While the deadly coronavirus seems to be subsiding in Connecticut for now, its impact on nursing homes has not. More than 6,700 beds are empty, and it may take many months of financial struggle before occupancy climbs back to pre-pandemic levels. Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for low-income people, only 15 were 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less. While the statewide average decline was 15%, the number of residents in 19 nursing homes has plummeted to 55% and below since January.
As coronavirus cases increase, posing heightened risks to the elderly, nursing homes will face growing scrutiny from state health inspectors. In Connecticut and nationally, complying with federal infection-control requirements is a challenge for some nursing homes. Between 2017 and 2019, 145 of Connecticut’s 217 nursing homes – or about 67 percent – were cited for infection-control violations, according to a Conn. Health I-Team analysis of data from the Centers for Medicare & Medicaid Services (CMS). (View list of nursing homes cited below).
With tougher standards, 48% of the state’s nursing homes—104 facilities—received a four- or five-star rating for staffing, data from the Centers for Medicare & Medicaid Services (CMS) show. Thirty-nine nursing homes (19%) earned a one- or two-star rating for staffing levels. Nursing Home Compare’s five-star system (5 being “much above average,” 4 “above average,” 3 “average,” 2 “below average” and 1 “much below average’) examines quality of care delivered, staffing and overall performance, among other factors. It gives consumers the ability to compare quality among facilities. CMS updated the rankings in April, following the release of new payroll data that gives insights into nursing home staffing trends.
In 2018, the state took the unusual step of issuing a consent order requiring a New Haven nursing home to hire an independent nurse consultant and implement minimum staffing ratios after inspections at the facility uncovered numerous lapses in care and safety violations. The order, agreed to in April by the Advanced Center for Nursing and Rehabilitation and the state Department of Public Health (DPH), tasked the independent nurse consultant with assessing the staff’s ability to do their jobs and evaluating how care is delivered. The minimum staffing ratios ordered are 30 patients to one licensed nurse on all shifts, on most units; 10 patients to one nurse’s aide on the first shift; 12 patients to one nurse’s aide on the second shift; and 20 patients to one nurse’s aide on the third shift. Officials at the facility didn’t return calls seeking comment. It isn’t often that DPH mandates staffing or requires nursing homes to hire consultants, but the order reflects a broader emerging problem affecting the care provided at many nursing homes: insufficient staffing levels and caregivers who lack training.
Most Connecticut nursing homes will see their Medicare reimbursements reduced in the coming year for having high resident readmission rates to hospitals. Of Connecticut’s 224 nursing homes, 75 percent (168) are being penalized by Medicare based on how often their residents were re-hospitalized within 30 days of discharge. Twenty-five percent (56) in Connecticut are receiving bonuses for having few readmissions, according to a Kaiser Health News (KHN) analysis of data from the Centers for Medicare and Medicaid Services (CMS). This is the first time nursing homes are being penalized or rewarded based on how many of their residents are readmitted to hospitals for conditions that could have been prevented. Medicare has administered a similar program for hospitals since the 2013 fiscal year.
Three years ago, Meredith Phillips’ mother, Georgia Svolos, fell and broke her kneecap, setting off a downward spiral that landed her in nursing homes on and off for a year. In one facility, she fell and broke her knee again, necessitating more surgery. All of the facilities were noisy and chaotic, and one smelled of feces. So, when Phillips learned recently about moves by the Trump administration to ease regulations and fines on nursing homes, she was alarmed. “I’m horrified and frightened,” says Phillips, who lives in Westbrook.
At the Governor’s House Rehabilitation & Nursing Center in Simsbury, 17 of the nursing home’s 73 beds sat empty this spring – a 23-percent vacancy rate that would have been unlikely five years ago. The home’s occupancy has fallen despite its above-average health care quality scores in the federal government’s rating system. “There are a lot of factors – a lot of initiatives out there now to keep people out of nursing homes,” said Keith Brown, the home’s administrator. “And with the increase in home care, we’re seeing a more frail resident population. So we have fewer residents, with higher acuity.”
The Simsbury home is not unique: Nearly a third of Connecticut’s nursing homes are less than 90 percent occupied, with Litchfield and Tolland counties bearing the highest vacancy rates, an analysis of state data shows.
Last summer, the state Department of Public Health fined a Danielson nursing home $580 after a resident whose feet were not properly secured to a wheelchair suffered a hip fracture. This January, a Waterbury nursing home was fined double that amount — $1,160 — after an incident in which a resident sustained a cut on the forehead during a fall, while being transferred to a toilet without proper precautions. Similarly, the Lutheran Home of Southbury paid a $615 state fine last spring, after a resident who was supposed to be served a “soft diet” was instead served a meal of ham and carrots and choked to death. Then more recently, in February, the state fined the Paradigm Healthcare Center of Norwalk double that amount — $1,230 — in connection with the death of a resident who choked on food that had been left on a tray at a nursing station. Why the differences in penalties?