On September 21, 2022, the Select Subcommittee on the Coronavirus Crisis held public hearings and issued a report assessing the performance of large, for-profit nursing home chains during the early phase of the Coronavirus pandemic. The Subcommittee’s ongoing investigation began in June 2020, and focused on five for-profit nursing home chains that collectively operated over 850 skilled nursing facilities, each of which had significant outbreaks across their facilities. The Subcommittee’s key findings paint an extremely negative picture of for-profit facilities, and include the following allegations:
- Many nursing home facilities were severely understaffed during the early months of the pandemic, leading to deficient care, neglect, and negative health outcomes for residents.
- Nursing home staffing shortages reportedly were common prior to the pandemic, and were exacerbated thereafter, with resident-to-nurse ratios as high as 39 to 1. One worker reported that management told them that “they were not permitted to increase the number of staff.”
- Residents reportedly went without hygienic care for hours – and sometimes days – resulting in infections.
- For-profit nursing home chains did not supply their workers with adequate personal protective equipment.
- One employee reported that staff were “told to share PPE with other employees.” Others reported that employees had to wear the same masks for seven days in a row and had to use “makeshift isolation gowns . . .” that had been stapled and taped together. Residents reportedly were denied cloth masks and instead were given handkerchiefs that did not properly fit, and caused safety hazards when tied around some residents’ necks.
- Many nursing homes pressured staff to continue working despite having symptoms of, or testing positive for, the Coronavirus, which endangered nursing home residents and other staff.
- A cook was found to have a 101 degree fever during a temperature screening required to enter the building. The cook was reportedly instructed “to put a wet rag on her head before her temperature was taken again.” According to the report, which was lodged by another employee, the cook’s “second temperature read 92 degrees and her first temperature was not recorded.” The cook was then “allowed to work.”
- Many reports highlighted a pattern of nursing home management threatening to fire or retaliate against employees if they called in sick.
- Many facilities refused to give paid sick days to employees and contractors who needed to quarantine, and did not require employees to quarantine despite testing positive, as then-current CDC guidance recommended.
- For-profit nursing home chains’ use of convoluted corporate structures may have helped to obscure profits and avoid legal and regulatory accountability.
- Nursing home chains typically held each nursing home facility through one or more operating companies that were separated from the ultimate parent by many levels of corporate intermediaries.
- One health care organization was comprised of more than 700 distinct corporate entities, many of which provided services to other entities within the organization, while others existed primarily to own interests in related entities, most likely to protect the parent entity from operating liabilities.
Witnesses at the Subcommittee’s hearing testified about the need for “a federal minimum staffing standard, increasing staff pay and benefits, providing opportunities for career advancement and creating a better work environment” to ensure nursing homes are able to retain staff and adequately care for residents, as well as the need for regulatory reforms aimed at “increasing financial and ownership transparency,” including “collecting, auditing, and making detailed facility-level data on the finances, operation, and ownership of all nursing homes publicly available in real time in a readily usable database.”
The Biden Administration has committed to a set of nursing home reforms aimed at improving the safety and quality of nursing home care, holding nursing homes accountable for the care they provide, and making facility ownership more transparent, among other proposals. Poor performing nursing homes, especially for-profit facilities, will likely remain under scrutiny for a long time to come.