A Plan to Protect Hoosier Senior Care Facilities: Improving Safety and Protection and Increasing Testing

May 21, 2020

COVID-19, the illness caused by the novel coronavirus, is devastating our senior population in nursing homes and long-term care facilities throughout the nation and here in Indiana. Governors in other states have been forthcoming with communications about long-term care facility outbreaks, while Governor Holcomb has refused to disclose this information that could be of enormous help to Hoosier families. He claims releasing the names of long-term care facilities with coronavirus deaths would violate the state’s relationship with private businesses it regulates.[i] Still Hamilton County Health Department started releasing this information weeks ago and has committed to reporting nursing home coronavirus cases and deaths on a weekly basis and other county health departments are also reporting this data.[ii] Hamilton and other county health departments now stand with 36 total states that are also voluntarily disclosing this data, including nine states providing comprehensive reporting of cases and deaths in long-term care facilities.[iii] If all these states can report this information, why can’t Indiana?

Despite Governor Holcomb’s refusal to release the names of the nursing homes and long-term care facilities that have patients and staff infected with the coronavirus, the Centers for Disease Control and Prevention (CDC) is now collecting this information on a weekly basis and plans to release it to the public later this month.[iv] Additionally, the CDC has released new and detailed guidance that Indiana nursing homes and long-term care facilities should follow.[v] If the federal government believes this information is important for the public to know, why doesn’t Governor Holcomb?

As of May 21, 2020, Indiana reported a total of 3625 COVID-19 infections and 732 deaths in our nursing home and long-term care facilities. Over 75 percent of COVID-19 deaths in Indiana are to Hoosiers over the age of 70.[vi]

Governor Holcomb has taken campaign contributions valued at nearly $100,000 from nursing home operators since 2016.[vii] Money talks, or in this case, pays for silence. Both the Governor and the Indiana Health Care Association/Indiana Center for Assisted Living claim established communication protocols between a facility and its residents and their representatives for routine health issues are appropriate during the pandemic.[viii] However, their combined unwillingness for full transparency limits Indiana’s ability to address the present crisis and to prevent more outbreaks across our entire senior care system. There are Hoosier lives at stake. As families consider care options for their loved ones, it should be easy for a Hoosier family to learn about the COVID-19 status of any Indiana licensed health or residential facility.

The coronavirus doesn’t discriminate. Our nursing homes and other licensed health and residential facilities are acutely vulnerable to widespread virus transmission no matter who owns and operates them or what the facility’s quality rating was prior to the pandemic. However, previously Indiana ranked last in the nation for long-term care provided to seniors and people with disabilities based on a study that looked at affordability and access, choice of setting and provider, support for family care, quality of life care and quality of care, and effective transitions.[ix] This is all the more reason for Indiana to align itself with other states that have been outpacing us for years in making necessary improvements in this area. Refusing to disclose nursing home data is just another example of where we fall behind.

The federal government classifies nursing homes and long-term care facilities below hospitals. This has contributed to testing delays and inadequate access to appropriate personal protective equipment (PPE).[x] Access to PPE is essential to safeguard health care workers and patients alike. Indiana needs a more comprehensive approach to protecting its vulnerable nursing home population that includes more testing and better communication and a leadership team prepared to effectively manage this crisis.

Nursing homes remain a huge problem for Indiana. The state and local health departments, with the assistance of statewide associations representing the facilities, should lead the planning for the upgraded responses now required in each facility to save lives.

As Governor, I’d:

  • Communicate detailed information about coronavirus cases and deaths, both for patients and staff in the Indiana senior care system that includes nursing homes, long-term care facilities, rehabilitation facilities, long-term and residential care homes, and retirement and senior living communities to the public on a daily basis.
  • Publish a list by county of those facilities that have adopted and fulfilled the new Centers for Disease Control and Prevention (CDC) guidelines.[xi]
  • Establish an immediate pipeline to recruit caregivers to address staffing shortages in our nursing homes and long-term care facilities, as the AARP has recommended to the federal government and states.[xii]
  • Develop a comprehensive, statewide reporting system to ensure appropriate staffing levels throughout Indiana’s nursing homes and long-term care facilities and offer triaged assistance when staffing falls below these levels.
  • Increase accessibility and availability of testing for patients and staff across Indiana’s entire senior care system, as the CDC recommends before allowing visitation to resume. West Virginia mandates testing for all nursing home patients and staff.[xiii]
  • Deny blanket lawsuit protection for nursing homes or long-term care facilities that would shield them from lawsuits stemming from negligence in this health crisis. Partial immunity from legal liability should only be considered on a limited case basis when a nursing home and/or long-term care facility acted in good faith to ensure proper infection controls and staffing were in place but either was intentionally prohibited or denied by the state or local government. The interests of patients should be placed ahead of the financial interest of providers.
  • Ensure our senior care facilities have access to medical-grade personal protective equipment to safely diagnose and treat infected patients, as the CDC recommends.
  • Expand telemedicine and virtual medicine capabilities to maintain continuum of care for elderly patients, while minimizing risks to caregivers.
  • Create regional COVID-only skilled nursing facilities to support care and recovery for elderly patients infected with the virus to prevent spread and to eliminate the need to isolate those infected – similar to a plan being implemented in some Massachusetts and Connecticut nursing homes.[xiv]

The $2 trillion federal coronavirus stimulus bill includes $200 million for the Centers for Medicaid and Medicare Services (CMS) to increase infection-control measures in nursing homes nationwide.[xv] Additionally, the bill includes $100 billion to provide grants to our health care system providers, including Medicare and Medicaid enrolled suppliers to cover reimbursement costs associated with care and expenses related to the coronavirus pandemic.[xvi] As Governor, I’d ensure federal reimbursements Indiana receives for nursing homes go toward funding the significantly enhanced response the pandemic requires. There are federal funds available to make the improvements I’m proposing in this plan, so we can avoid the need to raise taxes.

Although coronavirus can be deadly for anyone it infects, it’s particularly dangerous for seniors who are more likely to have underlying medical conditions. It’s a unique threat to our senior care system requiring full transparency for us to effectively manage the coronavirus crisis and eventually to overcome it. We can’t save every Hoosier, but with more and better communications and aggressive action we can save many more. As Governor, I’ll always put people before politics.

[i] “Hamilton County releases list of nursing homes with COVID-19 deaths,” WISHTV.COM8, April 30, 2020

[ii] Ibid and “The Most Vulnerable: 10 deaths reported at nursing home as county releases data on facilities,” Daily Reporter, May 12, 2020.

[iii] States Reporting of Cases and Deaths Due to COVID-19 in Long-Term Care Facilities, KKF, April 23, 2020

[iv] “Nursing Home COVID-19 Reporting Rules To Be Strengthened,” NPR, April 20, 2020

[v] Preparing for COVID-19 in Nursing Homes, Centers for Disease Control and Prevention

[vi] Indiana State Health Department, Indiana COVID-19 Data Report

[vii] ‘Reeks of cronyism’: Indiana still hiding nursing home coronavirus info, advocates say,” May 1, 2020, IndyStar

[viii] Guest Viewpoint: Association addresses long-term care resident and representative notifications (Indiana Health Care Association President), The Herald Bulletin, May 1, 2020

[ix] Long-Term Care Services and Supports State Scorecard, AARP Foundation, The Commonwealth Fund, and The Scan Foundation, 2017

[x] Ibid.

[xi] Preparing for COVID-19 in Nursing Homes, Centers for Disease Control and Prevention

[xii] “N.J. Nursing Home COVID-19 Deaths Speak to National Crisis in Facilities, AARP, April 17, 2020

[xiii] “Inside One State’s Plan for Mandatory COVID-19 Testing at Nursing Homes – and How Others Can Follow,” Skilled Nursing News, April 22, 2020

[xiv] In The Time Of COVID-19, We Should Move High-Intensity Prostate Care Home, Health Affairs, April 22, 2020

[xv] “Coronavirus Stimulus Bill Includes $200M for CMS Infection-Control Efforts At Nursing Homes and $100B in Health Grants,” Skilled Nursing News, March 25, 2020

[xvi] Ibid.

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