at a loss, but they’ve had some negative months,” Humiston admitted.

One of her facilities that was issued a CMP had been facing a difficult few months and she said that she applied for financial hardship for the facility.

“It was denied,” Humiston said. “I can show you we were in the hole for three months and I don’t know what else you want to call financial hardship.”

Another problem she has is with the fact that some of CMS’s CMPs limit an operator’s ability to bring on new staff.

“If you get a certain deficiency, they take your nurse aid class away. So here we are, we don’t have enough staff, now we don’t have a nurse aide class and have $30,000/$40,000 CMP in a building that’s never had COVID. It doesn’t make sense,” she said. “I would like to ask President Biden who does he think is going to take care of all these elderly if not us.”