Baker accused of misplaced COVID-19 priorities

TWO LEADING OFFICIALS in the state’s nursing home industry said on the Codcast that the Baker administration focused too much attention in the early stages of the COVID-19 crisis on hospitals and not enough on long-term care facilities.

“The state has done a tremendous job of focusing on hospital surge and doing all we can through social distancing and tracing methods to really try to protect our communities, but where the virus is most severe is in our long-term care facilities,” said Tara Gregorio, president of the Massachusetts Senior Care Association. “Clearly we do need to redouble our focus relative to the crisis in nursing facilities.”

Rich Bane, the president of BaneCare Management, which operates 11 nursing homes and two assisted living facilities in Massachusetts, echoed that sentiment. “There’s a sports metaphor here,” he said. “The state was guarding the wrong man early on.”

One possible sign of the state’s slow grasp of the nursing home situation was its data gathering. It wasn’t until April 2, when the total number of COVID-19 cases reached 8,966 and the total number of deaths hit 154 that the state started to report on the situation at nursing homes. Initially, the state only released information on the number of positive tests at long-term care facilities and the number of facilities with at least one COVID-19 case.

It took another eight days before the state started releasing information on the number of deaths at long-term care facilities, a statistic that made clear the depth of the problem. On April 10, the state reported 247 deaths at long-term care facilities, or 41 percent of the total across the state. Nine days later the number had risen to 884, or 52 percent of the state’s total.

The delay in releasing deaths may have been a failure to collect that information. Marylou Sudders, the secretary of health and human services, said on April 7 that the state had the data in hand and would make it publicly available that afternoon. But the information wasn’t released until four days later.

Gregorio said long-term care facilities weren’t actually required to submit the death data to the state until April 6. “On the one hand, we had been reporting through the MassMAP system incidents of COVID positive or COVID-suspect cases, but it really wasn’t until [April 6] that we received a directive from the state to begin reporting through their [Health Care Facility Reporting System] on COVID deaths or COVID-related deaths,” Gregorio said.

Sudders has promised more information on long-term care facilities this week. She was vague about what would be released, but indicated the state may start breaking down COVID-19 information by facility, which would allow the public to see whether cases are spreading throughout a community or concentrated in long-term care facilities. Some facilities already release that information. Bane announced on April 13 four deaths at his company’s facilities and on Sunday broke down positive cases by residents (146) and staff (65).

Bane said it’s not surprising that nursing homes have been hard hit by COVID-19. “When you think about it, it’s pretty intuitive,” he said. “All we’re hearing about is the importance of social distancing as the way to mitigate the virus, yet what happens in nursing homes is the exact opposite of social distancing. Our direct care staff provides hands-on care, intimate care, activities of daily living for frail elders who can no longer be cared for at home. So we are actually doing the exact opposite of what you’re supposed to do in the face of a contagion like COVID-19.”

Gregorio came on the Codcast a year ago to talk about the financial plight of the nursing home industry in Massachusetts. She said not much has changed since then – 70 percent of nursing homes are losing money – and the situation has worsened with COVID-19.

She said the Baker administration is stepping up with testing and personal protection equipment, but a shortage of employees is the big problem for nursing homes.

Gregorio said the job vacancy rate in the industry was 17 percent on March 1, which means about 5,600 direct care positions were empty. Now, she said, the vacancy rate is 40 percent, or 12,000 positions. And as the National Guard conducts more and more COVID-19 tests at facilities, the fear among staff rises and more leave. “The more we test the more we have a staffing problem,” she said.

Bane said the average starting wage rate for certified nursing assistants is $13 an hour and licensed nurses are in the high $20 to low $30 range. “We’re having to compete against hospitals that are paying $35, $40, $50 an hour for those nurses,” he said.

Gregorio said nursing home workers need to be paid a “hero’s wage” during the crisis – a doubling of what they currently receive. Bane said he is already paying more, but the compensation he receives from Medicaid doesn’t cover the cost.  Gregorio said many nursing homes aren’t paying other bills, most of which will come due in June and July.

Both Bane and Gregorio said they expect COVID-19 to linger longer in long-term care facilities than in the rest of society. She said cases will continue to surface until a vaccine for COVID-19 is developed.

“It doesn’t have to be the worst-case scenario,” Gregorio said. “We don’t need to lose 10 percent of our residents to this deadly contagious virus. And the way that we do it is by investing in testing, PPE, and a hero’s wage.”