After pandemic of ravaged nursing homes, new state laws protect residents

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When the coronavirus hit Martha Leland’s nursing home in Connecticut last year, she and dozens of other residents contracted the disease while the facility was on lockdown. Twenty-eight residents have died, including her roommate.

“The impact of not having friends and family come to see us for a year has been totally devastating,” she said. “And then the staff all got attached with the masks and shields, that too was very difficult to accept.” She summed up the experience in one word: “scary”.

But under a law Connecticut enacted in June, nursing home residents will be able to designate an “essential support person” who can help care for a loved one even in a public health emergency. Connecticut lawmakers also passed laws this year giving nursing home residents free access to the Internet and digital devices for virtual tours and allowing video cameras in their rooms so family or friends can monitor. their care.

Similar benefits are not required by the Centers for Medicare & Medicaid Services, the federal agency that oversees nursing homes and pays for most of the care they provide. But states may impose additional requirements when federal rules are insufficient or do not exist.

And that’s exactly what many are doing, spurred on by the virus that has hit frail older people the hardest. In the first 12 months of the pandemic, at least 34% of those killed by the virus were residents of nursing homes and other long-term care facilities, even though they represent less than 1% of the population. American population. The vaccine has since reduced virus-related deaths in nursing homes to about 1 in 4 covid-related deaths in the United States, which has risen to more than 624,000, according to the New York Times coronavirus case tracker .

“Part of what the pandemic has done is expose some of the underlying problems in nursing homes,” said Nina Kohn, professor at Syracuse University School of Law and a leading elder law scholar at the Yale Law School. “This may present an opportunity to correct some of the long-standing problems and reduce some of the major risk factors for neglect and abuse. “

According to a review of state law, 23 geographically and politically diverse states have adopted more than 70 pandemic-related provisions affecting nursing home operations. States have set minimum staffing levels for nursing homes, expanded visitation, mandatory access for residents to virtual communications, full-time nurses required at all times and infection control specialists, limited benefits for homeowners, increased room sizes, limited occupancy of two-person rooms, and improved emergency response plans.

The patchwork of state protection for nursing home residents is built into the country’s nursing home care regulatory system, a CMS spokesperson said. “CMS defines the minimum requirements that providers must meet to participate in Medicare / Medicaid programs,” he said. “States can implement additional requirements to meet specific needs in their state – which is a long-standing practice – as long as their requirements go beyond and do not conflict with federal requirements. “

Julie Mayberry, an Arkansas state representative, remembers a resident of a nursing home in her district who stopped dialysis last summer, she said, and simply said “Abandoned” because he could not live “in such an isolated world”.

“I don’t think anyone would have ever dreamed that we would tell people that they can’t bring someone in to check them out,” said Mayberry, a Republican and the main sponsor of the “No patient left alone, An Arkansas law ensuring that residents have a lawyer at their bedside. “It’s not someone who comes just to say hello or bring a recovery card,” she said.

When the pandemic struck, CMS initially banned visitors from nursing homes, but allowed facilities to allow visits during the lockdown for “compassionate care,” initially if a family member was on the move. to die and later for other emergencies. These rules have often been misunderstood, Mayberry said.

“Many retirement homes have told me that they are really afraid to allow a visitor in because they fear the state of Arkansas will fall on them and fine them for violation.” of the federal directive, she said.

Jacqueline Collins, a Democrat who represents Chicago chapters in the Illinois State Senate, was also concerned about the effects of social isolation on nursing home residents. “The pandemic has exacerbated the issue and served to expose this vulnerability among our long-term care facilities,” said Collins, who proposed legislation to make virtual tours a permanent part of nursing home life in. create a lending library of tablets and other devices residents can borrow. Governor JB Pritzker is expected to sign the measure.

To reduce the cost of the equipment, the Illinois Department of Public Health will provide grants from funds the state receives when nursing homes resolve health and safety violations. Last year, the Connecticut governor used the same fund in his state to purchase 800 iPads for nursing home residents.

Another issue that states are grappling with is staffing levels. a New York Attorney General’s investigation found that covid-related death rates from March to August 2020 were lower in nursing homes with higher enrollments. Studies over the past two decades confirm the link between quality of care and staffing levels, said Martha Deaver, president of the Arkansas Advocates for Nursing Home Residents. “When you cut staff, you cut care,” she said.

But under a 1987 federal law, CMS requires that facilities only have sufficient nursing staff to achieve or maintain the best possible well-being for each resident. Over the years, states have begun to tighten this vague standard by establishing their own staffing rules.

The pandemic has picked up the pace and created “a moment for us to draw attention to state lawmakers and demand change,” said Milly Silva, executive vice president of 1199SEIU, the union that represents 45 000 nursing home workers in New York and New Jersey.

This year, states have increasingly established either a minimum number of daily direct care hours for each resident or a nurse-to-resident ratio. For eight residents, New Jersey nursing homes are now required to have at least one certified nursing aide during the day, with further minimums during afternoon and night shifts. Rhode Island’s new law requires nursing homes to provide a minimum of 3.58 hours of daily care per resident, and at least one registered nurse must be on duty 24 hours a day, every day. Next door in Connecticut, nursing homes are now required to provide at least three hours of daily direct care per resident next year, one full-time infection control specialist and one full-time social worker per 60 residents.

To ensure that facilities do not derive excessive profits from the government payment they receive for caring for residents, New Jersey lawmakers have approved a requirement that nursing homes spend at least 90% of their income. their income to direct care. New York establishments must spend 70%, including 40% to pay direct caregivers. In Massachusetts, the governor issued regulations that require nursing homes to spend at least 75% on direct care personnel costs and cannot have more than two people living in a room, among other requirements.

Despite efforts to improve the protection of nursing home residents, the mishmash of unequal state rules is “a poor substitute for comprehensive federal rules if they were rigorously enforced,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group. . “The piecemeal approach drives and exacerbates existing disparities in health care,” he said. “And it puts people – regardless of wealth, race or gender – at even greater risk of ill-care and inhumane treatment. “

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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