Brief Shows COVID-19 Challenges Magnify Chronic Care Issues Inside U.S. Nursing Homes

covid-19 pandemic highlights

U.S. nursing home residents, totaling 1.2 million seniors and nonelderly people with disabilities living in over 15,000 facilities, are at increased risk of coronavirus infection and complications. The combined challenges of the facility setting and shared living environment, residents with underlying health conditions, the close contact that many care workers have with residents, and failures in facilities who do not provide quality care, all contribute to the high number of COVID-19 cases and outbreaks in the elder communities.

According to the Illinois Department of Public Health (IDPH), as of August 7, 20202:

  • More than 25,000 cases of COVID-19 have been traced back to nursing home residents and staff, resulting in 4,162 deaths.
  • About half of the cases are coming from populated Cook County, including the greater Chicago area and suburbs where 13,863 COVID-19 nursing home cases have been reported and 2,333 deaths of residents and staff.
  • Over half of all coronavirus cases in Illinois are tied to long-term care facilities, including nursing homes and assisted living centers.

Issues related to the rise in nursing homes battling the pandemic include:

  • overexertion due to reduced staffing levels
  • unsafe patient handling or transfers
  • lack of prevention programs and control of contagious and infectious diseases
  • hiring inexperienced workers and failing to train them
  • mismanagement of medications
  • wrongful evictions
  • abuse and neglect

The Kaiser Family Foundation (KFF) is a non-profit organization focusing on national health issues. On August 3, 2020, the organization recently published a “Key Questions” issue brief to help the public better understand how the coronavirus pandemic has highlighted historic care issues in nursing homes. The brief discusses how changes in infection control and prevention programs and written emergency preparedness plans have been ignited.

Summary of Kaiser Family Foundation Brief

According to the issue brief, “The COVID-19 pandemic has led to renewed interest among policymakers, the media, residents, and their families in nursing home regulation and oversight, as residents and staff are at increased risk of infection due to the highly transmissible nature of the coronavirus, the congregate nature of facility settings, and the close contact that many workers have with patients. …. This issue brief answers key questions about nursing home oversight and explains how federal policy has changed in light of COVID-19.”

The brief’s findings concluded:

  1. Infection control deficiencies were widespread and persistent in nursing homes before the COVID-19 pandemic, according to a May 2020 GAO report.
  2. Despite broad issues found in more comprehensive surveys before the pandemic, preliminary reports of targeted nursing home surveys focused on infection control and immediate jeopardy since March 4, 2020, reveal that only a small share have deficiencies. However, the pandemic has brought renewed attention to nursing home quality issues.
  3. While the pandemic has led to new federal guidance, funding, and reporting requirements, state survey agencies and nursing homes each may face issues related to funding, capacity, and data as the pandemic continues.

KFF’s “Key Questions” Takeaways

The briefing document also reviewed many questions and answers related to the types of nursing home regulation and oversight present before and during the COVID-19 crisis and what has been done since. The key questions asked are below. Each included a summary of actionable responses taken according to KFF findings.

How are the federal requirements for nursing home oversight enforced?

  • Certification of nursing home compliance with federal Medicare and/or Medicaid requirements generally is performed by states through regular inspections known as surveys.
  • The penalties for facilities found to be out of compliance with federal requirements vary depending on whether the deficiency is determined to immediately jeopardize residents’ health or safety.
  • Civil money penalties (CMPs) can be imposed for the number of days a facility is not in substantial compliance or for each instance that a facility is not in substantial compliance.
  • Additional remedies apply to facilities with patterns of deficiencies over time.

How have the federal nursing home requirements evolved over time?

  • Prior to the late 1960s, nursing homes were “essentially unregulated in most states,” and care quality was generally considered to be poor.
  • The IOM recommendations led to changes adopted in the 1987 Nursing Home Reform Act, which established Medicare and Medicaid requirements in three main areas: service provision, residents’ rights, and administration and other matters.
  • To help address continuing quality concerns, the 2010 Affordable Care Act (ACA) included some additional reforms.
  • The 2016 nursing home regulations issued by the Obama Administration were the first comprehensive update in 25 years.

What was the state of nursing home quality before and during COVID-19?

  • Infection control deficiencies were widespread and persistent in nursing homes prior to the COVID-19 pandemic, according to a May 2020 GAO report.
  • In regular surveys conducted from January 2019 through March 2020, nearly half of facilities received an infection control deficiency.
  • In response to COVID-19, CMS suspended state survey activities in March 2020, except for those related to infection control and immediate jeopardy.

How has nursing home oversight changed in light of COVID-19?

  • As the number of COVID-19 cases and deaths in nursing homes increased, CMS has issued guidance about how facilities should respond to the pandemic.
  • In April 2020, CMS announced the formation of an independent commission to conduct a comprehensive assessment of facility response to COVID-19.
  • As of May 2020, facilities must report COVID-19 data to the CDC and provide information to residents and their families.
  • In May 2020, CMS issued nursing home reopening recommendations and an informational toolkit with best practices for states to mitigate COVID-19 in nursing homes.
  • In June 2020, CMS issued additional guidanceto states on COVID-19 survey activities and enhanced enforcement for infection control deficiencies.
  • In late July 2020, CMS began requiring, rather than recommending, that all staff be tested weekly in nursing homes in states with a 5% or greater positivity rate.

What are the key challenges for nursing homes as the pandemic continues?

  • As the pandemic continues, state survey agencies may face issues related to funding, capacity, and data.
  • Nursing facilities also face a number of challenges in their continued pandemic response (understaffing, lack of equipment and resources, failures in infectious disease protocols and facility leadership).

Review KFF’s website for the full briefing released on August 3, 2020, titled Key Questions About Nursing Home Regulation and Oversight in the Wake of COVID-19.

Nursing Home Abuse and Neglect Help Related to COVID-19 in Illinois

Unfortunately, the pandemic has put a magnifying glass to these many quality care failures of U.S. nursing homes. And due to the disastrous response to the pandemic by several owners and operators, the attorneys at Levin & Perconti have launched more than 150 investigations regarding gross negligence related to COVID-19 outbreaks in Illinois. As experienced attorneys with more than 30 years of representing victims or nursing home abuse and neglect, we know many of these concerns have existed for decades and see the updated KFF’s report as another affirmation that more needs to be done to protect our elder family members and friends who rely on this care.

If you have concerns about a facility’s infection control practices:

  1. Talk to the Director of Nursing or administrator as soon as possible.
  2. Share your feedback with an Illinois nursing home negligence attorney at Levin & Perconti and a local long-term ombudsman.
  3. Call the IDPH hotline to report issues related to COVID-19 infections at long-term care facilities. You can call the Department’s 24-hour a day toll-free hotline at 1-800-252-4343.

If you wish to make a complaint about an Illinois nursing home by calling the state’s toll-free hotline at 1-800-252-4343, we advise you to offer as much accurate and clear information as you can. Common reasons for filing a complaint would be any violation of a resident’s rights, abuse in any form, neglect, inadequate care, insufficient staff, unsafe or unsanitary conditions, dietary problems, harassment, or mistreatment. Be prepared to describe what occurred and limit comments to the facts briefly. You will need to identify dates, names, places, times, facility, and location(s) and who was involved, what happened and when it occurred, where it occurred, and how it occurred. Describe any physical or emotional harm incurred by the patient.

Consulting with a nursing home abuse and neglect lawyer at Levin & Perconti to is another way to provide support to your loved one and learn more about your legal options.

Chicago Attorneys Leading the Fight Against Nursing Home Abuse and Negligence

At Levin & Perconti, we have the experience and resources to investigate nursing home abuse and neglect claims in Illinois and are currently standing up to violators who choose not to protect residents and staff from harm caused by infectious diseases. We want to know if there are unsafe living or working environments, if departments are understaffed, and there are a lack of contagious disease resources and protections available to workers and residents.

If you are considering a legal case against an Illinois nursing home related to COVID-19 or want to share your story to help others, please contact us for a free consultation at 877-374-1417 or 312-332-2872. All calls and discussions with our attorneys are confidential.

Also read: COVID-19 Questions & Answers About Illinois Nursing Homes

Source: KFF, Key Questions About Nursing Home Regulation and Oversight in the Wake of COVID-19 (Retrieved August 9, 2020),

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