Congress examines ‘horrors’ at for-profit nursing homes, blames poor staffing

·4 min read
A corporate organization chart of Genesis Health provided to Congress showing more than 700 discrete entities. Critics say the byzantine structure can help companies skirt regulations and only serve to confuse consumers.
A corporate organization chart of Genesis Health provided to Congress showing more than 700 discrete entities. Critics say the byzantine structure can help companies skirt regulations and only serve to confuse consumers.

Nursing home staff shortages contributed to neglect and deficient care during the pandemic, according to results of a congressional probe into the owners of 850 for-profit nursing homes.

The findings echo ongoing reporting by USA TODAY that revealed how many people died at nursing home conglomerates that own hundreds of homes nationwide.

Investigation of nursing homes: DYING FOR CARE

The Select Subcommittee on the Coronavirus Crisis held a hearing Wednesday to discuss the reports and potential reforms with experts and nursing home staff.

Representatives pointed to the lack of paid sick leave as pressure for infectious workers to work and spread COVID.

“Paid sick leave for nursing home workers allow staff to take care of themselves and their families and to keep residents safe," said Rep. Carolyn Maloney, D-NY. "Shockingly many nursing homes don’t offer paid sick leave to their workers at all, it puts staff in an impossible situation.”

What did the committee highlight?

Understaffing has plagued nursing homes during COVID-19 both because of increased resident needs and staff illness. The five chains probed by the committee were particularly troubled. One singled out was SavaSeniorCare facility in Georgia, which had a single nurse for 35 residents on a shift.

The committee found nursing home chains did not supply their workers with adequate personal protective equipment and some required staff to work even if they were exhibiting coronavirus symptoms or testing positive.

A cook at a facility in the Midwest was found to have a 101-degree fever during a screening before entering and told, “to put a wet rag on her head before her temperature was taken again” and allowed to work.

In reviewing information from homes beginning in 2020, the committee and found a pattern of management threatening to fire employees if they called in sick, with some told not to share with their coworkers if they had tested positive for COVID-19.

Organization charts show confusing structures

Committee investigators received organization charts and business listings for five of the largest nursing homes chains that showed a byzantine structure they said could help the companies skirt accountability and serve to confuse consumers.

They highlighted Genesis HealthCare, still the nation’s largest home with more than 350 facilities in 26 states. A chart showed more than 700 discrete corporate entities related to Genesis.

In one case, the committee found a single Genesis nursing home facility owned by two corporate entities, which had 11 intermediate entities between the facility and the ultimate parent company.

In response, a spokeswoman for Genesis noted their staff "put their own lives at risk to care for their patients and residents."

"With that said, as one of the largest providers of skilled nursing care in the country... it is common practice for large companies to have varied entities and structures," said spokeswoman Lori Mayer.

LOOKUP: See how homes fared during COVID's winter surge, 2020-21

The committee noted that it found in its probe of Genesis, Sava, Ensign, Consulate and Life Care that the companies have undergone significant renaming and reorganization since 2020. Both Consulate and Ensign lease many, if not all, of their buildings from real estate investment trusts, which profit from contracts with guaranteed annual rent increases, according to data compiled by USA TODAY from public records.

What’s happening to change some of these problems?

The White House is preparing to use its executive authority to tighten industry regulations.

The Centers for Medicare and Medicaid Services is planning to issue new rules about mandatory minimum staffing in spring of 2023.

More: 'Permanent shock' to nursing homes? Facilities fail to replace workers who quit after COVID outbreaks

Representatives for the industry, including the American Health Care Association, say that without more funding, they face an impossible task of hiring and paying additional staff. Staff resignations during and since the pandemic have been particularly problematic.

“Our profession is facing historic staffing and financial challenges – due in part to inadequate Medicaid funding – which have left many facilities struggling to keep their doors open,” ACHA president Mark Parkinson said in preparation of Wednesday’s hearing. “Hundreds of nursing homes have closed as a result, and more will follow without additional support.”

Nick Penzenstadler is a reporter on the USA TODAY investigations team. Contact him at npenz@usatoday.com or @npenzenstadler, or on Signal at (720) 507-5273.

This article originally appeared on USA TODAY: Nursing homes failed at care in early months of pandemic, report says