The Nursing Home Industry Responds

Virginia’s long-term care facilities have come under close scrutiny during the COVID-19 epidemic, understandably so, considering that roughly 60% of all COVID-19 deaths in Virginia have afflicted patients living in long-term care facilities. The nursing home industry has remained remarkably quiet throughout the crisis. But yesterday I received a communication from Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association.

Bacon’s Rebellion has been pretty tough on the nursing home industry and its regulators, so I thought it fair and reasonable reasonable to re-publish Hewett’s communication. Here, after deleting prefatory material, is what she had to say. — JAB

As you know, the coronavirus is of a particularly voracious nature. Even with the best infection control, it can spread at nursing homes and assisted living centers, which require high-touch care such as feeding, bathing and dressing residents – especially given the frequency of asymptomatic spread. The people we care for are high risk – not just now, but always. Public health policy must reorient itself to our community’s needs so we can do everything possible to keep our residents safe.

That said, confirmed coronavirus cases account for just 6% of all residents in our care. Long-term care facilities are taking significant steps to prevent further spread. Despite the challenges we face, most residents and staff members who are diagnosed with the virus make a full recovery – many without hospitalization. With the proper resources, we can ensure even more positive outcomes.

I wanted to pass along a few items that I thought would be of interest to you:

  • The World Health Organization recently called on policymakers to ensure we are not leaving long-term care facilities and the high-risk population they serve behind – not just now, but in the long-term as we are transitioning to a new normal.
  • A study by Harvard reports that the location of a long-term care facility has much more bearing on whether cases occur than other characteristics, including “Five-Star Rating on Nursing Home Compare; whether or not a facility had a prior violation with infection; or whether it was for-profit, part of a chain, or having a high Medicaid census.” These factors had no correlation with whether the facility had cases of COVID-19, said the researchers.
  • That sentiment was echoed yesterday at a Senate hearing looking at senior care amid the COVID-19 crisis. Dr. Tamara Konetzka, a professor of health economics and health services research at the University of Chicago, submitted testimony for the record on the topic, concluding that “no meaningful relationship between nursing home quality and the probability of at least one COVID-19 case or death” at nursing homes.
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20 responses to “The Nursing Home Industry Responds

  1. “Public health policy must reorient itself to our community’s needs so we can do everything possible to keep our residents safe.” Well said. I could not agree more.
    Comments on this site, at least by me, have focused on the very poorly considered nursing home laws and regulations in this state and the demonstrable failures of oversight and inspection of nursing homes by the Virginia Department of Health, their state regulator and federal inspector. The communication above by Ms. Hewitt gives me hope that the nursing home industry will constructively engage to help improve – not just increase – regulations and oversight to ensure the health and safety of both their employees and their clients.

  2. re: ” A study by Harvard reports that the location of a long-term care facility has much more bearing on whether cases occur than other characteristics, including “Five-Star Rating on Nursing Home Compare; whether or not a facility had a prior violation with infection; or whether it was for-profit, part of a chain, or having a high Medicaid census.” These factors had no correlation with whether the facility had cases of COVID-19, said the researchers.”

    Clearly not the drumbeat in BR.

    I have a suggestion.

    When you do these fairly critical pieces – is there a way to get the other side to lay out it’s view?

    What happens here in BR, sometimes seems so one-sided that one does wonder if it really is objective… and that’s especially true when blame is assigned… before that happens – an article like this might provide some balance.

    I DO give BR – CREDIT for printing it – even if a little late in the process though that research is fairly recent.

    Oh, and did Wise Ralph do what Cuomo did with recovering COVID19 patients and send them to Virginia’s nursing homes? true? no true?

    • Larry, Larry, Larry … BR is a CONSERVATIVE piece.

      Forget your “When you do these fairly critical pieces – is there a way to get the other side to lay out it’s view?”.

      We can always expect to have your liberally biased postings (on EVERY subject … BR posting must be your full time activity). No need for James to do it for you.

      • John, John,John, John, John… geeze guy

        No – BR started out as a fairly middle of the road – leaned right -but fairly objective and it has veered further and further to the echo chamber pablum… so it does need a counter ….

        hey… in BR – if you disagree with the far right pablum – you ARE, by definition a “liberal”!

        I undertand “conservative” but some stuff here is just plain biased out the wazoo… it doesn’t even pass the smell test… anymore.

        BUT BUT BUT –

        Every now and then Bacon does get a wild hair and posts something fairly objective and unbiased – like this info on nursing homes, and heckfire after about a dozen close “hit” pieces, well.. just refreshing as all get out!

        And John… your love for Daughtery… have you noticed that she won me over on the prisons! ;-)… I guess I must be a Conservative now, on that issue, eh?

        • Wow! I missed that last point.

          OABTW, I’ve been reading BR a long time and guess I missed the past “fairly middle of the road” bit. Thanks for the enlightenment…

          Enjoy your posts even I usually disagree. Cheers!

  3. “It’s about where you are and not who you are,” said David Grabowski, PhD, professor of health care policy, Department of Health Care Policy, Harvard Medical School. “What we’re seeing in our data is it tends to be larger facilities—urban facilities in areas with more cases—that tend to be the facilities with COVID cases.”

    We won’t know if the Harvard study applies to Virginia until the CDC or the nursing homes release the numbers. Most Virginia nursing homes have not released information on the number of infections in their facilities, so there’s no way to look at where the outbreaks occurred or the nursing home history of deficiencies.

    VDH has changed their outbreak dashboard reporting, and they only show the number and category of outbreaks by health district, not the number of cases or deaths related to outbreaks within the categories. We only know that 58.75% of all COVID-19 deaths statewide are in nursing homes. (681 of 1159)

  4. cjbova says;

    “We only know that 58.75% of all COVID-19 deaths statewide are in nursing homes. (681 of 1159)”

    58.75% of all COVID-19 deaths statewide are in nursing homes. (681 of 1159). These are startling numbers that speak volumes as to the competency of state supervision of nursing homes, and the huge variance in death rates of Coved-19 between state supervised nursing homes, and most all other citizens in the state, save for those with severe co-morbitities.

    It’s a pity that the state didn’t, and perhaps does not even now, spend far more time and money on protecting elders in nursing homes, and far less time, trying to close down businesses while locking down everyone else. With each passing day, it becomes clear that the real pandemic going on here now is abuse of governance of citizens in far too many cases.

    This quote too from University of Chicago, its intricate word play, is telling too.

    “research at the University of Chicago, submitted testimony for the record on the topic, concluding that “no meaningful relationship between nursing home quality and the probability of at least one COVID-19 case or death” at nursing homes.’

  5. One case? What about the probability of multiple cases?

    It’s not that a case might happen, but where there is inadequate staffing and basic attention to handwashing, cleaning and supplies like soap seen in deficiency reports, it’s a recipe for widespread illness and deaths.

  6. well , this is fairly interesting :

    Analysis of the Relationship between Nursing Home Quality and Covid-191In the past month, we set out to assess on a broader scale whether the pattern of COVID-19 cases and deaths in nursing homes appears to be random or connected to nursing home quality. We used a sample of nursing homes from 12geographically diverse states.We merged data from the Nursing Home Compare archives (for 2020 star ratings and some nursing home characteristics) and LTCFocus4(for racial distribution and percent of residents on Medicaid as of 20172) with states’ publicly available lists of long-term care facilities with reported COVID-19

    We relied upon data released as of May 13, 2020, in twelve states that had released case counts and, of those, eight states that had released death counts. For the case analysis, we analyzed a total of 5,527 nursing homes, of which 36% had at least one case. For the death analysis, we analyzed 3,461 nursing homes, of which 29% had at least one death. We calculated the percent of nursing homes with at least one case or death4by Nursing Home Compare star ratings, profit status, and several resident characteristics.

    Our analyses revealed three key results:

    1.We found a strong and consistent relationship between race and the probability of COVID-19 cases and deaths(Figure 1). Nursing homes with the lowest percent white residents were more than twice as likely to have COVID-19 cases or deaths as those with the highest percent white residents.

    2.We found no meaningful relationship between nursing home quality and the probability of at least one COVID-19 case or death. We measure quality using the Nursing Home Compare overall star rating. On average we see only a marginally lower probability of cases for nursing homes with higher quality ratings(Figure 2). That overall finding masks considerable heterogeneity(Figure 3). In some states, such as Illinois, nursing homes with higher quality ratings (4 or 5 stars) were marginally less likely to have a case of COVID-19, but in other states, such as New Jersey, higher quality homes were marginally more likely to experience a case. Both the direction and strength of the relationship between star ratings and COVID-19 cases across and within states can best be characterized as inconsistent.The Nursing Home Compare overall star rating is derived from scores across three domains of quality: inspections, staffing, and clinical quality measures. The inspections domain is based on the results from roughly annual visits of state surveyors to each facility to monitor compliance with requirements for participation in the Medicare and Medicaid programs. This domain is weighted most heavily in the overall ratings and is often considered the most objective. While the inspections-domain rating is more predictive than the overall star rating, the magnitude of the difference is not practically meaningful. The staffing domain and the clinical quality measures domain are not predictive.

    3.We found no meaningful differences by profit status and only a weak relationship with Medicaid. We found no significant differences in the probability of COVID-19 cases by profit status, with for-profit nursing homes and not-for-profit nursing homes being equally likely to have cases(36%). A suggestive but weak relationship was found for the percent of residents on Medicaid, with nursing homes somewhat more likely to have cases if they were more dependent on Medicaid.

    https://www.aging.senate.gov/imo/media/doc/SCA_Konetzka_05_21_20.pdf

  7. Larry, nice cherry-picking.
    Did you miss:
    “Adequate staffing is essential to achieving any reduction in infection risks in nursing home settings.”
    This final comment in that paragraph, “Thus, technical assistance in the form of temporary “surge teams” may also be needed to assist with measures to stem transmission and care for residents who are criticallyill with COVID-19 may be necessary in many nursing homes,” fits the medical/academic assistance James Sherlock discussed yesterday.

    Another you overlooked: “Prior to the pandemic, inadequate infection control practices such as inadequate hand-washing and treatment of linens were the most commonly cited deficiencies by nursing home inspectors.Almost 40%of nursing homes were cited with inadequate infection control in 2017.5 Thus, technical assistance may be necessary to ensure training in best practices in infection control.”
    This fits more current Virginia deficiencies as well.

    • that’s the boilerplate Carol… did you see the results and conclusions:

      ” We conclude from this analysis that at least the standard quality measures do not distinguish which nursing homes ended up with cases and deaths. While some nursing homes undoubtedly had better infection control practices than others, the enormity of this pandemic, coupled with the inherent vulnerability of the nursing home setting, left even the highest-quality nursing homes largely unprepared.

      And yet, the patterns of infections and deaths are not random. Consistent with racial and socioeconomic disparities in long-term care historically and in pandemic-related deaths currently, nursing homes with traditionally underserved populations are bearing the worst outcomes.”

  8. This disease is sending us many, many messages we don’t want to hear and probably will not heed. One involves the wisdom and justice of warehousing the old and sick the way we do. Another involves our own self-destructive behaviors which are intricately tied up with the deaths in this case: obesity, lung damage from smoking (and yes, from air pollution), cardio-vascular issues from our fatty animal protein and sugar-laden diets. Yes, there are take-aways related to poverty we don’t want to hear. And the big one about government overreach and the willingness of the people to be herded like sheep into abandoning their liberty and turning on their neighbors. Orwell got that right.

    • “Our results suggest that nursing homes serving nonwhite residents are most vulnerable to this pandemic. Because people who need nursing home care usually want to stay close to home, nursing homes are often a reflection of the neighborhoods in which they are located. Nursing homes serving predominantly non-white residents are more likely to be located in predominantly non-white neighborhoods and to draw staff from those neighborhoods. As these are the neighborhoods and the people being most affected by the pandemic, nursing homes in these areas are also most at risk.”

      Steve – are you sure that poor folks have worst habits that the more wealthy or lack access to health care that would help them treat their disease?

    • Yes, as Steve suggests, now we are beginning to understand the nuances of the death rates here with Coved – 19.

      So one of the advantages of Coved-19 (versus the common flu) is that we can now far more plainly see the categories of people that this Coved-19 targets and hence those of the great majority of us that it overwhelmingly leaves alone and unscathed.

      Hence the professional and amateur scare mongers in the health profession, the main stream press and media, and the highly partisan left elite are far less able to scare Willy-nilly many of us now. Freedom at last, no longer useful idiots. Apply this now to the Daily Progress article on Northam and his masks that I highlighted earlier. For example, his suggestion that our children, like with the flu, are gravely threatened by Coved 19, and that they also gravely infect us adults, like as with the flu.

      Stop your damn fear mongering, you people.

    • If only we had ice floes.

    • What air pollution? In general, the USA air has probably not been this clean in the history. Diesels are conceivably problematic but at least our country was not as diesel-focus as Europe. Coal is a problem but going down fast.

  9. Reed, did you notice the new VDH dashboard tab for MIS-C?
    Multisystem Inflammatory Syndrome in Children with 2 Cases in Fairfax Health District.

    There has been a sharply rising increase in the number of cases reported for children 0-9 in the past month from 129 to 846. (possibly from increased testing?)
    MIS has some features of Kawasaki Disease (KD) and UCSD School of Medicine’s Kawasaki Disease Research Center is keeping up on it. “We have long suspected that there may be different triggers for KD based on individual genetics. The emergence of this new problem suggests that the new coronavirus, SARS-CoV-2, may be a trigger for some children to develop KD. ”
    Watch for this to become the new reason for further shutdowns, even though it relates to children with a genetic predisposition, and is a rare condition.

    I expect to see reports down the line that a genetic predisposition to some autoimmune conditions, rather than lifestyle choices, is the major factor in severe COVID-19 in pre-retirement age adults.

    • Carol. This last time I heard this it was an outlier abroad or New England, perhaps, a very small group, very rare, and what I said above is current on growing numbers of reliable websites, and authorities.

      You say I assume, “Watch for this to become the new reason for further shutdowns, even though it relates to children with a genetic predisposition, and is a rare condition.”

      I agree. I will look into it, and get back. There is obviously a full court press on to scare folks, you see this all over news media and new study claims, so caution is wise under all circumstances, as all of this has become highly politicized, though I have no reason to doubt 2 cases reported in Fairfax.

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