COVID-19 Still Killing 800 a Month in Nursing Homes

Nursing home deaths from COVID-19 remain sharply down from their winter peaks, but the declines have now plateaued and more than 800 residents and staff members each month continue to die from the virus, according to an exclusive new analysis of federal data by AARP.  The analysis did not comment upon and likely did not factor recent data suggesting that seniors in nursing homes may have lower immune response from the vaccines. 

There was little change in the national rates of COVID-19 infections and deaths in nursing homes from mid-March to mid-May, the analysis shows, even as rates in the wider community continued dropping. More than 10,000 residents and staff members are becoming newly infected each month.

Experts say that limited vaccine uptake among long-term care workers, worker shortages and the recent relaxation of nursing home restrictions might be causing the plateau, although more data and analysis are required.

Since the pandemic hit, COVID-19 has killed more than 184,000 residents and staff of long-term care, which includes nursing homes, assisted living facilities and other residential settings. Those deaths constitute almost a third of America's entire COVID-19 death toll, according to the Kaiser Family Foundation.

In nursing homes, the infection and death rates peaked last winter, when close to 20,000 residents and staff were reported dead from COVID-19 in just four weeks from mid-December to mid-January; 1 in every 51 residents died from the virus.

Then, cases and deaths started to plummet, dropping more than 90 percent by mid-March, with the arrival of vaccines, tougher restrictions from governments, and high levels of natural immunity from months of high infection rates. Though the situation has improved, nursing home advocates say current COVID-19 rates in nursing homes shouldn't be accepted as the new normal.

The federal government asked the country's 15,000-plus nursing homes to loosen visitation restrictions in March. Citing widespread vaccinations of residents, drops in COVID-19 infections among residents and staff, and the tolls of separation and isolation on residents and their families, the federal Centers for Medicare & Medicaid Services (CMS) said facilities should allow indoor visits “regardless of vaccination status of the resident or the visitor."

The resulting uptick in visitors could, in part, be contributing to the halt in COVID-19 declines, according to Jennifer Schrack, an associate professor in the epidemiology of aging at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"Every visitor is another potential exposure, particularly those who are not vaccinated,” she says. “They have to really consider carefully if they're going to visit their loved one, and if they do, they should wear [personal protective equipment] and be very cautious, even if their loved one is vaccinated. … Low risk doesn't mean no risk.”

Unvaccinated staff, which could represent nearly half of the nursing home and assisting living workforce, may be an even bigger factor.

Source: Emily Paulin, AARP, June 10, 2021 COVID-19 Still Killing 800 a Month in Nursing Homes, AARP Analysis Shows, 

Nursing Home Mortality Rate Soared 32 Percent in 2020

The coronavirus pandemic’s “devastating impact” on nursing homes led to a 32% spike in overall mortality rate among Medicare residents during 2020, according to a new report by the Office of Inspector General. The spike means there were 169,291 more deaths in 2020 than would be expected if the mortality rate had remained the same as in 2019. There were 3.1 million Medicare beneficiaries who resided in nursing homes in 2020. 

Each month of 2020 had a higher mortality rate than the corresponding month a year earlier. In April 2020 alone, a total of 81,484 Medicare beneficiaries in nursing homes died — more than twice the number in April 2019.

Federal investigators added that the data shows the pandemic had “far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had COVID-19.” This blog has previously addressed the higher rate of medical mistakes and errors and neglect that occurred amidst the pandemic as well as the horrific impacts from isolation, loneliness, and lack of psychological care and treatment.

The findings also revealed that more than forty percent of Medicare beneficiaries (1.3 million beneficiaries), in nursing homes had or likely had COVID-19 in 2020. The number of infected beneficiaries swelled dramatically during the spring of 2020, with just over 21,000 diagnosed as having or likely having the disease between January and March. By the end of June, the number was close to 419,000. 

Federal researchers also found about half of Black, Hispanic and Asian beneficiaries in nursing homes had or likely had COVID-19 in 2020. Each group was more likely than their white counterparts to contract the disease. 

Harvard health policy expert David Grabowski, Ph.D., said those who work in the field “knew this was going to be bad” but didn’t think “it was going to be this bad.” “This was not individuals who were going to die anyway,” Grabowski told the Associated Press. “We are talking about a really big number of excess deaths.”

“The COVID-19 pandemic has been devastating for Medicare beneficiaries in nursing homes,” the government watchdog agency wrote. “The toll that the COVID pandemic has taken on Medicare beneficiaries in nursing homes demonstrates the need for increased action to mitigate the effects of the ongoing pandemic and to avert such tragedies from occurring in the future.”  

The report is the first in a three-part series focusing on the impact of COVID-19 in nursing homes. Upcoming analyses are expected to focus on strategies nursing homes have used to combat the pandemic. 

Source: D. Brown, "Nursing home death rate soared 32 percent in 2020," McKnight's Longterm Care News (June 23, 2021).

Nursing Home Residents May Have Lower Vaccine Immune Response

A COVID-19 vaccine administered to nursing home residents in northeast Ohio was less effective in creating an antibody response in them than in a control group of health care workers, according to a Case Western Reserve-led study.

Some residents responded "reasonably well," but a portion responded "poorly to very poorly," concluded university researchers. What's not yet clear is why, or what the threshold for protection is when measured in terms of antibodies.

"We urgently need better longitudinal evidence on vaccine effectiveness" to inform best practices for nursing home infection control measures, outbreak prevention and potential indication for a vaccine boost, stated the study. Its co-principal investigators include David Canaday, MD, a professor in the School of Medicine’s Division of Infectious Disease, and Mark Cameron, PhD, an associate professor in the school’s Department of Population and Quantitative Health Sciences.

Once COVID-19 reached the United States, nursing homes became hotspots, with a rapid rise of infections and deaths; when vaccines became available, nursing home residents were among the first to receive them.  The study focused on the antibody immune response in residents by comparing a blood sample taken before the first vaccination, with another taken about two weeks after the second one.  It included 149 residents and a younger control group of 110 health care workers. All participants received the Pfizer vaccine.

Researchers examined three measures of antibodies; in all cases, residents had lower levels. For example, residents had a quarter of the anti-virus antibodies as the control group.

Canaday said the study's results can’t be compared to Pfizer’s vaccine efficacy rate of 95% because the Pfizer clinical trial focused on the number of adults of any age who got COVID-19, not the quantity of antibodies in the blood.

"The vaccine does make an immune response in almost every nursing home resident, although the magnitude is lower than in the younger age," Canaday said.

The study was the first outcome from a $2.3 million National Institutes of Health grant focused on COVID-19's spread in nursing homes awarded to Canaday, Cameron and fellow co-principal investigator Stefan Gravenstein, MD, a geriatrician and professor at Brown University.

They are now exploring varying responses to COVID-19 in nursing home residents and what level of antibodies is protective.

"There are so many questions to be answered surrounding the role of one's immune system in determining whether an infected individual has a mild, moderate or very severe form of COVID-19," Cameron said, "especially in people who are older or have underlying health issues that put them more at risk for poor outcomes."

Nearly 40% of SNF's Reported No 2020 COVID-19 Deaths; SNF Risk of Death Still Ten Times Higher than Independent Living

In rare good news regarding health outcomes in nursing homes, particularly during the pandemic, a recent study found that nearly 40% of nursing homes reported no COVID-19 deaths during 2020.  The new study was conducted by NORC at the University of Chicago.  The analysis, which was funded by the National Investment Center for Seniors Housing & Care, estimated 2020 COVID mortality rates in seniors housing by level of care and compared the rates to seniors who lived in non-congregate settings. Findings were based on data from five states.

Thirty-nine percent of skilled nursing facilities experienced no COVID-related deaths during the year, while about two-thirds of independent living, 64% of assisted living and 61% of memory care prosperities experienced no related deaths.   The analysis also found that COVID-19 deaths across senior housing correlated with how ill the average resident was and the amount of care they needed: 

“The facts include that COVID-19 transmission is more likely with close person-to-person contact and mortality increases with age and comorbidities. This study shows senior housing isn’t homogeneous, and mortality was higher in property types whose residents, on average, are sicker and require higher levels of care,”

Brian Jurutka, NIC’s president and CEO, said in a statement. 

SNFs and memory care had the highest adjusted mortality rates from COVID-19 with 59.6 and 50.4 deaths per 1,000 residents, respectively.

Resident deaths in independent living settings were statistically comparable to the rates of death for older adults living in non-congregate settings in the same geographic area. Independent living had average adjusted mortality rates of 5.9 per 1,000. That’s compared to the 6.7 per 1,000 found for seniors living in the same counties. For Aging in Place Planning purposes, that means that independent and non-congregant settings showed no higher mortality rate. 

The analysis included data from 3,817 senior housing properties across 113 counties in five states: Colorado, Connecticut, Florida, Georgia, and Pennsylvania.

Source: D. Brown, "39 percent of nursing homes had no COVID deaths: report,"  McKnight's Long-term Care News (June 3, 2021) (last accessed 6/3/2021). 

Guardian Lawfully Refused Family's Request to Remove Ward from Nursing Home Amidst Pandemic

COVID-19 may have revealed with horrific and heart-breaking clarity just how deeply is the bias for institutional care in our legal and health care systems.  A recent Maryland case, arising from pandemic decision-making, may provide an object lesson regarding this bias, and is another in a string of cases revealing the dangers of guardianship. 

Mary Boone suffered from dementia and lived in a nursing home. Due to discord between Ms. Boone’s two daughters, the court appointed an independent guardian for Ms. Boone. In April 2020, one of Ms. Boone’s daughters, Sherry Feggins, filed an emergency motion to remove her mother from the nursing home and relocate her to Ms. Feggins’ house due to concerns about COVID-19 in the nursing home.

The guardian opposed the motion, arguing that Maryland’s governor had ordered people to shelter in place. She also noted that Ms. Feggins did not provide a care plan for Ms. Boone at her house. Ms. Boone’s doctor submitted a statement that moving Ms. Boone would worsen her dementia and put her and the facility at risk for COVID-19. Ms. Feggins argued, additionally, that her mother had suffered abuse at the facility. The court denied Ms. Feggins’ motion, and Ms. Feggins appealed.

The Maryland Special Court of Appeals affirmed, holding that it was in Ms. Boone’s best interest to remain at the facility. 

The court ruled that “it is the welfare of the ward that is of chief concern -- not the wishes of the relatives nor the convenience of the guardian.” The Court determined that Ms. Feggins did not provide sufficient proof that changing Ms. Boone’s residence would be in her best interest.  In the Matter of Boone (Md. Ct. Spec. App., No. 432, May 13, 2021).

An Aging in Place Plan with a clear appointment of a primary decision-maker,  providing for a succession of decision-makers, and conferring authority to implement aging in place plans and preferences, may have prevented this case and controversy.   

CMS Requires LTC Providers Report Weekly COVID Vaccine Data; Data Made Public

Long-term care facilities are required to report weekly data on COVID-19 vaccination status for both residents and staff under a new interim final rule, putting more pressure on providers to remain transparent with their efforts. 

The Centers for Medicare & Medicaid Services (CMS) announced the new regulation, which apply to long-term care facilities and intermediate care facilities for individuals with intellectual disabilities.  Enforcement begins June 14. 

As data becomes available, CMS will post facility-specific vaccination status information so that it can be seen openly by the public on CMS’ COVID-19 Nursing Home Data website, the agency said.

CMS added that the new mandate is designed to assist in monitoring uptake among residents and staff, and aid in identifying facilities that may be in need of additional resources to respond to the COVID-19 pandemic.

LTC facilities are already required to report COVID-19 testing, case and mortality data to the National Healthcare Safety Network for residents and staff, but they have not been required to report vaccination data.

“These new requirements reinforce CMS’ commitment of ensuring equitable vaccine access for Medicare and Medicaid beneficiaries,” Lee Fleisher, MD, CMS’ Chief Medical Officer and director of the Center for Clinical Standards and Quality, said in a statement. 

“Today’s announcement directly aids nursing home residents and people with intellectual or developmental disabilities who have been disproportionately affected by COVID-19. Our goal is to increase COVID-19 vaccine confidence and acceptance among these individuals and the staff who serve them,” he added. 

Some states had already been collecting and monitoring such data, and Maryland last week said it would require its providers to feed information to a public-facing dashboard.

A growing movement to track

CMS had hinted that a national vaccination reporting requirement could be in the pipeline for providers. The agency put forward a new SNF Quality Reporting Program measure as part of its Skilled Nursing Facility Prospective Payment System proposal for fiscal year 2022. 

The proposed rule would have require skilled nursing facilities to report staff COVID-19 vaccination rates to the Centers for Disease Control and Prevention National Healthcare Safety Network starting Oct. 1. Currently, staff vaccination reporting is voluntary.

The agency on Tuesday added that it’s also seeking comment on expanding the reporting policy to other congregate care settings, such as assisted living facilities, psychiatric residential treatment facilities and group homes.

Regulators said they are specifically interested in comments on “potential barriers facilities may face in meeting the requirements, such as staffing issues or characteristics of the resident or client population, and potential unintended consequences.”

The rule also requires providers to report the use of therapeutics administered to residents for treatment of COVID-19. The agency said reporting their use will help government officials and other stakeholders “monitor the prevalence of these treatments, their impact on reducing the effect of COVID-19 on nursing home residents, and support allocation efforts to ensure that nursing homes have access to supplies to meet their needs.”

Tuesday’s rule would have been more expansive, CMS added, but logistical concerns kept the range limited.

“Because we are not able to guarantee sufficient availability of single dose COVID-19 vaccines at this time, or in the near future, to meet the potential demands of facilities with relatively short stays, we are focusing on facilities that have longer term relationships with patients and are thus also able to administer all doses of and track multi-dose vaccines,” they said in a summary of the interim final rule, scheduled to be published in the Federal Register on Thursday.

Source: D. Brown, "BREAKING: New CMS rule requires LTC providers to report weekly COVID vaccine data, which will be made public," McKnight's Long-term Care News (May 11, 2021) (last accessed 5/11/2021).

Single Rooms Might Have Prevented 31% of Long-Term Care COVID-19 Deaths

A study spanning several countries found that the infrastructure of long-term care has to change drastically to protect residents from health threats like COVID-19, with simulations finding that 31% of coronavirus deaths in Ontario, Canada, would have been prevented if all residents had had single-occupancy rooms. 

“Community outbreaks and lack of personal protective equipment were the primary drivers of outbreak occurrence in long-term care homes, and the built environment was the major determinant of outbreak severity,” George Heckman, a professor at the University of Waterloo in Ontario, Canada, said in a statement  on the study, which was published in the Journal of the American Medical Directors Association.

The study drew from an international virtual town hall held in fall of last year and hosted by Provincial Geriatrics Leadership Ontario (PGLO). The gathering focused on three themes: updating the built long-term care environment, public health versus individual health, and staffing.

Outbreaks in Ontario during the first wave of COVID-9 “were not uniformly distributed, with 86% of infections occurring in 10% of homes,” according to the study. The primary determinant of nursing home outbreaks in the Canadian province — as in the U.S. — was the extent of COVID-19 circulation in the surrounding community, the study observed.

Simulations found that 31% of infections and 31% of deaths would have been prevented by single rooms for all Ontario long-term care residents — but 30,000 additional private rooms would have been necessary for this to occur.

Research in the U.S. found that outbreaks were more likely when staff members commuted from neighborhoods with high COVID-19 circulation — and in large homes with more staff traffic, with high-occupancy rooms associated with large outbreaks. Nursing homes that were less crowded, such as those built on the Green House model, had better outcomes and lower hospitalization costs, the study noted.

“The fact that smaller homes not only support better resident outcomes but are more resilient against infectious outbreaks should prompt policymakers to reimagine LTC infrastructure in a post-pandemic world,” the authors wrote.

Design features of the built environment for long-term care “that promote greater multiplicity and comingling of viral vectors — staff or residents — are strong determinants of the risk and extent of outbreaks,” according to the study; investing in smaller LTC units could minimize those vectors in addition to supporting better resident outcomes.

“However, excessive down-sizing may leave residents vulnerable to situations similar to those reported by small Italian LTC homes, as in the United States where outbreaks led to critical staff shortages,” the study authors added. “The solution may lie in architectural approaches that distinguish small-scale living from small-scale housing, using uncrowded and home-like residential spaces. Such infrastructure must be supported by dedicated staff embedded in a responsive organizational structure sufficiently large enough to ensure adequate staff coverage and to share operation resources.”

Those points echo calls from across the nursing home world to invest in better staffing and smaller, more homelike setups for nursing homes.

The authors of the JAMDA study went one step further.

“Any new large-scale developments based on clearly unhealthy institutional architectural designs should be strongly discouraged,” they wrote.

COVID Propels Aging in Place; Institutionalization of Seniors Drops

In the wake of the pandemic, Americans are avoiding nursing homes and other rehabilitation homes for the elderly.  Increasingly, Americans are caring for their loved ones in their own homes. This is the assessment of investigative journalists writing for the Wall Street Journal (WSJ).

America has a long history of relying upon institutions to care for the at-risk elderly. "The U.S. has the largest number of nursing-home residents in the world. But families and some doctors have been reluctant to send patients to such facilities, fearing infection and isolation in places ravaged by Covid-19, which has caused more than 115,000 deaths linked to U.S. long-term-care institutions."

Since the spring, there has been a drop in the number of patients in nursing homes and similar facilities. According to the report, "[o]ccupancy in U.S. nursing homes is down by 15%, or more than 195,000 residents, since the end of 2019, driven both by deaths and by the fall in admissions." 

This has created financial problems for nursing-homes, with even the biggest U.S. nursing-home company stating that it may not have the money to fulfill its financial obligations. 

The shift away from institutions may be permanent.  Big insurers, home-health-care companies and some hospital systems are betting the new patterns of referral and care established amid the crisis will remain in place for the long term. They say doctors, hospital managers and families have seen how some older patients with significant care needs can be sent home. Just as the pandemic has spurred greater adoption of long-considered practices such as working from home, it has brought a re-evaluation of the role of nursing homes.

“We implemented a complete switch of mind-set to say home is the default” for patients leaving the hospital, even frail ones,  Peter Pronovost, chief clinical transformation officer at University Hospitals, an Ohio-based system told WSJ reporters.  “I don’t think we’re ever going to go back,” he said. “The drive to get every patient home who can be home is going to continue.”

Home-health-care companies and major hospital systems, including Iowa-based UnityPoint Health and South Carolina’s Prisma Health, are building new offerings to support sicker patients recovering at home, often using technology to allow close monitoring.  Also fueling these efforts are pandemic-related regulatory changes that allow Medicare to pay for digital doctor visits and intense, hospital-level care in patients’ homes.

Some nursing-home companies say they too are adjusting bulking up their own home-focused offerings and aiming to upgrade buildings and staff to capture a new group of sicker patients who might come to them for hospital-level care.  Eventually, nursing-home operators say, demographics will buoy their industry, as more baby boomers require institutional care. Well before that, they say, vaccines should stem the tide of Covid-19 in their facilities.

“Do I think that more patients will be moved to home? Absolutely. It’s the right thing to do for the patient, it’s the right thing to do for the system, and it’s the right thing to do for the cost,” said David Parker, president of ProMedica Senior Care, a major nursing-home operator that also owns a home-health-care provider and is part of ProMedica Health System.

Nursing-home use in the U.S. has been declining gradually for years. In 2019, occupancy was 80%, down from 84% a decade earlier, according to the Kaiser Family Foundation.

Reduction in disability rates is helping to reduce reliance on institutional care.  The non-disabled component of the Medicare-enrolled 65-and-over population has also been rising: in 1982, 74 percent of Medicare-enrolled 65-and-older individuals were “non-disabled.” That number rose to 81 percent in 2004–2005. This trend is reflected in the fact that the percentage of Medicare-enrolled 65-and-older individuals who reside in institutional settings (i.e., nursing homes) has decreased over time, to less than 5 percent in 2004–2005. 

Surveys have long shown many patients don’t want to go to nursing homes. The pandemic has made them even less popular, according to a September survey of adults 40 and older by AARP. Just 7% said they would prefer a nursing home for family members needing long-term care, and 6% said they would choose one for themselves. Nearly three in 10 respondents said the pandemic had made them less likely to choose institutional care.

For years, government policies have paradoxically both encouraged and discouraged intuitional care.  Certain government policies have encouraged alternatives to nursing homes. Medicaid programs, which cover long-term care for poorer adults, have increasingly paid for long-term services that help patients remain at home such as health-care aides, though funding has long fallen short of demand.

In Medicare, which typically encourages a limited nursing-home stay after a hospital visit, more people have been getting their benefits through insurance companies, which have held down costly nursing-home stays. The companies now provide coverage to around 36% of Medicare beneficiaries, according to the Kaiser Family Foundation. Medicare has also begun paying health-care providers in ways that reward them for bringing down overall costs, giving the providers an incentive to reduce referrals to nursing homes.

The Trump administration gave Medicare insurers more flexibility to spend money on things that improve patients’ home setups. It also made pandemic-related tweaks that allow Medicare coverage for more types of care in the home.  The options have been exploited by insurance companies and health care providers to help transform the industry.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS) predicted the shift from istitional to home-based care: "[w]e should be able to provide more services in the home setting that can enable somebody to be independent."  She noted that "Covid is going to force a national conversation about how we take care of our elderly, and clearly there are issues in nursing homes that go beyond infection control."

During his campaign, President-elect Joe Biden promised to spend $450 billion to make sure people who need long-term care can get support in the home and community.  “There’s no daylight between the Trump administration and the Biden administration on the desire to see more folks cared for in the home,” said Robert Kocher, an Obama White House health adviser now at venture-capital firm Venrock.

The number of Medicare-financed residents of nursing homes fell 28% in April and 34% in May from a year earlier, as the pandemic turbocharged efforts to steer Medicare patients away from nursing homes and as hospitals referred fewer after surgeries, according to an analysis of billing records done for the WSJ by data firm CareSet Inc. The decline occurred even though, during the pandemic, the Trump administration waived a requirement that Medicare beneficiaries stay three days in a hospital before going to a nursing home.

In addition, some nursing homes shut off admissions in the spring,  Susan Craft, vice president of population health at Henry Ford Health System in Detroit told the WSJ.  "It was a forced period for us to work on home-care programs,” said Gloria Rey, the director of post-acute care at Henry Ford. “We’re continuing to work within our organization to make going home the priority.”

Major Medicare-plan providers Humana Inc. and UnitedHealth Group Inc. say they are working to develop programs that would allow sicker patients to be discharged from hospitals to their homes. The shift in nursing-home use “is probably one of the trends coming out of Covid, along with telemedicine, that is going to act as a real accelerant and be sustainable,” said Susan Diamond, who leads the home business of Humana, one of the biggest Medicare insurers and also a major home-health owner.

Nursing homes’ loss has been a gain for home-health companies, which provide services such as therapy and nursing visits, though typically not 24-hour care.

Data from CarePort Health, a unit of Allscripts Healthcare Solutions Inc. that helps manage post-hospital care, show that referrals from hospitals to nursing homes and home-health providers both plunged in April. By October, though, referrals to home-health providers were at 109% of their 2019 baseline level, while nursing-home referrals had flattened at 83% of their baseline.

The falloff has been a disaster for the nursing-home industry, because Medicare pays better than the long-term stays Medicaid covers. Despite billions in pandemic-related government aid, some nursing homes have closed or been sold in recent months.

A November a survey by the American Health Care Association, a nursing home industry group, found 65% of nursing homes were operating at a loss. Mark Parkinson, the association’s chief executive, said 10% to 20% might file for bankruptcy without additional government aid.

Genesis Healthcare Inc., the biggest U.S. nursing-home company, told investors in August it might not be able to continue as a going concern. Its loss in the third quarter deepened, and in November it said it would need ongoing government support to sustain its operations. Its shares have languished at less than $1.

On the other side, shares of Amedisys Inc., the largest publicly traded home-health-care company, are up nearly 75% in 2020. It saw strong volumes and higher profits in the third quarter.  “We want to take care of sicker and sicker patients, and show we can do it,” Amedisys CEO Paul Kusserow said.

Nursing-home officials said they worry that some frail patients could be left without enough supervision and support if sent home. A 2019 study published in JAMA Internal Medicine that compared Medicare hospital patients discharged to nursing homes with patients who got traditional home-health services found the latter were more likely to be readmitted to the hospital. Mortality and functionality of the groups, however, were similar.

To help patients who are sent home, some hospital systems and home-health firms, including Amedisys, are building new, often tech-heavy programs that layer on extra services and aim to reproduce aspects of nursing-home-level care in patients’ homes.

Prisma Health, an 18-hospital system in South Carolina, in May launched Home Recovery Care, a joint venture with a company called Contessa Health Inc. that provides operational support and technology for the service. Some hospital patients who might qualify for a nursing-home stay are instead sent home using the new program, which some insurers pay for, Prisma Health officials said. 

See Anna Wilde Mathews & Tom McGinty, "Covid Spurs Families to Shun Nursing Homes, a Shift That Appears Long Lasting," Wall Street Journal, December 21, 2020. 

Ohio Permits Owners to Revise Property Tax Valuations Where Impaired by Covid-19

Ohio Governor Mike DeWine signed Ohio Senate Bill 57 on April 27, 2021, which becomes effective July 26, 2021. The new law allows an owner of property impacted by COVID-19 or associated state orders to file a special board of revision valuation complaint with a tax valuation date of October 1, 2020 to allow for the consideration of COVID-19 associated impacts to the property. Under previous law, the tax year 2020 valuation date was January 1, 2020 – before many properties were impacted by COVID-19 and before any associated state orders were implemented.

Property owners will have until August 25, 2021 to file this special valuation complaint for tax year 2020. The existing deadline was March 31, 2021. In order to file this special valuation complaint, the claimed reduction in value cannot be a general claim based on market conditions, but must be related to specific circumstances that apply to the specific property.  The request for reduction must allege with particularity that the property value decreased between January 1, 2020 and October 1, 2020 specifically as a result of COVID-19 or associated state orders. Failure to comply with these requirements in the special valuation complaint will result in a dismissal of the complaint.

Consumer Voice Issues Summaries of CMS Visitation and CDC Quarantine Guidance

In the wake of COVID-19 isolation concerns in skilled nursing facilities(see, e.g., "Seniors Dying from Isolation Amid Pandemic- One Analysis Suggests Tens of Thousands," and "Survey Suggests 64% of Residents Don't Leave Rooms to Socialize; More Report Profound Loneliness"), the National Consumer Voice for Quality Long Term Care has published takeaways from the most recent CMS guidance on SNF visitation. The full CMS guidance is available here. 

Here are some of  the highlights:

• Facilities should allow indoor visitation at all times and for all residents except in certain specific circumstances.

• There are now fewer circumstances under which indoor visitation can be completely suspended.

• Fully vaccinated residents can have close contact, including touch, with visitors as long as they wear a mask and practice hand hygiene.

• Visitors should not be required to be tested or vaccinated as a condition of visitation.

• CMS continues to emphasize that facilities shall not restrict visitation without a reasonable clinical or safety cause and that nursing homes must facilitate in-person visitation consistent with the federal nursing home regulations.

• Visitation must be person-centered and “consider the resident’s physical, mental, and psychosocial well-being, and support their quality of life.”

Consumer Voice has also released the Summary of the Centers for Disease Control and Prevention's Guidance on Quarantine for Residents of Long-Term Care Facilities. The full CDC guidance is available here.

Early COVID-19 Vaccinations Reduce Nursing Home Cases

A new study recently found that facilities that started the COVID-19 vaccination process earlier were less likely to have new cases  compared to providers who started inoculations weeks later. 

"Early group" nursing homes had 2.5 fewer COVID-19 infections per 100 at-risk residents after one week when compared to late group facilities. In addition, they had 5.2 fewer cases per 100 after five weeks. 

The study, led by Brown University researchers, was conducted using data from 280 Genesis HealthCare facilities. Nursing homes in the early group conducted their vaccine clinics from Dec. 18, 2020 to Jan. 2, while the late group’s clinics were between Jan. 3 and 18. 

Rates of hospitalizations and deaths were also down for providers who started the vaccination process earlier. Findings showed that after seven weeks earlier vaccinated facilities five fewer hospitalizations and/or deaths per 100 infected residents. 

Brown University biostatistician and co-author Roee Gutman said the findings reveal just how quickly the vaccine starts to work within long-term care facilities. 

“We see that the mRNA vaccine is useful and has a strong protective effect relatively soon after it is being administered,” Gutman told McKnight’s Long-Term Care News.  The full study was published in the Journal of the American Geriatrics Society.

“It is significant because the original Pfizer trial was not performed on this population and it only examined severe COVID cases. Because residents are tested regularly, we can see that the number of infections is lower than those that vaccinated later and a measure of COVID severity is lower. Second, we see that the mRNA vaccine works on this very old and frail population,” he added. 

Researchers said they hope the findings “make it possible for nursing homes to begin controlled efforts to open up to family visitation and alleviate other restrictions, thus reversing the social isolation which has become virtually universal during the pandemic.”  As previously discussed on this blog, isolation has been devastating to this older vulnerable population:

• Seniors Dying from Isolation Amid Pandemic- One Analysis Suggests Tens of Thousands;
• Heartbreaking Study Finds that Contact with Nursing Home Residents Fell by More than Half;
• Survey Suggests 64% of Residents Don't Leave Rooms to Socialize; More Report Profound Loneliness. 

The statistics also provide even more evidence that the vaccination is effective in reducing the spread of the disease. 

Source: D. Brown, "Nursing homes with early COVID vaccinations less likely to have new COVID cases,"  McKnight’s Long-Term Care News April 20, 2021).

New York Repeals Health Care System Protection from COVID-19 Liability

New York Gov. Andrew Cuomo recently signed a bill repealing a state law protecting health care facilities and professionals from COVID-19 related lawsuits.

The Emergency or Disaster Treatment Protection Act was enacted in April 2020 at the inception of the COVID-19 pandemic. At least fifteen states passed some form of liability protection for health care workers and institutions in the wake of the pandemic.  New York lawmakers voted nearly unanimously (149-1) last month to repeal the portion of the law that offered protection from both civil and criminal liability.  These laws remain controversial.

Nursing homes and their staff are among those affected by the repeal, which went into immediate  effect upon signing, or April 6, 2021, per Law360. 

Nursing homes will be vulnerable to COVID-19 related lawsuits on a going forward basis, however, the repeal is not retroactive, leaving in place protections for incidents that occurred during the period that the law was in effect.

Nursing home and elder care advocates have celebrated the repeal as a restoration of the rights that protect nursing home residents from abuse or neglect. 

On the other hand, the Greater New York Hospital Association and the Greater New York Health Care Facilities Association have strongly opposed the repeal, according to ABC News.

This action may trigger a trend in states repealing COVID-19 legal protections for health care workers and/or institutions, but given the circumstances unique to New York and Governor Cuomo, the action may prove to be an outlier.

SNF COVID Crisis Over? SNF COVID Deaths Fell 66% in Wake of Vaccine Clinics as Overall U.S. Fatalities Rose 61%

After a year of remarkable tragedy in nursing homes, a new analysis of federal COVID-19 data shows a significant drop in resident deaths in the weeks after vaccine clinics began, a trend made even more striking given the simultaneous spike in U.S. coronavirus deaths over the same period. The detailed analysis, courtesy of the Kaiser Family Foundation (KFF), paints a much-needed portrait of the COVID-19 pandemic as it has impacted, and continues to impact long-term term care facilities (LTCFs).  According to KFF, the final months of 2020 were the deadliest months of the pandemic for many LTCFs across the country, with over 26,000 COVID-19 deaths in LTCFs reported between Thanksgiving weekend and December 31, 2020. 

The end of 2020 saw the approval of the first coronavirus vaccines and the launch of vaccine administrations in LTCFs through the Pharmacy Partnership for Long-Term Care on December 21st, 2020 (Pfizer-BioNTech) and December 28th, 2020 (Moderna). As of February 22, 2021, about 4.5 million residents and staff have received one or more dose through the Partnership; over 2 million residents and staff have received both doses. In addition, some states and some LTCFs have vaccinated residents or staff outside the Partnership. Vaccinations have increased outside of LTCFs as well, though at a significantly lower rate. 

Weekly deaths in nursing homes fell 66% between the last week of December, when the federal government’s long-term care vaccination partnership with CVS and Walgreens ground into gear, and the first week of February, according to the Foundation.  That decline nonetheless represents more than 2,000 fatalities, but it came as nationwide deaths, excluding nursing homes, spiked 61% to nearly 20,000 during the week ended February 7, prompting the Foundation to ponder whether the end of the crisis in LTCFs has finally come into view.

KFF stopped short of definitively concluding that the vaccine clinics were the direct cause of the drop, noting that not every facility started the inoculation process on the same day, but the general association is obvious.

“According to the CDC, there has been strong evidence that the vaccines prevent severe illness and death, and the sharp divergence in deaths inside and outside of LTCFs is consistent with that evidence,” KFF observed. “In addition, given the emerging research around the vaccines’ ability to prevent transmission of the virus, there is reason to believe that the vaccine may be playing a part in reducing virus transmission within nursing homes, contributing to the more rapid decline in new cases in nursing facility residents than in the overall population.”

Total case numbers in nursing homes dropped 83% in the post-clinic period, far outpacing the 45% dip among the general, non-LTC population. “While cases have dropped both within and outside nursing facilities, new nursing facility resident cases peaked earlier (week ending December 20, 2020) as compared to in the general non-nursing facility resident population (week ending January 10, 2021) and declined at a faster rate in nursing facilities than outside nursing facilities,” KFF noted.

The most recent data marks a swift turnaround from record-high death counts seen in LTCFs at the beginning of 2021.  One in every 51 residents of LTCFs died during the four weeks bookending New Year’s Day, for a grim total of nearly 20,000, according to an AARP analysis.

“While the record high death rate in the four weeks ending Jan. 17 represents only a slight increase from the previous month, when 1 in every 53 residents died from COVID-19, it is more than a quadrupling of the resident death rate at the end of the summer,” AARP noted.

The gains also came amid continued concerns about relatively low uptake of vaccines among nursing home staff. Only 37.5% of workers accepted vaccinations during the first month of clinics, according to the Centers for Disease Control & Prevention (CDC), as compared to 77.8% of residents.  Meanwhile the debate regarding mandating vaccines roils. 

Sources:

"Nursing Home COVID Deaths Fell 66% in Wake of Vaccine Clinics — Even as Overall U.S. Fatalities Rose 61%," Skilled Nursing News, February 25, 2021.

Is the End of the Long-Term Care Crisis Within Sight? New COVID-19 Cases and Deaths in Long-Term Care Facilities Are Dropping, KFF, February 24, 2021.