(Bloomberg) -- One nurse caring for more than 30 patients. Hours- or even days-long waits for basic care. Threats against sick staff. These are some of the conditions described in a new congressional report examining several for-profit nursing-home chains in the early days of the pandemic.
The report by the House of Representatives’ Select Subcommittee on the Coronavirus Crisis examined five for-profit chains operating about 850 homes with 80,000 residents during the early months of the pandemic, drawing on complaints filed against the companies. About 70% of nursing homes in the US are run by for-profit operators.
Almost 160,000 nursing-home residents and more than 2,600 workers have died of Covid-19 as of Sept. 4, according to the Centers for Medicare and Medicaid Services. While the communal setting of nursing homes and the frailty of patients were a big factor, so were operators who cut corners and provided inadequate care, the subcommittee said.
Research has pointed to worse outcomes for patients at for-profit homes that are already grappling with soaring labor and supply costs, and severe staffing shortages. More than 300 homes have shuttered since the beginning of the pandemic, with more distress on the horizon.
The report said one patient waited four hours for water, while another wasn’t changed or cleaned for two days after vomiting on herself. Elsewhere, workers were asked to share personal-protection equipment, and homes pressured staff to work while sick with Covid symptoms or with positive test results. Others reported to work because they had no sick leave.
Opaque ownership structures that allow companies to shirk responsibility exacerbate these problems, the report said.
“These chains typically held each nursing-home facility through one or more operating companies that were separated from the ultimate parent by many levels of corporate intermediaries,” the report said -- in one case, 11.
Not only does that make it harder to track ratings and other quality measures, it can also mask the true financial picture at facilities, the subcommittee said.
There are also systematic inequities in care, with worse conditions at homes with a majority of Black residents, New York University professor Jasmine Travers said in testimony submitted to the subcommittee. Infections were 13.6 percentage points higher and deaths 3.5 percentage points higher in homes where at least 50% of residents were Black compared with homes where none were.
The subcommittee, which is headed by Democratic Representative James Clyburn of South Carolina, is holding a hearing on its investigation beginning Wednesday at 2 p.m. local time.
Adelina Ramos, a certified nursing assistant at a home in Rhode Island, said at one point she was responsible for 26 “extremely fragile” residents along with only one other CNA, a nurse and a housekeeper.
“My residents couldn’t eat or drink without help,” she said in her testimony. “They couldn’t move or get out of bed by themselves, and for many it takes two staff members to lift them out of bed. They all required oxygen changes every 15 minutes.”
Severe staff shortages have persisted, she said, as CNAs flee low wages and poor working conditions.
“One of my hardest days during 2020 was when one of my patients was slipping away and wanted me to sit at her bedside but I couldn’t stay because there were twenty other residents who also needed me,” Ramos said.
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