Congressional investigators pinned for-profit skilled nursing operators into a corner Wednesday, releasing a scathing report describing “dire” conditions caused by alleged lack of preparation and mismanagement in the first three months of the pandemic.

But providers — especially the five large chains singled out for criticism — were having none of it. 

Along with the Centers for Medicare & Medicaid Services, the House Subcommittee of the Coronavirus Crisis singled out the following large chains for withering criticism after examining the companies’ records and interviewing a variety of employees:

  • Consulate Health Care 
  • Ensign Group
  • Genesis HealthCare 
  • Life Care Centers of America 
  • SavaSeniorCare  

The chains collectively operated more than 850 skilled nursing facilities charged with the care of more than 80,000 residents as of June 2020. Each experienced “significant” coronavirus outbreaks. 

The subcommittee examined the period from March to June 2020, one of the most bewildering, dangerous times in U.S. history.

Some 35% of all COVID-19 deaths and infections disproportionately involved nursing home residents and staff early in the pandemic. The congressional investigators said at least some of the carnage could have been averted had facilities had better infection control plans, practices and products in place. The report also harshly viewed what authors described as convoluted corporate ownership structures.

Report disputed

Companies and their executives told McKnight’s Long-Term Care News that researchers were selective in their reporting, had skewed data and generally revealed a lack of perspective.

Ensign Group CEO Barry Port

“While we appreciate the goal of the subcommittee in their examination of the COVID-19 experience specific to the skilled nursing industry, we are certainly disappointed in what we believe to be an incomplete presentation of the information produced to them from our organization,” said Ensign CEO and Director Barry Port in an email to McKnight’s. “For example, the ‘Selected Reports’ isolated by the subcommittee and attached to its press release are silent on the results of the investigations into the subject allegations involving Ensign-affiliated entities, the majority of which were unsubstantiated. Further, none of the claims of inadequate PPE were validated. While we specifically asked the Subcommittee to disclose the outcomes in conjunction with the allegations, they elected not to do so.”

Ensign has grown by leaps and bounds during the pandemic and how operates in 259 facilities in 13 states.

“We are proud to be part of an industry that is full of kind, committed, competent and caring people who worked tirelessly to serve and protect facility residents and each other during one of the most significant health-related events in our history,” Port said.

Investigators took Genesis to task for its complex corporate structure in particular, even publishing an illustration of its many-layered hierarchy. Genesis spokeswoman Lori Mayer said Wednesday such complexity is natural for a company of its size.

“As the COVID-19 pandemic took siege across the United States, we were on the frontlines providing essential guidance to those heroes who put their own lives at risk to care for their patients and residents,” Mayer said. “We thank them for their dedication and compassion. With that said, as one of the largest providers of skilled nursing care in the country — providing services within more than 200 affiliated locations, it is common practice for large companies to have varied entities and structures.”

Conflicting official advice

A spokeswoman for SavaSeniorCare noted that the Coronavirus Crisis subcommittee formally requested information, including complaint logs, from the five companies in June 2020. She noted that her company’s compliance hotline diligently tried to keep up with responses to family members and others concerns and submitted full copies of call logs, which in some cases included allegations and complaints.

“In each instance, the allegations were investigated and, in many cases, the allegations were not substantiated.  If allegations were substantiated, in whole or in part, the compliance team took steps to ensure that corrective action was taken and monitored,” said Annaliese Impink, spokeswoman for SavaSeniorCare Administrative and Consulting LLC.

“Our compliance team and our center, district and division team members did their best to respond to these calls as quickly as possible,” Pink added. “The [subcommittee] press release that was issued on September 21, 2022, regarding these complaint logs does not acknowledge what steps Sava took to address the noted concerns. Instead, the press release implies that the complaints are factually accurate.”

In fact, this was not always the case, she said, especially in the uncertain days in the first six months of the pandemic, when official guidance varied often.

“For instance, the Committee’s press release highlights allegations from a staff member indicating that they were supposed to wear the same mask for 7 days,” Pink noted. “However, that was, in fact, the guidance that was released directly from the [Centers for Disease Control and Prevention] early on in the pandemic due to severe PPE shortages across the country.  Providers were doing their best to maintain staffing levels, provide necessary PPE, and comply with the array of often conflicting guidance from federal, state and local agencies. Our staff and our leadership gave of their time freely and unconditionally, many times spending hours and days away from their own families to assure that residents were getting the care they needed.”

A spokeswoman for Life Care Centers of America said she expected the company to respond to the subcommitte’s inflammatory report after its accompanying subcommittee hearing Wednesday afternoon. But McKnight’s had not received LCCA’s response by production deadline later that night.

Inquiries to a legal representative and an executive with Consulate Health Care did not produce a response as of late Wednesday.

‘Nearly every nursing home struggled’

Major long-term care associations, meanwhile, defended provider efforts during that period, when PPE shortages around the world were rampant and the first vaccines were still more than six months away.

“This report focuses on the early stages of the pandemic when every long-term care provider in the country was pleading for public health agencies and policymakers to send aid to the frontlines and prioritize our nation’s most vulnerable population,” said American Health Care Association President and CEO Mark Parkinson in a statement Wednesday. “It’s unfortunate that we need to remind lawmakers what those early days were like. No matter the business structure, nearly every nursing home in the country struggled with acquiring personal protective equipment due to supply chain disruptions, testing due to limited supply, and additional staff support due to most government support being directed toward hospitals.”

Circumstances have changed significantly from the early days, when governmental responses were slow or muddled, supply chain difficulties dominated and less was known about COVID-19, Parkinson added.

“Once long-term care received the aid we had been pleading for and public health agencies prioritized our nation’s most vulnerable for life-saving vaccines, we saw tremendous progress in reducing cases and deaths,” he noted. “However, serious challenges remain, including a historic labor crisis. If we want to learn from this pandemic, we need to focus on these larger issues that are faced by all nursing homes.”

LeadingAge, an association for nonprofit providers and housing organizations, did not comment directly on the report ripping its for-profit colleagues. But it did issue a statement Wednesday that addressed related criticisms of the sector from the affiliated House Select Subcommittee’s hearing on the impact of the coronavirus in nursing homes.

“For decades, our country’s long-term care system has failed older adults and the aging services providers who care for them,” said LeadingAge President and CEO Katie Smith Sloan. “Never was that failure more catastrophic than during the COVID public health emergency’s early days.”

Providers “begged” for help with critical resources such as PPE, tests and increased support for staff. Instead, PPE and aid promised by the federal government arrived weeks and sometimes months late, and often it was in disrepair, Sloan said. 

“It’s time to fix our country’s broken system of financing, oversight and support for nursing homes,” she concluded.