Graeme Sloan/Sipa USA via AP Images
Sen. Joe Manchin (R-WV) speaks to media at the Capitol in Washington, February 2, 2022.
Until Tuesday, Sen. Joe Manchin (D-WV) was listed as a corporate officer of a state-run nursing home in West Virginia, new reporting by the Prospect shows.
The John Manchin Sr. Health Care Center is one of four nursing homes operated by the state, which has the largest population of people with disabilities in the country. In a study by AARP and the Commonwealth Fund, West Virginia’s long-term care received the second-worst ranking of all 50 states.
The nursing home and an attached clinic serve Sen. Manchin’s home county of Marion, in deep coal country near the Pennsylvania border. The center opened in 1899 as a hospital for miners, and was renovated in the early ’80s by the senator’s brother, John Manchin Jr. On a filing with the West Virginia Secretary of State, the senator’s nephew, John Manchin III, is now listed twice as both a member and an organizer of the limited liability company (LLC).
Sen. Manchin was listed as the LLC’s organizer until Tuesday afternoon. Then, less than 24 hours after the Prospect contacted the senator’s Washington, D.C., office for comment, his name was removed from the filing. A spokesperson said, “Sen. Manchin is not affiliated with this facility and any filing that indicates he is was done incorrectly.”
Manchin did not respond to questions from the Prospect about whether the family’s nursing home played a role in his opposition to President Biden’s Build Back Better legislation. The elder care plank of the reconciliation spending bill aimed to fix a chronic care shortage chiefly by paying in-home caregivers, rather than sending more seniors to nursing homes.
Any material interest the Manchin family has in the center is trivial when compared with the senator’s sprawling interests in coal, which were in conflict with the green-energy investments proposed by Build Back Better.
But a bitter fight unfolding over the fate of the Manchin Center is emblematic of West Virginians’ struggle to preserve what’s left of the state’s defunct social safety net, something the Build Back Better Act might have ameliorated.
ELDER CARE ADVOCATES, local residents, and a bipartisan group of state lawmakers are beating back an effort to close the Manchin Center, along with two other state-run care facilities.
That’s not because the center is without problems. After years of low and failing grades in health inspections, it was fined $13,905 in October 2019 and more than $8,000 over several occasions in 2021. Staff vaccination has lagged, with just 56 percent of staff vaccinated for COVID-19, lower than the 84 percent state average, according to the federal Medicare site. A 2019 workplace grievance lawsuit was decided in favor of former staff who described a hostile work environment—and that was before COVID-19 put unprecedented strain on health care staff.
But residents of Marion County say that the center has become a community fixture, and some 30 residents would struggle to find alternative placements at for-profit facilities.
A bitter fight unfolding over the fate of the Manchin Center is emblematic of West Virginians’ struggle to preserve what’s left of the state’s defunct social safety net.
When Cathie Metheny’s mother needed full-time care for her severe dementia, she told the Prospect, the family looked everywhere. They toured a Genesis HealthCare facility that was overcrowded, and a private nursing home in Bridgeport that upset her. “When you walked in, the smell overtook you to the point where you thought you were going to die right there,” she said.
Metheny remembered a government-run option that she had actually relied on for years. As a schoolteacher, she had long recommended that new students get mandatory health tests at the clinic of the Manchin Center, where she also went for her own flu shots.
She visited the long-term care facility and was thrilled with what she found. Metheny’s mother has been there since 2019 and receives outstanding care, she said. And the center is more than a nursing home. On Thanksgiving, Metheny took over ten pounds of Italian sausage. She sings Christmas carols, plays music at monthly mass, and even paid to have the piano tuned.
After care went remote during the COVID-19 pandemic, the facility remained a nerve center for Marion County. It ran a telehealth service that averaged nearly 400 patients per month, according to Debbie Harvey, the executive director of Marion County Senior Citizens, an advocacy group. That group also relied on the Manchin Center’s kitchen to make 225 meals a day for their food distribution program.
Yet, with emergency funding from the pandemic drying up, and an extreme shortage of health care workers, state officials are now making the case that it is time to take the Manchin Center out of public operation.
“SOME OF OUR MOST VULNERABLE PEOPLE in West Virginia live in these facilities,” said Joey Garcia, a state delegate from Marion County. “They are not wanted by certain private providers. And so, if you close these facilities, my greatest fear is that we already have people that are falling through the cracks, and this will increase that.”
Lawmakers and Marion County residents trace the push to shut down the state-run hospitals to Bill Crouch, secretary of the state Department of Health and Human Resources (DHHR). Crouch has urged cutting costs and balancing the state budget, said Mike Caputo, a state senator from Marion County.
“There are people in these health care facilities across West Virginia that, quite frankly, don’t have anywhere else to go,” Caputo said, echoing Garcia.
In fact, Crouch agrees with their assessment.
“If someone can’t get placed in the private sector, it’s always been us taking these folks,” Crouch said at a meeting last October. The DHHR’s nursing homes, he said, “serve as a safety net for the most vulnerable, the most disadvantaged, the elderly. We take the patients who are more vulnerable and who are more difficult.”
An infusion of cash for home or community-based care, like the one proposed in Build Back Better, would have eased the burden on government-operated facilities.
That’s precisely why Crouch thinks it’s time to retire them. Since they take difficult patients who would be rejected elsewhere, Crouch has argued, they become costlier to run.
Along with Republican lawmakers who introduced a bill to close state-run care facilities, Crouch has said for years that the hospitals are run-down, and the cost of utilities and maintenance makes them impossible to keep open. He has taken advantage of the pandemic labor crunch in nursing to press ahead toward closure.
Garcia is skeptical of the cost-savings argument. He requested information on the center’s solvency and received a standard rundown breaking down shared state and federal Medicare costs, with no glaring losses.
Crouch has insisted that the Manchin Center cannot accept new patients during the pandemic, even when current residents pass away, despite a long waiting list. “They’re trying to prove that they won’t succeed,” Garcia said, adding that DHHR has cast state-run health facilities as a “scapegoat” for budget deficits.
“DHHR and its leadership philosophically believe that private hospitals are better than public institutions,” Garcia said.
Before being appointed secretary, Crouch ran a Charleston-based health care lobbying firm. And even after taking office, he kept an ownership stake in the firm while it lobbied for private long-term care facilities in the state, the Charleston Gazette-Mail reported. And the department’s ties to the private sector run deeper. Rae Bates, assistant to the secretary at DHHR, was previously executive director of a Genesis HealthCare nursing home, according to his LinkedIn page.
Crouch, Bates, and the DHHR did not respond to multiple calls and requests for comment from the Prospect.
SENIORS IN MARION COUNTY are short on everything, Harvey says. They could use more home health aides, more medical resources, more food support. The kitchen at the Manchin Center prepares meals for her meal distribution system at cost, and she’s not sure how she will find a replacement if it shutters. Even with federal funding, it’s hard to keep the program operational, she says. “Meals is one program you must always lose money on.”
More than 1 in 5 Americans are caregivers, tending to adults who are aging or ill, or children with special needs. Most of that labor is unpaid. In West Virginia, the need is even higher.
The Build Back Better plan, as passed by the House, included about $150 billion for Medicaid home and community-based services over ten years. It would have put funding toward remunerating home care workers, who are in chronic shortage, and reducing the backlog of care recipients waiting for in-home support. As the baby boomer generation ages, demand for home care services is rising.
An infusion of cash for home or community-based care, like the one proposed in Build Back Better, would have also eased the burden on government-operated facilities.
There are just over 150 state-run nursing facilities in the U.S., which is about 1 percent of nursing homes, according to AHCA/NCAL, an association representing assisted-living centers. While hospitals have faced staffing difficulties, the caregiver workforce shortage is even more acute in the nursing home industry. Bureau of Labor Statistics data shows that, from the start of the pandemic to November of last year, long-term care facilities lost some 234,000 employees.
Cathy Reed is president of the Greater Fairmont Council of Churches, which has just put out a resolution opposing the bill. She herself is disabled, and eats meals at the Manchin Center. She has called Crouch’s office at least five times, she said, and received no reply.
Metheny has also contacted her elected officials, including Sen. Joe Manchin.
“If Joe would see me on the street, he would know who I am. He could probably call me by name, and I know he would know my parents,” she said. Like Manchin, Metheny’s mother is from the small town of Farmington. She pressed the senator’s office for attention to the Manchin Center, she said, and “never heard from him.”
“Maybe they should have socked some of this COVID money away,” Metheny said. “These are a group of people that really cannot speak for themselves. My mother cannot speak for herself.”
A Manchin spokesperson did not comment on the senator’s stance on the dispute.
Reed, Harvey, and other elder care advocates are now mounting a campaign against the latest push to close the center. In an ideal world, Reed reflected, there would be more caregiver resources in Marion County, including widely available home health care. But, she said, “the system is broken.”
