The Impact of COVID-19 on Nursing Home Residents and Staff and What We Can Do Better

Legislation | March 18, 2021 | by Marsha R. Greenfield

On March 17 the Senate Finance Committee held a hearing entitled “A National Tragedy: COVID-19 in the Nation’s Nursing Homes”. Witnesses addressed the out-sized impact of the pandemic on nursing home residents – more than 170,000 dead, 40% of total deaths – and staff, and made recommendations about how to protect residents and improve quality.

On March 17 the Senate Finance Committee held a hearing entitled “A National Tragedy: COVID-19 in the Nation’s Nursing Homes”. Witnesses addressed the out-sized impact of the pandemic on nursing home residents – more than 170,000 dead, 40% of total deaths – and staff, and made recommendations about how to protect residents and improve quality. It was very clear from the statements by the members of the Committee as well as testimony, that attention must be paid to workforce, improving how we identify, measure and report on quality, and transparency.

Witnesses (written testimony can be accessed here) included

  • Adelina Ramos, a certified nursing assistant from at a for profit nursing home in Rhode Island, representing SEIU, who spoke of her personal experiences caring for residents with Alzheimer’s during the pandemic, short-staffing at her home, low wages and the impact on direct care workers who are predominately women of color, and the challenges of isolation.
  • Denise Bottcher, State Director, AARP Louisiana, addressed AARP’s five priorities for nursing homes, including ensuring adequate personal protective equipment for residents, staff, visitors, and others as needed; prioritizing testing; improving transparency on COVID-19 and demographic data, vaccination rates of residents and staff by facility, and financial accountability; ensuring access to in-person or virtual visitation per federal and state guidelines; and ensuring quality care for residents through adequate staffing, oversight, and in-person access to long-term care ombudsman.
  • Quiteka Moten, MPH, CDP, State Long-Term Care Ombudsman, State of Tennessee, who spoke of the challenges facing the ombudsman program during the lock-down of nursing homes, including inability to investigate complaints and to advocate for residents, especially residents being involuntarily discharged. She recommended developing new strategies to improve staff recruitment and retention; support for ombudsmen as essential to the system responding to nursing home quality; more geri-psych units to improve diagnosis and treatment; and, finally, an established, uniform system for communicating with families during a public health emergency.
  • R. Tamara Konetzka, Ph.D., Louis Block Professor of Public Health Sciences, epartment of Public Health Sciences, The University of Chicago, who has presented on LeadingAge’s daily COVID-19 policy call, spoke about her ground-breaking research on causes and implications of the pandemic on nursing homes, reiterating that “the two strongest and most consistent predictors of worse COVID-19 outcomes are nursing home size, with larger facilities being more at risk, and COVID-19 prevalence in the surrounding community,” as opposed to star rating, staffing, access to PPE, etc. It is important to understand causation if we are to address the tragic impact of COVID on nursing homes, and she pointed out, when asked what could have been done better, was for the public health system to contain the disease. Dr. Konetzka also testified about other areas of research into the impact of COVID-19 – racial disparities, and the importance of adequate staffing as an intervention. Her recommendations included (1) providing rapid assistance at the time of an outbreak, such as the strike teams in the American Rescue Plan; (2) provide greater assistance to large facilities in communities of color that might not benefit from incentives for high performers; (3) accurate and rigorous data collection; (4) infection control practices important but would not have prevented the crisis; (5) increase direct care staffing. Finally, she supported fiscal transparency to understand where public and private dollars are going, and noted the challenges raised by increased ownership by private equity firms.
  • John Dicken, Director, Health Care, United States Government Accountability Office, has testified several times before the committee on reports by GAO on nursing home quality. He testified to the report issued on the 17th by GAO entitled COVID-19 IN NURSING HOMES: HHS Has Taken Steps in Response to Pandemic, but Several GAO Recommendations Have Not Been Implemented. GAO was particularly concerned that HHS has not implemented the recommendations in the Nursing Home Commission Report issued September 2020, despite promising GAO that it would release a plan for implementation; and that HHS has not developed a strategy to collect data from nursing homes prior to May 2020. The Report pointed to declines in deaths and cases since the vaccination program began, improvements in access to PPE, concluding “Effective federal oversight and support for nursing homes are especially critical during times of widespread disease outbreak, as the pandemic has demonstrated.”
  • Dr. David Gifford, Chief Medical Officer American Health Care Association/National Center for Assisted Living, was the final witness. He emphasized how the pandemic is the greatest tragedy to confront residents, family and staff in his long experience, and that “it is critical that we figure out what happened, why it happened, and what we can do to keep it from ever happening again.” He reiterated Dr. Kontezka’s findings relating to community spread, impact of size and funding, and lack of correlation to what we would normally expect (quality, infection control, etc.). He emphasized the 8-point plan put forward by LeadingAge and AHCA, the Care For Our Seniors Act, with its focus on workforce, infection control, quality improvement, improving the current oversight process, and modernizing the nursing home setting.

What we can expect from the questions asked by Senators: lots of interest in transparency and the role of private equity; workforce – staffing, compensation, career paths for direct care workers; racial disparities at all levels (staffing, residents, funding); data for research and to understand the impact of the pandemic; role of federal government moving forward. The committee will hold two more hearings on nursing homes, and we anticipate that these issues will be front and center.

For LeadingAge, our collaboration with AHCA on the Care For Our Seniors Act, coupled with our larger vision of aging and our commitment to be the trusted voice for aging, places us in the forefront of this need to address the impact of the pandemic and how we move forward positively.