As the Delta variant raises new concerns about the safety of the country’s nursing homes, the Biden administration has tacitly reversed a controversial Trump policy that capped fines on facilities that put residents at risk or injured.
The number of deaths in nursing homes, which peaked late last year, has fallen sharply since the introduction of the Covid-19 vaccines. They account for nearly a third of the total death toll from the U.S. pandemic.
However, insufficient staffing, lack of protective equipment, and poor infection control remain concerns in the country’s 14,000 skilled care facilities, proponents and some officials say.
And although 81 percent of nursing home residents are vaccinated, only 58 percent of workers are vaccinated, according to federal data, increasing the risk of outbreaks even in fully vaccinated elderly residents.
As the delta variant is fueling the recent surge in cases, there are signs of a creeping rise in infections in nursing homes, especially among workers. The Centers for Disease Control and Prevention is also investigating the source of outbreaks in Colorado nursing homes where vaccination rates may be low.
The policy of lowering penalties passed by the Trump administration in 2017 instructed regulators at the Centers for Medicare and Medicaid Services to fine a nursing home for any day it did not meet federal standards. The loose policy reduced many penalties to a single fine and effectively lowered amounts from hundreds of thousands of dollars to a maximum of $ 22,000.
The shift – sought by the nursing home industry, a powerful lobby – was part of the Trump administration’s withdrawal of state regulations in many areas of the business.
“It’s the most obvious change the Trump administration has made,” said Toby Edelman, a senior prosecutor at the Center for Medicare Advocacy. “It’s a much, much lower penalty.”
Many of the nursing homes listed for poor infection controls and failing to protect residents from avoidable accidents, neglect, abuse, and bedsores are repeat offenders. Higher fines act as a deterrent and more likely to signal strong enforcement of the rules, Ms. Edelman said.
With little fuss, the Biden government revoked earlier guidelines on the Centers for Medicare and Medicaid Services website in early July, saying it had “determined that the agency should retain the discretion at this point to impose one penalty per day if necessary Circumstances of prior non-compliance. ”Under the new policy, regulators can impose penalties either per day or per instance.
July 29, 2021, 12:22 p.m. ET
Consumer groups challenged the directive in a federal lawsuit in January, arguing that weakening enforcement puts residents at greater risk. The AARP Foundation, which filed the lawsuit together with Constantine Cannon, welcomed the Biden government’s decision. Medicare officials declined to comment, citing the lawsuit.
The industry’s main trading group, the American Health Care Association and the National Center for Assisted Living, said in a statement that the daily fines are “only drawing valuable resources away from an already underfunded industry, especially at an unprecedented time when care” Houses need every support to protect their residents. “
However, critics of Trump’s policy say it is a mere slap on the wrist for nursing homes, even those at greatest risk of harming patients and workers. A year ago, a Washington state nursing home, Prestige Post-Acute and Rehab Center at Kittitas in Ellensburg, had a major outbreak that infected 52 residents and 43 employees, according to a survey conducted for Medicare. Fifteen residents died.
The facility did not meet infection control standards for more than a month, according to the survey, and poorly screened employees who were sick and potentially infected. A cook who reported being symptomatic to her immediate supervisor was instructed to keep coming in while other staff, including a nurse and assistant, continued to work despite the illness. Staff described arbitrary screening attempts.
Understand the state of vaccine mandates in the United States
Federal regulators fined Prestige a total of $ 21,295 in March 2021, using the system of “instantaneous” penalties. If fined a day, the nursing home could have been fined more than $ 600,000.
Maureen McKinney’s husband, known as Buck, was one of the residents who died of the virus in the home in July 2020. “I was just horrified,” she said when she found out about the fine.
Ms. McKinney said she urged state regulators to investigate after witnessing testing delays and failures to isolate sick people, including when her husband’s roommate fell ill. “I’ve decided that I’ll be adamant,” she said.
Prestige Care, which is headquartered in Vancouver, Washington, and operates facilities across the western United States, said it relies on regulators “to adequately set and enforce quoted fines, and we do.” work with them to address the issues ”. they quote. “
The company added, “Losing members of our community is difficult in all circumstances, and the Covid-19 pandemic has only added to our deep grief for the patients lost to the virus.”
When the Trump administration directed regulators to punish nursing homes on a case-by-case basis, the policy became the norm, said Kelly Bagby, a senior attorney with the AARP Foundation. The lower fines were even levied in cases like the Washington state facility, where residents were found to be in so-called “imminent danger,” which threatened serious harm.
“The corrosive effect of this change needs to be underlined,” said Ms. Bagby.