The investigation was disclosed in mid-June and targets the Centers for Medicare & Medicaid Services, along with Genesis HealthCare, Life Care Centers of America, Ensign Group, SavaSeniorCare and Consulate Health Care. Lawmakers sent letters to the entities requesting various information in regard to their responses to COVID-19. 

The letters call on the companies to provide information about their ownership and organizational structures, as well as detailed lists of long-term care facilities they own and operate. Lawmakers also requested resident demographic information, confirmed or suspected cases at facilities, supply information about personal protective equipment, complaint information, compensation for executives, and revenues.

The subcommittee is also seeking information regarding CMS’s enforcement and supply actions.

That’s the belief of at least several of the 25 members of the Coronavirus Commission for Safety and Quality in Nursing Homes, who were named in late June. 

“I envision a concept of shared accountability,” said Janet Snipes, executive director of Holly Heights Care Center in Denver. “I had the opportunity to participate in two very different infection control surveys, one that was collaborative and focused on systems/practices and another which focused on the ‘gotcha!’ mentality. I learned that the spirit of collaboration in the first survey was truly helpful.

“I feel surveyors and QIOs alike should be held accountable for achieving and meeting the needs of the resident, helping us secure PPE and testing, working collaboratively to answer questions, [and] consulting with our staff on alternate practices when conventional standards are not available,” she told McKnight’s. 

CDC Director Robert Redfield said the agency is working with drugmakers to hike vaccine availability and safe testing options.

The effort is an attempt to head off a potential wave of flu and COVID-19 infections. This year, about 60% of U.S. adults say that they plan to get a flu shot, according to a recent Reuters/Ipsos poll. That is significantly more than in past years.

From 2014 to 2017, nursing home residents accounted for 7% of ED visits made by patients ages 60 and over. 

When broken down into age groups, nursing home residents ages 60 to 69 composed 2% of emergency department visits; those ages 70 to 79 accounted for 6% of visits; and residents aged 80 to 89 made up 12% of visits. Meanwhile, those ages 90 and over were responsible for 24% of visits.

Also, on July 29, staffing measures and star ratings will be held constant and be based on data submitted by Dec. 31, 2019, the memo said. The systems are used for the consumer-facing Nursing Home Compare website and Five-Star Quality Rating System.

Moreover, CMS said that it will remove a one-star staffing downgrade for applicable facilities; those facilities will have their measures and ratings temporarily suppressed.

Those facilities “now will not have the opportunity to correct and improve their staffing rating since the ratings will be held constant,” CMS said. 

Fines will range up to $5,000 for a provider found out of compliance and having deficiencies that are not widespread. If they are widespread, fines can reach $10,000.

Fines can hit $15,000 for providers that have been cited twice or more in the last two years but with deficiencies that are not widespread. The fines can reach $20,000 if the deficiencies are widespread.  

Provider groups expressed concern with the government’s new penalties.

“Nursing homes should be held accountable when they fall short, but escalating threats of punishment will not change the outcomes for vulnerable adults if providers are still left without the tools they desperately need,” LeadingAge President and CEO Katie Smith Sloan said.

“This situation will get worse if surveyors are only looking for reasons to find deficiencies and issue fines instead of identifying ways for nursing homes to make real changes and help them improve their infection control programs,” added Mark Parkinson, president and CEO of the American Health Care Association.

“I am asking you to personally investigate mounting evidence that FEMA shipments of PPE are deeply delayed, frequently stocked with useless and expired supplies, and delivered in quantities radically insufficient to help protect older Americans from the deadly coronavirus,” wrote LeadingAge President and CEO Katie Smith Sloan in a letter to the vice president, who heads the White House’s coronavirus task force. 

Following this request, four Democratic lawmakers questioned the quality and amount of PPE delivered to nursing homes from the Federal Emergency Management Agency.

“We look forward to continued conversations with and briefings from FEMA and the Supply Chain Stabilization Taskforce as we work to protect our nation’s most vulnerable by ensuring that staff and residents at nursing homes and other long-term care facilities have adequate access to PPE,” Sens. Elizabeth Warren (MA), Chuck Schumer (NY), Bob Casey (PA) and Maggie Hassan (NH) said in a letter to the agency. 

A:I’m thrilled and honored. It’s just going to be a very challenging year. 

Q: What’s looming large?

A:Obviously, there are two challenges: The pandemic has had major impacts on the healthcare delivery system. That will have to be taken into account with our deliberations. Then there are some basic things: How are we going to have meetings public and details like that. 

Q: How is COVID-19 going to affect MedPAC’s decisions regarding nursing homes? 

A:It is clear that the long-term care providers … are really challenged by the COVID-19 pandemic, and the clinical characteristics of COVID-19 put a lot of burden on those providers. When we look at the health of the industry we’ll have to take everything into account.

Q: What is your aim as chair?

A:My main goal is to provide the best advice for Congress to ensure Medicare beneficiaries have access to high-quality, efficiently provided care. We are at a very challenging time for the healthcare system, so I want to make sure our recommendations reach the highest standards for analytic vigor and address the most important topics [for] Congress.

“Managing COVID-19 in the SNF is uniquely challenging because the SNF serves both as a home and a medical facility,” wrote corresponding author Paula Lester, M.D., a geriatrician at NYU Winthrop Hospital. “The time has come to consolidate our learnings as a field in terms of caring for at-risk elderly … especially as we prepare for a potential second wave of infections.”

The recommendations include creating COVID-19-specific units; conducting twice-daily resident screenings; reviewing advance directives; and using serial testing to identify infected staff. 

In a McKnight’s interview, Lester urged as-yet unaffected facilities to use the recommendation to prepare for a “likely eventual outbreak.” 

“Facilities without cases currently should assess if they have sufficient and appropriate PPE, retrain staff on infection control and proper use of PPE, rethink their visitation policies and out-on-pass procedures, anticipate need for back-up staff and strategize for COVID-positive units or areas,” she said. “Anticipating and preparing for COVID in a SNF is a highly proactive and vital process.”

Investigators documented a climb between 2013 and 2015 and a post-fracture mortality rate of about 42% in 2014. Survivors were likely to suffer infections and pressure ulcers, leading to functional decline and diminished quality of life.

“In general, nursing home residents are older and sicker, with more cognitive and functional impairment than community-dwellers,” reported lead author Sarah D. Berry, M.D., MPH, of Harvard Medical School. “One possible explanation for these high rates is the underutilization of medications to treat osteoporosis.”

A separate study in the journal Bone points to diabetes as a possible culprit. Researchers at England’s University of Sheffield found patients with type 1 and type 2 diabetes are more likely to suffer hip and nonvertebral fractures. Insulin use and longer diabetes duration contribute to the increased risk.

The researchers called for increased awareness and routine assessments for bone density and bone strength as part of diabetes care.