The current data indicate that the rate of booster shots administered to nursing home residents is comparable to the national average for adults over the age of 65. It also shows the rate of booster shots administered to nursing home staff lags behind the national average of those over the age of 18 (for staff).

 As the CDC has reported, receiving a booster dose is the most effective way to avoid serious illness from COVID-19, including the Omicron variant. By posting these data, CMS is highlighting this information for the public and other stakeholders to help increase the number of nursing home residents and staff who obtain a booster shot.

CMS is also urging facilities to communicate with their fully vaccinated staff members and residents about the importance of staying up to date with COVID-19 shots to protect the vulnerable nursing home population. The new booster data will be displayed along with the other COVID-19 vaccination data already included on the Medicare.gov Care Compare website.

 The CMS Omnibus Health Care Staff Vaccination rule requires that, by the Phase 2 implementation dates, (PDF) staff be fully vaccinated, meaning individuals have completed their primary vaccination series, which is two weeks after a person has received their dose of a single dose vaccine, or two weeks after the second dose of a two-dose vaccine. CMS requires that nursing homes educate their residents and staff and offer the COVID-19 vaccine, which includes the booster, but does not currently require booster doses. CMS is working with long term care (LTC) providers to identify strategies and partnerships to obtain and administer COVID-19 vaccines and boosters for residents and staff. These efforts include working with the LTC community to identify and promote best practices for increasing vaccination rates. CMS continues to analyze vaccination data for residents and staff that nursing homes submit to the Center for Disease Control and Prevention’s (CDC’s) National Health Safety Network (NHSN) and deploys its Quality Improvement Organization (QIO) teams to assist nursing homes with low rates of vaccinations and disparities in access to vaccinations. LTC providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, including boosters, either in the local community or on-site.

Medicare and Medicaid-certified nursing homes have been reporting COVID-19 data in the CDC’s NHSN since May 2020. Providing the booster information on the consumer-friendly Care Compare site is one more tool that allows people to have a more comprehensive understanding of the environment they live in or are considering for themselves or a loved one.

The vaccination section is located below the Star Ratings on Care Compare. To view vaccination rates, select ‘View COVID-19 Vaccination Rates’.  The vaccination and booster data posted on Care Compare is updated every other Thursday with the most recent available data. For example, on Thursday, February 17, the vaccination and booster data will be updated with data reported in NHSN as of February 6. The display is delayed by a week and several days because of the validation and posting process. Updates will continue every other week.

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As part of its commitment to improve transparency and help families and caregivers find the best nursing home care for their loved ones, the Centers for Medicare & Medicaid Services (CMS) is now posting data on COVID-19 vaccine booster shots administered to nursing home residents and staff on the Medicare.gov Care Compare website. The data will show resident and staff booster rates at the facility level and will include national and state averages.

The current data indicate that the rate of booster shots administered to nursing home residents is comparable to the national average for adults over the age of 65. It also shows the rate of booster shots administered to nursing home staff lags behind the national average of those over the age of 18 (for staff).

 As the CDC has reported, receiving a booster dose is the most effective way to avoid serious illness from COVID-19, including the Omicron variant. By posting these data, CMS is highlighting this information for the public and other stakeholders to help increase the number of nursing home residents and staff who obtain a booster shot.

CMS is also urging facilities to communicate with their fully vaccinated staff members and residents about the importance of staying up to date with COVID-19 shots to protect the vulnerable nursing home population. The new booster data will be displayed along with the other COVID-19 vaccination data already included on the Medicare.gov Care Compare website.

 The CMS Omnibus Health Care Staff Vaccination rule requires that, by the Phase 2 implementation dates, (PDF) staff be fully vaccinated, meaning individuals have completed their primary vaccination series, which is two weeks after a person has received their dose of a single dose vaccine, or two weeks after the second dose of a two-dose vaccine. CMS requires that nursing homes educate their residents and staff and offer the COVID-19 vaccine, which includes the booster, but does not currently require booster doses. CMS is working with long term care (LTC) providers to identify strategies and partnerships to obtain and administer COVID-19 vaccines and boosters for residents and staff. These efforts include working with the LTC community to identify and promote best practices for increasing vaccination rates. CMS continues to analyze vaccination data for residents and staff that nursing homes submit to the Center for Disease Control and Prevention’s (CDC’s) National Health Safety Network (NHSN) and deploys its Quality Improvement Organization (QIO) teams to assist nursing homes with low rates of vaccinations and disparities in access to vaccinations. LTC providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, including boosters, either in the local community or on-site.

Medicare and Medicaid-certified nursing homes have been reporting COVID-19 data in the CDC’s NHSN since May 2020. Providing the booster information on the consumer-friendly Care Compare site is one more tool that allows people to have a more comprehensive understanding of the environment they live in or are considering for themselves or a loved one.

The vaccination section is located below the Star Ratings on Care Compare. To view vaccination rates, select ‘View COVID-19 Vaccination Rates’.  The vaccination and booster data posted on Care Compare is updated every other Thursday with the most recent available data. For example, on Thursday, February 17, the vaccination and booster data will be updated with data reported in NHSN as of February 6. The display is delayed by a week and several days because of the validation and posting process. Updates will continue every other week.

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WASHINGTON (AP) — Deaths among Medicare patients in nursing homes soared by 32% last year, with two devastating spikes eight months apart, a government watchdog reported Tuesday in the most comprehensive look yet at the ravages of COVID-19 among its most vulnerable victims.

The report from the inspector general of the Department of Health and Human Services found that about 4 in 10 Medicare recipients in nursing homes had or likely had COVID-19 in 2020, and that deaths overall jumped by 169,291 from the previous year, before the coronavirus appeared.

“We knew this was going to be bad, but I don’t think even those of us who work in this area thought it was going to be this bad,” said Harvard health policy professor David Grabowski, a nationally recognized expert on long-term care, who reviewed the report for The Associated Press.

“This was not individuals who were going to die anyway,” Grabowski added. “We are talking about a really big number of excess deaths.”

Investigators used a generally accepted method of estimating “excess” deaths in a group of people after a calamitous event. It did not involve examining individual death certificates of Medicare patients but comparing overall deaths among those in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus surge last spring. It does not attribute a cause of death but is seen as a barometer of impact.

Death rates were higher in every month last year when compared with 2019. The report documented two spikes with particular implications for government policy and for protecting the most vulnerable in future outbreaks of life-threatening illnesses. In April of last year, a total of 81,484 Medicare patients in nursing homes died. Then eight months later, after lockdowns and frantic efforts to expand testing — but before vaccines became widely available — nursing home patients accounted for a staggering 74,299 deaths in December.

“This is happening long after it was clear that nursing homes were particularly vulnerable,” said Nancy Harrison, a deputy regional inspector general who worked on the report. “We really have to look at that. Why did they remain so vulnerable?” Federal investigators are still drilling down to try to document the chain of causes and effects.

Responding to the report, the Centers for Medicare and Medicaid Services said that nearly 80% of nursing home residents and more than 55% of staff are now vaccinated, and the agency is working to protect health and safety. CMS sets standards for nursing homes.

The two main nursing industry groups, the American Health Care Association and LeadingAge, said the grim statistics reflect the consequences of society and government not placing a high enough priority on the needs of frail elders. That “showed once again how ageism can result in policies that treat older people as expendable,” said Katie Smith Sloan, president of LeadingAge, which represents nonprofit homes.

Tuesday’s report was the most comprehensive yet from the government because it included statistics for the early part of last year, during the initial coronavirus surge. Medicare did not require nursing homes to report COVID-19 cases and deaths occurring before May 8, more than four months into the pandemic year.

In another new finding, the report showed that cases and deaths among Asian American patients tracked with the more severe impacts seen among Blacks and Latinos. Indeed, Asian Medicare enrollees in nursing homes saw the highest increase in death rates, with 27% dying in 2020 compared to 17% the previous year. For whites, the death rate grew to 24% in 2020 from 18% in 2019, a significant increase but not as pronounced.

Death rates for Hispanic and Black patients were 23% last year, up from 15% in 2019.

The inspector general’s office based its analysis on Medicare billing data. It also included patients in Medicare Advantage plans sold by private insurers. Although Medicare does not cover long-term care, the vast majority of nursing home patients are elderly, and Medicare does cover their medical needs. The report included both patients who live in nursing homes as well as those temporarily at a facility for rehabilitation.

Health economist Tamara Konetzka of the University of Chicago, who also reviewed the report for AP, said building an estimate from individual death certificates would have faced another set of challenges. Especially in the first wave of the pandemic, many who died would not necessarily have been tested for COVID-19, for example.

“By looking at excess deaths you can get away from some of the measurement issues and say how much worse things were in 2020 than in 2019,” explained Konetzka, who has testified before Congress on the impact of COVID-19 in nursing homes.

The inspector general’s findings about Asians highlight a riddle for researchers, said Konetzka. The reasons for higher cases and deaths among Blacks, Hispanics and Asians may not necessarily be tied to race and ethnicity. Instead, minority patients may be clustered in homes located in communities with more severe outbreaks.

The report also found that low-income nursing home patients covered by Medicare and Medicaid together were much more likely to have gotten COVID-19. The infection rate for that group reached 56%, and 26% died.

Some states suffered worse impacts. By the end of December more than half of the Medicare patients in nursing homes in Connecticut, Illinois, Louisiana and New Jersey had or likely had COVID-19.

Although nursing homes locked down in March of last year, government efforts to help were haphazard. The industry complained of chronic shortages of protective gear, including basics like masks and gowns.

The Trump administration initially delegated responsibility for testing to states before belatedly marshaling more federal resources. HHS later laid the groundwork for vaccinations under the Trump administration, and the Biden administration followed through. As vaccination rates rose, nursing home cases plummeted, allowing facilities to again permit family visits.

The country can’t move on yet, said deputy inspector general Harrison. “Hopefully, COVID will go away,” she said. “But once that happens, there will always be infectious diseases, and we all need to ask ourselves what we can do to protect vulnerable nursing home residents going forward.”

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Jones was a case manager for a resident at Brookdale Senior Living in Riverside, east of Los Angeles, in 2017 when she failed to properly assess an ulcer on the woman’s right heel, prosecutors said.

“As a result, a Plan of Care was never developed and the ulcer worsened into a wound that required the resident to undergo emergency surgery to her right foot, which had become septic and gangrenous,” the attorney general’s office said in a statement. Jones also failed to notify a doctor and the woman’s family that her heallth was declining as a result of the lack of care and she eventually died, prosecutors said.

“Elder abuse does not always come in the form of a physical attack. It can result from utter neglect and lack of proper care, as we allege in the case of Emily Jones,” Attorney General Xavier Becerra said in his office’s statement. “Assisted living residents are a vulnerable population all too often victimized by acts of neglect and improper care.”

“Brookdale Senior Living does not have a record of employing anyone with this name and date of birth, including at its former Brookdale Riverside location, so we cannot provide a comment on this case,” said a statement from Tennessee-based Brookdale Senior Living.

“With that being said,” the statement added, “Brookdale takes the safety and wellbeing of our residents very seriously and this type of conduct or behavior by an individual at Brookdale would never be tolerated under any circumstance.”

AP News • Contributed

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Nursing homes have become ground zero in the coronavirus disease 2019 (COVID-19) pandemic, with outbreaks causing high rates of illness and death among vulnerable residents living together in close quarters.

That’s why the Centers for Medicare & Medicaid Services (CMS) has taken a series of aggressive actions over the last several months to protect nursing home residents against the spread of this new coronavirus.

We understand how terrifying these outbreaks are for nursing home residents and their families, and how essential it is for them to know what is going on inside nursing homes.

So, we acted accordingly. Beginning in May, CMS required nursing homes that participate in Medicare and Medicaid to inform residents, their families, and their representatives within 12 hours of when a single confirmed COVID-19 case is reported, or when three or more residents or staffers develop respiratory symptoms within 72 hours of each other.

Residents, families, and their representatives also must be given weekly updates or be told by the end of the next day each time a subsequent COVID-19 case is confirmed and/or three or more residents or staffers develop respiratory symptoms within 72 hours of each other.

Nursing homes also must include information about what actions they’re taking to prevent or reduce the risk of transmission, and inform residents and their families about how those actions will change normal operations in the nursing home.

But we didn’t stop there. We also developed a system so the public could quickly and easily access data reported to the Centers for Disease Control and Prevention on the prevalence of COVID-19 at every CMS-certified nursing home in the country. This information is now publicly available in a searchable database that allows people to look up individual nursing homes and see how many COVID-19 cases and deaths, among both residents and staffers, have been reported there. This new system of national reporting for nursing homes is unprecedented.

The data can be found at our Nursing Home Compare website. (See the “Spotlight” section for the link.) CMS will update the data weekly and take enforcement action against nursing homes that do not report the required information. About 15,400 nursing homes nationwide are certified to accept people enrolled in Medicare or Medicaid.

The Nursing Home Compare website features a Five-Star Quality Rating System to rate nursing homes, with one star indicating the lowest overall quality of care and five stars indicating the highest. Early analysis of reported COVID-19 data shows that facilities with a one-star health inspection rating were more likely to have larger numbers of COVID-19 cases than facilities with a five-star health inspection rating.

In March, CMS and the states suspended standard inspections of nursing homes and began looking specifically for violations of infection control and prevention rules. We also provided a focused infection-control survey tool for nursing homes to do self-assessments to ensure they were taking necessary steps to protect their residents against COVID-19.

CMS is providing additional support and technical assistance to low-performing nursing homes through its Quality Improvement Organizations. QIOs are composed of health quality experts and clinicians with experience in helping healthcare providers to improve the quality of care for people with Medicare. CMS directed QIOs to focus their efforts on providing education and training to all nursing homes in the country.

Finally, CMS recently provided state and local officials with recommendations on phased re-openings of nursing homes in their areas, including when and under what circumstances to allow visitors.

Visits from family and friends are generally restricted at nursing homes now to help control and prevent the spread of the virus, except in compassionate care situations. We understand how hard it is to be separated from loved ones, especially elders, for so long.

But as nursing homes meet certain criteria, they may be in a position to allow visitors again. Our guidelines recommend that visitation be allowed in Phase 3 with screening and additional precautions, including social distancing and hand hygiene (e.g., use of alcohol-based hand rub upon entry). We also recommend that all visitors wear a cloth face covering or facemask for the duration of their visit.

You can read more about the reopening guidelines here:

https://www.cms.gov/files/document/qso-20-30-nh.pdf-0

Be assured that CMS will use every tool at its disposal to protect the health and safety of America’s nursing home residents.

-Seema Verma

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THE CORONAVIRUS FILES

The coronavirus pandemic has exposed the chasms, the fissures, the cracks in many American institutions. Nowhere, though, are they more apparent than in the nation’s arrangements for long-term care — specifically, in its nursing homes, where some 1.4 million people, mostly women, live out the rest of their days.

The virus has exposed what advocates for better treatment and families of loved ones in nursing facilities have known for years. Care is often substandard, infection control sometimes non-existent, living space overly crowded, staff members too few to keep residents safe, and a regulatory system that looks good on paper but too often looks the other way when politics and lobbying trump good enforcement and resident safety.

In May, the Government Accountability Office released a damning report showing that only 18% of the country’s nursing homes had no deficiencies for infection control and prevention in one or more of the years from 2013 through 2017, before the virus hit. That’s a grim indictment of how America cares for its most vulnerable elders. “It is a policy failure based on moral negligence,” said Larry Polivka, executive director of the Claude Pepper Center at Florida State University. “We need to understand more clearly this moral failure that is responsible for the crappy long-term care system we have built over the decades. It comes from not caring enough about older people when they need help.”

“What’s happening in nursing homes is shocking but not surprising. It was a catastrophe waiting to happen.” — Howard Gleckman, Urban Institute

Over the past few weeks, I watched momentum build for police reform and swift action taken in New York state by Gov. Andrew Cuomo, who told his TV audiences it was the time to “seize the moment” and enact significant police reforms by taking advantage of a political opportunity that doesn’t come very often. At the same time America’s nursing home tragedy was unfolding. Could the time be right for seizing the moment and enacting nursing home policies that would result in better, more humane care and fewer deaths next time a deadly pathogen strikes?

“What’s happening in nursing homes is shocking but not surprising. It was a catastrophe waiting to happen,” said Howard Gleckman, a senior fellow at the Urban Institute. But will the media continue digging after these early waves of deaths to show why better care is so crucial? Or will the coverage disappear when the shocking headlines subside?

I have been struck by the number of news outlets that have covered America’s nursing home horror show since the beginning of April. That may be the most attention given by the media to poor quality care ever, but certainly in the last few decades. Journalists have done their jobs well during COVID-19, despite obstacles and turmoil in their own newsrooms, bucking a long-running bias from editors against publishing too many stories about old people. One reporter told me when she was covering nursing homes before the pandemic that it was akin to pushing a giant boulder uphill. “As you know,” she said, “It’s hard to get news organizations to commit a sustained focus on nursing homes most of the time.”

Despite furloughs, Detroit Free Press reporters have managed exemplary reporting about the state’s lack of transparency and discrepancies between state and federal data. Reporters at the Palm Beach Post and Miami Herald chronicled the failures of the administration of Gov. Ron DeSantis to protect nursing home patients, even as the state refused to release the crucial numbers for weeks. The Florida news media threatened legal action before DeSantis relented. In Arizona, the Arizona Republic (also hit with furloughs) had to file a lawsuit to force information about cases from the state health department. The paper lost, but the governor has instructed nursing homes to release the numbers of infections and deaths to residents their families and anyone who has applied to live in that facility. Not exactly the best solution, but a start nevertheless.

In Boston, the Globe and other news outlets filed public records requests to get information about nursing home deaths that the state had been withholding from families and residents for months. Yet the nursing home team still managed to produce stories like this one. The nursing home team has been dismantled and one of the reporters transferred to the higher education beat.

Where should reporters go from here? To help answer that question, I rang up 11 of the country’s top experts in long-term care to assess why we’ve had such bad outcomes among nursing home residents and what we as a country can do.

Other outstanding reporting points to the need for changes in the way the way nursing homes are staffed and residents cared for. Reuters published a fine, thorough investigative report by Chris Kirkham and Benjamin Lesser that focused on serious staffing problems at a Life Care home in Massachusetts as well as the Hammonton Center for Rehabilitation and Healthcare in New Jersey. Lisa Desjardins of The PBS News Hour also examined poor staffing in a comprehensive piece. Dylan Scott at Vox gave a good overview of why nursing homes have been so vulnerable during the pandemic. One of his conclusions: The U.S. spends a lot less on long-term care than other nations, a key failure of U.S. policy that Vox and others need to explore further. The Louisville Courier Journal reported on the results of the state’s inspection reports conducted this spring, pointing out implausible results for readers to ponder. The inspections examined 154 facilities out of 285 in the state, including some with highest numbers of cases. The state inspectors, however, cited just two facilities for infection-related deficiencies. Both cases involved problems with employees not wearing facemasks.

All this good reporting raises the question: Where should reporters go from here?

To help answer that question, I rang up 11 of the country’s top experts in long-term care to assess why we’ve had such bad outcomes among nursing home residents and what we as a country can do, especially over the next 10 years when the first of baby boom generation reaches age 85 and are likely to need institutional or in-home care. Their suggestions offer a kind of road map for coverage as the nursing home saga continues.

Staffing is paramount, said all the experts I talked to. Too few staff figured into most of the tragedies this spring. The problem is hardly new. The Nursing Home Reform Act of 1987 required nursing homes to have “sufficient staff” to meet the needs of residents, and one RN director of nursing on duty eight hours a day, seven days a week, and a licensed nurse on evening and night shifts. But this standard has been criticized as inadequate. This minimum has not changed and advocates believe it is too low. “In over 30 years we haven’t been able to get a meaningful standard passed,” said Charlene Harrington, professor emeritus at UCSF’s School of Nursing. “One nursing home can make as much as $1million a year by understaffing.” It’s hardly surprising that when nursing home staff at homes across the country came down with COVID-19 and had to quarantine, residents were neglected. It’s also no secret that staff in many facilities is underpaid. All the experts I talked to suggested higher salaries were a key to better care.

Ownership, especially by for-profit chains, needs some careful scrutiny. Reporters would do well to investigate the ownership of facilities in their communities. Ownership is typically complex, involving complicated financial arrangements between nursing homes and service providers. “We don’t have good financial regulation,” Harrington says. “We know from research that the worst nursing homes have more Medicaid patients, poor quality and less staff, and are for-profit.”

Federal payment sources need a reexamination. The U.S. spends about 1% of GDP on long-term care while other developed countries spend between 2% and 4% percent. “One way or another we have to put more money in the system,” said Gleckman from the Urban Institute. A better-funded system would allow us to get rid of double rooms and four to a room, and allow for better common spaces and modernized facilities. Much of the money is still going to traditional nursing homes, even though older people and their families typically prefer home and other community-based elder living arrangements. Those are generally funded through Medicaid waivers, and there are long waits in many states for these services.

Waiver programs may be under even greater stress right now because of looming shortfalls in state budgets. Is there a better way to fund such programs that most families prefer?

Lax regulation by the Centers for Medicare and Medicaid Services (CMS) has been a major story only recently, but it has been a problem for years. Recent coverage, like the reporting done by the Detroit Free Press showing discrepancies between and state and federal stats on nursing home deaths, and the infection data examined by Louisville Courier Journal, point to regulatory stories waiting to be written.

Experts raised one overarching question. Why does the federal payment system treat people needing nursing home care differently from patients needing gallbladder surgery? Why, in other words, do families have to impoverish themselves before Medicaid pays for their care, while Medicare pays for gallbladder surgery and most other care needed by those same people without requiring them to “spenddown” and use up most of their assets first? Why isn’t nursing home care financed as social insurance like hospital care is financed under Medicare?

“There’s still general acceptance that it’s the family’s responsibility to take care of their family members,” said Judy Feder, former dean of the Georgetown’s Public Policy Institute. “We’re still relying on family care and underpaid workers to give the care, and that’s why this is such a wasteland of inattention.”

Journalists who’ve covered the pandemic’s nursing home story so well might just begin to change that narrative. The horrors are so immense; the numbers of deaths are so high. The future care for all Americans is at stake.

-Trudy Lieberman

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