Senate Democratic Leadership issues report on the Administration’s response to COVID-19 in nursing homes

Legislation | July 01, 2020 | by Marsha R. Greenfield

A report entitled COVID-19 IN NURSING HOMES How the Trump Administration Failed Residents and Workers was released on July 1, 2020 by Senators Bob Casey (D-PA), Ranking Member of the Senate Aging Committee, Gary Peters (D-MI), Ranking Member of the Homeland Security and Government Affairs Committee (HSGAC), and Ron Wyden (D-OR), Ranking Member of the Finance Committee.

A report entitled COVID-19 IN NURSING HOMES How the Trump Administration Failed Residents and Workers was released on July 1, 2020 by Senators Bob Casey (D-PA), Ranking Member of the Senate Aging Committee, Gary Peters (D-MI), Ranking Member of the Homeland Security and Government Affairs Committee (HSGAC), and Ron Wyden (D-OR), Ranking Member of the Finance Committee.

The report’s thesis is the despite early warnings that the coronavirus pandemic “would have a devastating impact on residents and nursing home workers, the Trump Administration failed to execute a coordinated strategy to adequately prepare and respond to the pandemic.” Much of its analysis tracks the experience of LeadingAge members, and many of its recommendations reflect LeadingAge’s positions.

Findings included:

  1. Lack of Timely and Complete COVID-19 Case and Death Data for Nursing Homes, including failing to timely track and report to the public cases in nursing homes, count all deaths since the pandemic began, and collect demographic information.
  2. Delayed Support and Limited Resources for Nursing Homes, including “failing to implement a cohesive plan to ensure a steady supply of PPE to frontline workers…including workers at nursing homes”, failing to leverage the Defense Production Act or FEMA’s response capabilities; failing to properly target and send adequate supplies to nursing homes; and sending the provider relief funds too late after authorization. The report is not completely accurate here, as PRF funds began to be distributed in April, but it is accurate in its description of the challenges associated with determining the amounts to be distributed and access to funds for Medicaid providers.
  3. No National Testing Strategy, including recommending “regular testing of nursing home residents without providing a plan or the resources required to implement this recommendation”.
  4. Late and Lacking Oversight, noting that it took weeks for the Administration to provide information to surveyors on how to conduct oversight and over a month to disseminate the funds allocated through the CARES Act for infection control inspections.

The report made the following recommendations, some of which are included in legislation that has been introduced since May by Sen. Casey but also by Sen. Tim Scott (R-SC), and Sen. Chuck Grassley (R-IA), based on a draft of elder justice legislation that is expected to be filed imminently:

  1. Ensure adequate data collection. Accurate information on cases, deaths, and availability of supplies are essential to target relief.
  2. Support States and nursing homes. “Congress should provide adequate funding for States and nursing homes to help slow the spread of the virus and save lives.” For LeadingAge members, this is bedrock necessity.
  3. Provide urgently needed PPE and testing. “The provision of these essential supplies requires adequate funding”. Again, a fundamental principle of LeadingAge’s advocacy on behalf of our members, staff and residents.
  4. Invest in home and community-based services. LeadingAge has also advocated for expanded Medicaid HCBS funding, along with PPE, testing and other supportive services to protect older persons in their home. We would add, of course, that funding for low income senior housing is fundamental to supporting older persons in the community, although this prerequisite to HCBS was not mentioned in the report.
  5. Facilitate promising strategies, such as cohorting, surge teams and infection control assistance, all of which have bipartisan support and with the proper funding and expertise could be extremely helpful.
  6. Elevate the workforce. The report references providing additional pay and benefits for frontline workers, which has some bipartisan support and is also a key LeadingAge principle.
  7. Support pandemic mitigation efforts, noting that “FEMA must consider how to support mitigation efforts for health emergencies, such as pandemics, when managing grant programs for eligible facilities like nursing homes”, such as changing how it calculates which expenses are eligible for reimbursement, as some of our members have noted.
  8. Improve emergency management and infection control in nursing homes, recommending that CMS and FEMA, along with their state counterparts, “conduct a comprehensive review of emergency management and response programs, and how these programs interact with nursing homes, to better address need.”
  9. Anticipate and mitigate need, by using data-driven information to anticipate and manage emergencies like the current pandemic. The report concludes by noting that “our Nation’s emergency management apparatus does not have the protocols in place or the capacity needed to quickly understand the effects of a disaster on a community, project its impacts, and model potential outcomes to best anticipate need.”

The authors have not indicated how they intend to use this report, but as noted before, legislation has been introduced to address some of the recommendations, especially around PPE, testing, workforce, HCBS, and promising strategies, and we anticipate that some of these provisions may garner enough bipartisan support to be included in the next coronavirus package.