Is CMS putting older adults at increased risk during the pandemic?

Photo: Travis Wise via Flickr

As states struggle to contain cases and deaths from COVID-19, nursing homes and other senior care facilities remain epicenters of outbreaks and fatalities. Yet a rule proposed last year by the Trump Administration would allow facilities to cut back on infection prevention measures, according to recent reports in The New York Times and USA Today.

It seems counterintuitive, but CMS still supports this yet-to-be-finalized proposal. Currently, facilities must employ infection prevention specialists at least part time; they receive specialized training to ensure safety protocols are followed. The rule change would allow nursing homes to hire consultants, who are only required to “spend sufficient time” at the facility. CMS says this would reduce regulatory burden while still ensuring quality care.

CMS should be strengthening, not rolling back infection prevention regulations, said Lindsay Heckler, a supervising attorney at the Center for Elder Law & Justice, in Buffalo, in the USA Today story. “It makes no sense at all – prior to pandemic, but more so now during a pandemic – to roll back any of the necessary infection and control requirements and the federal regulations,” she told reporters Marisa Kwiatkowski and Tricia L. Nadolny.

Even some nursing facility owners question the timing of the proposed rule. “I don’t believe any of us are going to relax our standards on infection control or PPE or any other preventive,” said Carol Silver Elliott, president & CEO of Jewish Home Family, New Jersey and New York, during a recent webinar. The online event was hosted by Leading Age, which represents over 5,000 aging organizations, including nursing homes.

“We are teaching infection control every single week, over and over again,” she said. “At the end of the day, people have to practice good infection control within our walls and within their own lives. That’s the only way we’re going to keep our elders safe.”

Nursing homes need more PPE and more testing so they can better manage patients and staff and isolate anyone at risk. “We are alarmed to see that states are reopening without protecting older adults — even as the virus rages on,” said Katie Smith Sloan, president of LeadingAge. Over half of Leading Age members say their current PPE supplies will last two weeks or less.

According to Kaiser Health News, nursing homes account for at least half of COVID-19 related deaths in at least six states. The article also includes a breakdown of data collection and reporting requirements for a majority of states. The New York Times posted this map of states with confirmed COVID-19 cases in at least one nursing home. Some states, like Georgia, identify nursing homes by name, others, like Virginia, aggregate data but don’t name specific facilities.

This lack of transparency has left families and elder advocates angry and confused. Even if individual families are notified of potential cases, much of the data remains a black hole to the general public. The Arizona Republic and other media in the state are have filed a lawsuit to obtain this data from their department of health services.

In a sobering opinion piece in The Washington Post, Nina Kohn, a law professor at Syracuse University who has spent her career studying older adults’ civil rights, wrote:

“It’s hard to see the lack of protection for nursing home patients — both before and during the coronavirus crisis — as anything except evidence that older people’s lives are deemed less worthy than those of younger people.”

As I recently wrote here, I reached out to CMS to ask when nursing home COVID data will be publicly posted. They told me it would be available “soon.”

I’m still waiting.

Here are some questions to answer when reporting on long-term care facilities and COVID-19:

  • What is the COVID situation like in long term care facilities in your state?
  • Are you able to obtain facility-level data?
  • Where are the hot spots, and why?
  • How are owners/administrators approaching these cases and/or deaths?
  • What are the families told?
  • Were any of these facilities previously cited by inspectors for inadequate infection control protocols? What do local advocates say about the potential relaxation of CMS rules?

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