Senate Democrats on Friday urged the CMS to step up its regulations for nursing homes after recent hurricanes led to patient deaths.
In an investigative report, Senate Finance Committee Ranking Member Sen. Ron Wyden (D-Ore.) and his colleagues called for significant new requirements including a new "safe and comfortable temperature standard" for long-term-care facilities and mandatory back-up power systems that can maintain that temperature.
A dozen patients died of heatstroke at one Florida nursing home after Hurricane Irma swept through the area in 2017 and knocked out power. An additional 118 people were evacuated from the facility for emergency treatment for dehydration, heat stress and other conditions brought on by the extreme heat, as attendants moved fans into the rooms and tried to keep the patients replenished with ice and water. The facility ended up running out of ice.
The committee Democrats also want to see more federal involvement in emergency plans, nursing home evacuations and rules for when administrators decide when to keep residents "sheltering in place" during a natural disaster or when to evacuate them.
In the end, Hollywood Hills temporarily lost its Medicaid funding and operating license.
Along with the new temperature standard, the Democrats advised banning the use of spot coolers like electric fans as a way to maintain the mandatory temperature. The lawmakers also urged federal, state and local regulators to coordinate with electricity companies to put nursing homes on the priority list for power restoration during heat emergencies.
The report also highlighted investigations into dozens of Texas nursing homes that kept residents in the flooding facilities during Hurricane Harvey last year.
As record-breaking rains battered southwestern Texas, a photograph of elderly people in nightgowns and wheelchairs "sheltering in place" waist-deep in murky, debris-filled water went viral. They were awaiting air rescue out of La Vita Bella nursing home in Dickinson, Texas.
But the Senate investigation also blasted Senior Care Centers, a company that owns 92 nursing homes across the state. Senior Care Centers staff at the "facility and corporate level" as Hurricane Harvey battered the state's south and southwest regions decided not to evacuate the elderly in their care despite warnings of catastrophic flooding.
At one Senior Care Center facility—Lake Arthur Place nursing home—a volunteer pulled a gun on the facility's director to try to force him to evacuate the residents. When police arrived, they backed him up, handcuffing the director who refused to help with the evacuation.
A sworn affidavit from a police officer who arrived by boat to check on the facility states that water was 10 to 12 inches deep "throughout the entire facility" and that there was a "strong odor of human feces and urine."
Some patients remained in their rooms, while others sat in hallways. The people in wheelchairs had "their lower extremities submerged in flood waters."
The CMS' Office of Inspector General warned in a 2006 report after a barrage of hurricanes that nursing homes in the Gulf Coast states failed to effectively plan for emergencies. A follow-up in 2012 concluded that a growing number of nursing homes were falling behind in compliance with existing standards.
In 2016, the CMS finalized new rules for emergency preparedness but the date for compliance wasn't set until two months after Harvey and Irma hit. The agency also finalized a set of reforms for long-term-care facilities.
"While the hurricanes examined in this report occurred before these new emergency requirements and regulations took effect, the investigation found major gaps and insufficiencies in the regulatory approach taken by CMS," the Senate Finance Committee report states. "Furthermore, more than a year after these hurricanes made landfall, CMS has failed to revise its emergency preparedness guidance, which it told the Minority staff it would do."
