Unsanitized: Eighteen Deaths Per Hour in America’s Nursing Homes

Plus, more on the anti-police brutality protests, and what’s next for unemployment. This is The COVID-19 Daily Report for June 3, 2020.

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First Response

The numbers are stark and we know they’re incomplete. Based on reports to the Center on Medicare and Medicaid Services (CMS), more than 25,000 U.S. nursing home residents have officially died from contracting COVID-19. That doesn’t include 400 staff at the facilities who have succumbed to the virus. And even that number is wrong, because only 80 percent of all nursing homes reported their data, and it only goes through the beginning of May. (The Washington Post estimates the number at 28,000.)

Another study from conservative Avik Roy and his colleagues, based on state-level data from the 43 states that track nursing home facilities separately, finds that as much as 42 percent of all deaths from COVID-19 come from the nursing home population, which comprises about 0.6 percent of all Americans. That would be more like 40,000 deaths, or more.

The numbers are hard to contemplate: between 25,000 and 40,000 elderly lives, in the last 90 days, to be generous on the timeline side. That’s between 12 and 18 deaths per hour, every hour, for the last three months. And given that housing a bunch of dying patients isn’t a selling point for these mostly for-profit facilities, and because of the vagaries of statistical analysis of coronavirus (in New York, if nursing home residents die in the hospital, they aren’t counted as nursing home deaths), that number is higher.

Read all of our Unsanitized reports

The reason this generally isn’t a national scandal is that it’s all happened out of sight. It’s an indictment of the way our culture flows through video clips instead of statistical analysis. There’s been a crime here: CMS reports that the worst nursing homes for patient care and staffing had disproportionately more deaths. And it’s been an ongoing crime. First of all, this data has been hidden for months, amid outcries from patient families. Second, we know that states like New York both required patients with COVID-19 discharged from hospitals to be returned to nursing homes without proper isolation, and that states like New York, again, gave immunity to nursing home executives from prosecution over misconduct.

But it’s worse than that. Trump’s CMS proposed loosening nursing home regulations last year specifically involving infection prevention, and did reduce fines against nursing homes that harm residents back in 2017. Plus, CMS rolled back an Obama-era rule that had banned nursing homes from forcing families to sign arbitration agreements to shield them from court litigation in the event of abuse. It’s been one lobbyist-fueled deregulatory action after another.

And even that doesn’t tell the whole story, because one reason the arbitration rule got in place under Obama was the habitual misconduct of patients, “from preventable falls to patient neglect to financial theft to even physical and sexual abuse.” So-called “adverse effects” from medical care in nursing facilities affected more than 1 in 5 patients, according to a Health and Human Services Inspector General report in 2014. GAO found last year that abuse is under-reported in nursing facilities.

This coincides with, of course, profit-seeking. HCR ManorCare, one of the largest nursing home networks in the country, was in the private equity portfolio of the Carlyle Group, and it has a history of health code violations, short-staffing and patient neglect. Carlyle weighed down ManorCare with debt, and as a result the company couldn’t properly administer its duties. It eventually got sold to a nonprofit.

(This continues a trend of the worst businesses in America being affiliated with the private equity industry: for-profit colleges, payday lenders, detention camps for children, bail, prison phone and medical companies. That tear gas you’re seeing on TV lately? The two largest producers are private-equity owned. Pepper spray? Also private equity.)

The industry was a catastrophe waiting to happen, completely unprepared for a viral outbreak and indeed with procedures effectively set up to facilitate one. Reform must go on the list of things to fix in a society laid bare by the coronavirus. That includes boosting home care and giving families more choices for their loved ones. The demise of the CLASS Act, a proposed federal long-term care insurance system placed into Obamacare, has made elder care a ticking time bomb, and the system we have is clearly inadequate.

Yet there is relative silence about the failings of long-term care facilities, and really long-term care in general. Despite 18 dead lives per hour.

Odds and Sods

I have a piece today at the Prospect about the really amazing saga of the Office of the Comptroller of the Currency, where the past two leaders used to be high-ranking officials with OneWest Bank (as was their hiring manager, Treasury Secretary Steve Mnuchin). In the past 48 hours, the former and current OCC head have taken actions that will make it harder to reverse disinvestment in downtrodden communities and raise interest rates on people desperate for funds during the economic crisis. Brian Brooks, the new OOC leader, even threatened mayors to reopen their cities for the benefit of the banks. It’s all at the link.

You can read all of our coronavirus coverage at prospect.org/coronavirus. And I’m happy to get your thoughts and tips; email me here.

Protest Update

Protests yesterday were in many locations bigger, and for the most part more peaceful, although police provocations continued. Protesters remained defiant in the face of a built-up militarized police (and military) presence. And Donald Trump, ever the coward, has quietly backed off federalizing more military forces, instead pulling the move of declaring victory and getting out.

This anecdote is really priceless: you may know about Rahul Dubey, the D.C. resident who took 75 protesters into his home as the police chased them and tried to smoke them out. It turns out that Steve Maviglio, a top Democratic consultant here in California, is Dubey’s landlord. And he decided to grouse about Dubey being late with the rent, to glorious consequences.

I know Maviglio quite well. If there’s a bad idea in state government or a high-priced corporate-backed campaign to run (like the proposition bankrolled by landlords—other landlords, I guess—to stop rent control), Maviglio’s behind it. He once said to me that Democrats winning a 2/3 legislative majority in California would be like Obama winning Alabama (Democrats did so in the very next election and have held it for years). He is the epitome of warmed-over conventional wisdom, and I am loving every minute of his triumphant debut on the national stage.

Bye Bye Superdole

What’s notable in this CNBC report is not that Republicans are intransigent about eliminating the $600 increase in unemployment checks, it’s that Senate Democrats are bargaining about other options. That undermines the House bill and likely spells the end of the policy that runs out July 31.

What goes in its place? There’s one complicated plan tying extra amounts in unemployment checks to state unemployment rates, which sounds way too difficult to administer. There’s another plan for weekly wage subsidies, an enhancement to a worker’s paycheck which is being called a “bonus” for returning to work. That bonus would run out on July 31 too, however, which makes it hardly worth the effort. A third idea is a benefit lump sum, with the upfront money being equivalent to the current deadline.

The White House proposal is apparently about encouraging vacations, so it’s completely in la-la land. And all the while, cities and states are begging for help. Education job losses just in April exceeded the entire Great Recession.

Good thing Nancy Pelosi has the House out of session for June, not like there’s anything going on.

Today I Learned

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