The nursing home industry has resisted federal emergency plan requirements for many years. These federal plans include strict guidelines for disasters, including a pandemic. A recent report from ProPublica says that 43 percent of nursing homes in the United States have violated the federal requirement, including many of the nursing homes that have COVID-19 outbreaks.
Nursing Homes Resist Federal Emergency Plan Requirements
In 2016, the nursing home industry’s largest lobby sent a letter to President Donald Trump urging him to roll back new guidelines for long-term care facilities. The industry opposed more strict regulation and the requirement that nursing homes make plans for hazards, such as the outbreak of an infectious disease. The emergency plans would require nursing homes to create a plan for addressing their response to an emergency. The emergency plans required nursing homes to plan their response for:
- Sheltering in place or evacuating
- How they plan to provide food and water
- Management of medication and healthcare plans
- Plans for backup power in the event of an outage
- Training staff on how to properly implement the plan
- Practicing implementation at least twice each year
- If possible, participate in a drill with local agencies
Some nursing homes were slow to comply, and others seemingly ignored the requirement. Between November 2017 and March 2020, inspection data from watchdog groups, ombudsman and advocates show an alarming number of violations. During this time, inspectors noted at least 24,000 deficiencies across more than 6,500 facilities. That means around 43 percent of U.S. nursing homes were in violation of the emergency planning requirement guidelines.
Sadly, many believe this number to be much higher. Because of the way that the Centers for Medicare and Medicaid Services (CMS) tracks data, it is almost impossible to determine exactly how many violations were specific to infectious disease outbreak plans. Routine infection control standards were not included in the above analysis.
Did Nursing Home Failures Contribute to Outbreak?
What, at the time, was “extremely burdensome” now seems like it could quite literally have been a life saver. Without these plans in place, nursing homes have struggled to manage the COVID-19 pandemic and resulting outbreaks in their facilities. As it stands, 42 percent of coronavirus deaths occur in nursing homes.
Nursing home advocates believe that nursing homes could have been better prepared to handle COVID-19. They say that,
“More detailed plans accounting for expected staff and equipment shortages would have likely resulted in fewer deaths and illnesses at nursing homes stricken by the coronavirus.”
Advocates note that the emergency plan requirement does not require facilities to stockpile or take drastic measures. Instead, it requires nursing homes to create contingency plans and consider how an outbreak could impact staffing. As a result, nursing homes that prepare, train staff ahead of time and have contingency plans could more easily manage an outbreak and prevent severe illness or deaths.
Pat McGinnis, executive director of California Advocates for Nursing Home Reform says,
“It’s just a river of grief, and it could have been prevented.”
A Pattern of Unpreparedness
Over the past two decades, advocates have easily determined that nursing homes across the U.S. are not adequately prepared for a disaster. In 2005, the U.S. Department of Health and Human Services and the Inspector General both agreed that nursing homes were unprepared for such an emergency, even when following federal guidelines.
In 2009, the Government Accountability Office found that more could be done to educate healthcare providers on flu pandemic preparedness and emergency plans. The outbreak of swine flu underscored that sentiment as the flu spread rapidly through nursing homes.
In 2013, the Centers for Disease Control and Prevention (CDC) proposed an update to their emergency preparedness requirements for all healthcare providers participating in the Medicaid and Medicare programs. The nursing home industry objected to the CDC’s recommendations citing them as “costly” and “burdensome.” Consequently, for the next three years, the industry pushed back against new requirements. The nursing home industry argued that the requirements of additional personnel and equipment would risk the economic stability of some facilities.
In 2017, the Trump administration proposed rollbacks to the new requirements. Public health officials said that a rollback would “undo potentially life-saving improvements.” CMS still pushed forward saying it was,
“Critical for facilities to include planning for infectious diseases within their emergency preparedness program.”
At the time, CMS could not possibly know just how critical such plans would be. But instead of implementing these plans, many facilities simply did the bare minimum to keep their Medicare and Medicaid funding. There is inadequate oversight and enforcement of emergency plans. Furthermore, inspectors generally focus on immediate hazards, which may draw focus away from emergency plans. That may have resulted in many inspections not including a review of emergency plans at all.
Nursing Homes Become a Hotspot for Coronavirus
While no one could have anticipated how the novel coronavirus COVID-19 would impact nursing homes, it is fair to say that better preparedness could have prevented some of the worst outbreaks. Instead, nursing homes have become a hotspot for coronavirus outbreaks and deaths. What’s more, many of the facilities with the worst outbreaks are the same facilities in violation of federal emergency plan requirements.
California, for example, has the highest rate of citations from nursing home inspectors. Since November 2017, California’s nursing homes average three emergency-preparedness violations per facility. At least 56 facilities have received citations for completely failing to plan for a potential pandemic.
New Mexico is another state with a high number of citations for failing in their emergency-preparedness plans. In New Mexico, 31 percent of deaths related to coronavirus have occurred in nursing homes.
In New York, more than 5,800 nursing home residents have died from coronavirus or complications. New York facilities, however, have fewer citations overall, with just one deficiency per facility.
In North Carolina, there were less citations among their more than 400 facilities. Since November 2017, only 44 emergency-preparedness citations have been issued to 40 facilities. Still, some of the hardest-hit facilities during the coronavirus pandemic have been found to have not completely followed emergency-preparedness guidelines.
What do these numbers tell us? They tell us that long-term care facilities must prepare for infectious disease outbreaks. The result of not preparing is human lives, and many believe nursing home coronavirus deaths are wrongful and were preventable. Melanie McNeil, Georgia’s long-term care ombudsman reiterates this sentiment,
“Facilities should have been better prepared for this. The cost is human lives. That’s the cost of not being prepared. We know that people in long-term care are vulnerable.”