2:13 PM CT on 6/15/20
(AP) A grim blame game with partisan overtones is breaking out over COVID-19 deaths among nursing home residents, a tiny slice of the population that represents a shockingly high proportion of Americans who have perished in the pandemic.
The Trump administration has been pointing to a segment of the industry — facilities with low federal ratings for infection control — and to some Democratic governors who required nursing homes to take recovering coronavirus patients.
Homes that followed federal infection control guidelines were largely able to contain the virus, asserts Seema Verma, head of CMS, which sets standards and pays the bills. "Trying to finger-point and blame the federal government is absolutely ridiculous," she says.
Verma says data collected by her agency suggest a connection between low ratings on safety inspections and COVID-19 outbreaks. But several academic researchers say their own work has found no such link.
Advocates for older people say the federal government hasn't provided needed virus testing and sufficient protective gear to allow nursing homes to operate safely. A White House directive to test all residents and staff has been met with an uneven response.
"The lack of federal coordination certainly has impeded facilities' ability to identify infected persons and to provide care," Eric Carlson, a long-term care expert with the advocacy group Justice in Aging, told lawmakers. "That absence remains important as facilities are attempting to open up, which requires an extensive reliance on testing."
Democrats are critical of the Trump administration response.
"We need action," says Sen. Bob Casey, D-Pa. "We need a plan from CMS and we need resources to stop the spread of COVID-19 in nursing homes."
With more coronavirus legislation possible this year, congressional Democrats are pressing for a national testing plan and additional resources for nursing homes. Republicans are mainly seconding the administration's arguments.
During a recent briefing for lawmakers, Rep. Steve Scalise of Louisiana, the No. 2 House Republican, blamed New York Democratic Gov. Andrew Cuomo for the high numbers of deaths in his state. A since-rescinded state directive that nursing homes had to accept recovering coronavirus patients "ended up being a death sentence" in New York and several states with similar policies, Scalise said.
Scalise echoed earlier, less forceful, comments from CMS head Verma, who has said such state orders were "not appropriate" and "may have contributed to this issue as well."
But Harvard researcher David Grabowski, who serves on a nonpartisan commission advising Congress about Medicare, says neither state policies, nor "bad apples" among nursing homes, have driven the outbreak.
Instead, Grabowski says it's simpler: Because the virus can be spread by people who show no symptoms, that means if it's already in a community, the staff can unwittingly bring it into the nursing home. Once inside it easily spreads among frail residents living in close quarters.
"The secret weapon behind COVID is that it spreads in the absence of any symptoms," Grabowski told lawmakers at a recent briefing. "If COVID is in a community where staff lives, it is soon to be in the facility where they work."
He proposed a federal effort to regularly test nursing home staff and residents, along with greater supplies of masks, gowns and other protective gear.
"The federal government needs to own this issue," said Grabowski.