Trump-era limit on fines for nursing home safety lifted

As the Delta variant raises new concerns about the safety of nursing homes across the country, the Biden administration quietly rolled back a controversial Trump policy that had limited fines on facilities endangering or injuring residents.

Deaths in nursing homes, which peaked at the end of last year, have fallen since the introduction of the Covid-19 vaccines. They represent nearly a third of the total death toll from the American pandemic.

But insufficient staff, shortages of protective equipment and poor infection control remain concerns in the country’s 14,000 skilled nursing facilities, advocates and some officials say.

And although 81% of nursing home residents are vaccinated, only 58% of workers are immune, according to federal data, increasing the risk of an outbreak even among fully vaccinated elderly residents.

With the Delta variant behind the recent spate of cases, there are signs of a gradual increase in infections in nursing homes, especially among workers. The Centers for Disease Control and Prevention is also investigating the source of outbreaks in Colorado nursing homes where vaccination rates may be low.

The policy favoring weaker sanctions, adopted in 2017 by the Trump administration, ordered regulators at the Centers for Medicare and Medicaid Services to stop fining a nursing home for each day it was not meets federal standards. The relaxed policy reduced many penalties to a single fine, reducing amounts from hundreds of thousands of dollars to a maximum of $ 22,000.

The change – sought by the nursing home industry, a powerful lobby – was part of the Trump administration’s retreat from government regulations in many industries.

“This is the most obvious change made by the Trump administration,” said Toby Edelman, senior policy lawyer at the Center for Medicare Advocacy. “It’s a much, much lower penalty amount.”

Many of the nursing homes cited for poor infection controls, failing to protect residents from preventable accidents, neglect, abuse and pressure sores, are repeat offenders. Higher fines are a deterrent and are more likely to signal strict enforcement, Edelman said.

With little fanfare, the Biden administration revoked previous guidelines on the Centers for Medicare and Medicaid Services website in early July, saying it had “determined that the agency should retain discretion for the time being to impose a penalty per day where applicable to address specific circumstances of prior non-compliance. Under the new policy, regulators can impose penalties per day or per instance.

Consumer groups had challenged the policy in a federal lawsuit in January, arguing that the weakening of the app put residents at risk. The AARP Foundation, which filed the lawsuit with Constantine Cannon’s cabinet, applauded the Biden administration’s decision. Citing the lawsuit, Medicare officials declined to comment.

The industry’s leading trade group, the American Health Care Association and the National Center for Assisted Living, said in a statement that the fines imposed on a daily basis “only take valuable resources away from an industry already under- funded, especially during an unprecedented time when nursing homes need all the support they need to protect their residents.

But critics of the Trump policy say it offered a simple slap on the wrist for nursing homes, even those that were at the greatest risk of harming patients and workers. A year ago, a Washington state nursing home, the Prestige Post-Acute and Rehab Center at Kittitas in Ellensburg, experienced a major outbreak, where 52 residents and 43 employees were infected, according to an investigation. conducted for Medicare. Fifteen residents died.

The facility failed to meet infection control standards for more than a month, the investigation found, inadequately screening employees who fell ill and were potentially infected. A cook who told her immediate supervisor to be symptomatic was ordered to continue entering, while other employees, including a nurse and an aide, also continued to work despite their discomfort. Employees described random tracing attempts.

Federal regulators fined Prestige a total of $ 21,295 in March 2021, using the “per instance” penalty system. Had he been fined a day, the nursing home could have been penalized over $ 600,000.

Maureen McKinney’s husband, known as Buck, was one of the residents who died from the virus at home in July 2020. “I was just horrified,” she said when she learned of the fine.

Ms McKinney said she pushed state regulators to open an investigation after witnessing delays in testing and failures to isolate those who were sick, including when her husband’s roommate fell ill . “I decided I was going to be relentless about it,” she said.

Prestige Care, which is headquartered in Vancouver, Wash., And operates facilities throughout the western United States, said it relies on regulators “to properly set and enforce fines for citations, and we work with them to resolve issues. they quote.

The company added, “Losing members of our community is difficult under any circumstances, and the Covid-19 pandemic has amplified our deep sorrow over the patients lost to the virus.. “

When the Trump administration ordered regulators to impose fines on nursing homes per instance, the policy became the norm, said Kelly Bagby, senior counsel at the AARP Foundation. Lower fines have been imposed even in cases like the Washington state facility, where residents were in what is called “immediate risk”, at risk of serious harm.

“The corrosive effect of this change should be emphasized,” Ms. Bagby said.

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