Dire conditions inside for‑profit nursing home chains contributed to deadly, early-pandemic conditions inside facilities, while “convoluted corporate structures” may have helped companies “obscure profits and avoid accountability,” according to a blistering report issued this morning by a congressional subcommittee.
The report found that many nursing homes were understaffed during the early days of the pandemic, exacerbating conditions and leading to “deficient care, neglect, and negative health outcomes.”
The report keys into workers’ allegations that managers at some of the nation’s largest for-profit chains intentionally kept staffing low and did not supply their workers with adequate personal protective equipment.
The Subcommittee of the Coronavirus Crisis launched an investigation that led to today’s report in June 2020, targeting the Centers for Medicare & Medicaid Services and the nation’s five largest for-profit nursing home companies.
A briefing held just before the investigation began included experts who testified that troubling business practices by for-profit nursing homes including intentional understaffing, low pay and lack of paid leave contributed to the severity of the COVID crisis.
Investigation results were released this morning, hours before a fresh panel of nursing home experts was expected to reexamine many of those issues, as well as others that have emerged during the nearly three-year old pandemic. That hearing begins at 2 p.m. ET.
Since the beginning of the pandemic, more than 200,000 staff and residents of long-term care facilities have died from COVID-19. Despite widespread availability of vaccines and treatments, outbreaks have continued to affect many facilities. While a federal vaccine mandate offered protection for a time, only 43% of staff and 57% of residents are up to date on their vaccines, according to CMS data.
‘Greed’ and ‘pressure’ questioned
Investigators in today’s report cited individual employees’ reactions in many instances to illustrate alleged patterns of wrongdoing by the for-profit companies investigated.
The release includes a selection of reports made directly to several major, for-profit nursing home chains from March through June 2020.
It said that many nursing homes “pressured staff to continue working despite having symptoms of or testing positive for the coronavirus — endangering nursing home residents and other staff.” Such stories “highlighted a pattern of nursing home management threatening to fire or retaliate against” employees that called in sick, the report said.
“I understand the building needs to save money, but I feel we are being over worked and taken advantage of so administration can save money and look good to corporate,” investigators quoted one employee as saying in a section addressing “corporate greed.”
Previously, witnesses warned the subcommittee that nursing homes faced a lack of COVID testing tools and personal protective equipment and were weakly overseen by CMS during the Trump Administration.
“Despite CMS’s broad legal authority, the agency has largely deferred to states, local governments, and for-profit nursing homes to respond to the coronavirus crisis,” Rep. James E. Clyburn (D-SC), subcommittee chairman, wrote at the time.
In addition to requesting information from CMS on its guidance and practices, the subcommittee demanded information from several larger, privately owned nursing home companies that together operated more than 850 facilities in 2020. They were:
- Genesis HealthCare
- Life Care Centers of America
- Ensign Group
- SavaSeniorCare
- Consulate Health Care
The subcommittee sought documents from each on cases and deaths, testing, personal protective equipment, staffing levels and pay, legal violations, and efforts to prevent further infections.
Since the investigation began, private ownership and private equity investors in particular have come under fire nationally. The Biden Administration called out the role of private equity in its Feb. 28 nursing home reform plan and in the State of the Union address.
The administration says that private equity’s investment in nursing homes ballooned from $5 billion in 2000 to more than $100 billion in 2018 — with about 5% of all nursing homes now owned by private equity firms.
The Government Accountability Office this spring began a separate investigation to assess the reach and impact private equity investments have had on the nursing home industry. That report is expected this fall.
The release includes a selection of reports made directly to several major, for-profit nursing home chains from March through June 2020.
It said that many nursing homes “pressured staff to continue working despite having symptoms of or testing positive for the coronavirus — endangering nursing home residents and other staff.” Such stories “highlighted a pattern of nursing home management threatening to fire or retaliate against” employees that called in sick, the report said.
For-profit operating tactics blamed
Investigators cited individual employees’ reactions in some instances to illustrate instances of or patterns of alleged wrongdoing by for-profit companies investigated.
“I understand the building needs to save money, but I feel we are being over worked and taken advantage of so administration can save money and look good to corporate,” investigators quoted one employee as saying in a section addressing “corporate greed.”
Drawing on data and reports it demanded from the target skilled nursing providers, the investigation also led to the conclusion that for-profit nursing home chains’ “use of convoluted corporate structures may have helped to obscure profits and avoid legal and regulatory accountability.”
The report noted that Genesis Healthcare had more than 700 discrete corporate entities as of June 2020, many of which acted as service providers to others within their family structure. In a press release this morning, the subcommittee included a complex drawing with layers of intermediaries between a building and its corporate owner, demonstrating just how difficult it can be to understand operations.
The subcommittee said the structures used by Genesis were consistent with those used by four other companies involved in the investigation, though it is important to note that at least Genesis and Consulate have gone through major leadership and organizational changes since 2020.
Experts have argued that regulatory penalties and publicly reported information about nursing home quality are assigned st the facility level, but the public has no easy way to understand the practices or infractions of managers or owners.
“Convoluted corporate structures may serve to shield nursing home chains from close scrutiny by the public, including residents and their family members,” Wednesday’s report said.
This is a developing story. Please check back for more details.
