Trump administration relaxing oversight of nursing homes

Washington, DC

THE Trump administration has been working to relax regulations governing America's nursing homes, including rules meant to curb deadly infections among elderly residents.

The main federal regulator overseeing nursing homes proposed the rule changes last summer, before the coronavirus pandemic highlighted the vulnerability of nursing homes to fast-spreading diseases.

The push followed a spate of lobbying and campaign contributions by people in the nursing-home industry, according to public records and interviews. The coronavirus has killed 13 residents at a nursing home in Washington state; dozens more residents and employees there have fallen ill.

Seeking to prevent further contagion, some states, including New York, have banned most non-medical personnel from setting foot inside nursing homes and other long-term care facilities, which nationally have about 2.5 million residents.

Last July, the federal Centers for Medicare and Medicaid Services, or CMS, set in motion a plan to weaken rules imposed by the Obama administration that required every nursing home to employ at least one specialist in preventing infections.

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The proposed rules - which the agency is completing and has the power to enact - eliminate the requirement to have even a part-time infection specialist on staff. Instead, the Trump administration would require that anti-infection specialists spend "sufficient time at the facility".

Critics say the proposed requirement is so vague that it would be essentially meaningless - and dangerous. "It adds up to less time, less infection control," said Anthony Chicotel, a staff lawyer for California Advocates for Nursing Home Reform.

He said the proposed change was "alarming." Attorneys general in 17 states have called the proposed rules a threat to "the mental and physical security of some of the most vulnerable residents of our states."

The White House referred questions to the Medicare and Medicaid agency. In an interview on Saturday, the agency's administrator, Seema Verma, said the proposed rule changes were not about easing up on nursing homes but "about not micromanaging the process". The proposed changes to the infection-prevention rules, she said, could actually result in a "higher level of staffing".

"We have to make sure that our regulations are not so burdensome that they hurt the industry," she said.

Ms Verma emphasised that the rules were still in the proposal stage and not yet complete. "We have to make sure that we get it right for the sake of patients," she said.

Infection-prevention specialists are supposed to ensure that employees at nursing homes properly wash their hands and follow other safety protocols. They are widely considered the front line for stopping infections, among the leading causes of deaths in nursing homes.

Each year, about 380,000 residents are killed by infections, according to the Medicare agency. Failure to prevent them is also the leading cause of citations that state inspectors bring against nursing homes.

The coronavirus has laid bare such problems, most starkly at the Life Care Center of Kirkland, Washington, where 13 residents have died after being infected with the virus, and more than a third of the facility's roughly 180 employees have contracted the illness. The Kirkland facility, which scored a top quality rating of five stars from the federal government, has had problems before.

In April 2019, the Medicare agency wrote it up for failing to "consistently implement an effective infection control programme".

In its report, the agency described the concerns of a resident's daughter, who said that nurses allowed her mother's heel, which had an open wound, to touch the ground, calling the practice "unhygienic".

The agency found that the facility's shortcomings put residents "at risk for harm and transmitting/acquiring infections". The agency, which levied a US$67,000 fine, said the problems were quickly fixed.

In recent weeks, nursing home operators nationwide have been cracking down on visitors. Ronald Silva, whose company manages two dozen nursing homes in Indiana and Georgia, said his facilities began screening all workers and vendors three weeks ago. The Centers for Medicare and Medicaid Services provided new guidance for nursing homes this month, telling inspectors to scrutinise whether employees were following key safety precautions, like regularly washing their hands.

Vice President Mike Pence echoed that guidance, emphasising that all federal inspectors should focus, at least for now, on making sure that facilities are working to prevent and control infections.

"We're going to put all inspection resources, at the state level, focused on infectious disease, looking at nursing homes being a focal point of vulnerability and a vulnerable population," Mr Pence said at a press briefing on March 3.

Mr Pence did not mention the Trump administration's proposals to relax the Obama-era rules.

The proposed changes are part of a broader effort by the Trump administration to unfetter businesses from regulations. In the case of nursing homes, relaxed regulations are projected to save the industry about US$640 million a year, according to estimates from the Centers for Medicare and Medicaid.

In its first year, the Trump administration changed how nursing homes were fined when they violated rules. Previously, they were typically penalised for every day in which a violation persisted. But the agency changed the guidance for inspectors, encouraging them to hand out a single fine - rather than a series of daily penalties - for most infractions.

Under the Trump administration, the average fine imposed on a nursing home has dropped more than 30 per cent from US$41,260 to US$28,405, according to an analysis of federal data by Kaiser Health News.

A spokeswoman for the nursing home trade group said that loosening the requirement to have an infections specialist on staff would allow facilities to "provide greater flexibility to meet" to thwart infections. NYTIMES