Hospitals & Nursing Homes: Old Dangers on the Increase During a Pandemic?

Searcy Denney Scarola Barnhart & Shipley
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Searcy Denney Scarola Barnhart & Shipley

Hospitals in Florida and the rest of the country generally are careful about safety measures, staff-to-patient ratios and infection control. There are specific standards of care they must meet in the communities they serve.

But, enter the world of corporate healthcare and private equity firms. Basic safety equipment is a part of meeting any reasonable standard of care in hospitals and other institutions. That safety equipment and proper levels of patient to staff ratios come at a cost to corporate owners. For example, health care providers have had enough stress heaped upon them by this pandemic, are reporting they are being provided with sub-par personal protective equipment (PPE) and are being told to reuse face masks not intended to for reuse.

“Some Palm Beach County nurses who work for health-care giant Tenet Hospitals start their shift sobbing,” reads an article by The Palm Beach Post titled “Coronavirus Florida: Tenet hospital nurses describe culture of fear.” “They fear for their safety because they lack proper masks, gowns and eye protection as they care for patients infected with this deadly coronavirus strain. They worry about infecting other patients. They worry about bringing it home to their families. Nurses and doctors have looked online for these items only to be rebuffed by hospital administrators who say they must adhere to their established supply chains. Some are threatened with being fired if they bring their own makeshift personal protective equipment – or PPE. Others have simply quit. Health care professionals for Tenet say they are caught in a deadly game of Catch-22: Treat coronavirus patients without proper protective gear or lose their jobs.”

Corporate hospitals have found a way to deal with the increased cost burden:

“Of course, hospitals can lower their costs in a lot of ways that make patient care worse. Tenet, for example, furloughed an astonishing 10% of its staff in March and April. It also stopped contributing to 401(k) retirement accounts, rationed PPE (and threatened to fire employees who brought their own), and slashed hours for its nurses. Some nurses were sent home mid-shift, leaving others to watch sections as big as 20 patients. At a Tenet hospital in Massachusetts, nurses filed more than 50 reports over two weeks in April, documenting specific instances of how the downsizing jeopardized patients. One declared she had “[never] been more ashamed to work” somewhere.”  

Many organizations have experienced trouble finding face masks, hand sanitizer and antibacterial wipes – let alone ventilators – but to force frontline workers to make dangerous decisions that could negatively affect their health and the health of those in their care is just plain wrong.

“Tenet says that it is required to use CDC-approved PPE that the company provides,” according to The Post article. “Any donations or procurement of alternate PPE must be routed through the corporation’s national supply chain for vetting. A Tenet FAQ released to medical staff outlined how it is rationing N-95 masks, which are tight-fitting and very efficient at filtration. The masks will be used for three shifts, which for many nurses who work 13-hour shifts, constitute a week of work. But the Joint Commission for Accreditation of Healthcare Organizations, which accredits more than 22,000 U.S. healthcare organizations and programs, said in a statement that hospitals should allow healthcare workers to use whatever is necessary to protect themselves during this pandemic. It said privately owned masks and respirators almost certainly are better than nothing at all.”

Hospitals, though, received some of the first and largest CARES Act bailouts:

  1. Common Spirit Health (Chicago): $713 million
  2. HCA Healthcare (Nashville, Tenn.): $700 million
  3. Tenet Healthcare (Dallas): $517 million
  4. Long Island Jewish Medical Center (New Hyde Park, N.Y.): $278 million
  5. Community Health Systems (Franklin, Tenn.): $245 million
  6. Mayo Clinic (Rochester, Minn.): $220 million
  7. Holy Name Medical Center (Teaneck, N.J.): $213 million
  8. Sutter Health (Sacramento, Calif.): $205 million
  9. Tisch Hospital (New York City): $203 million
  10. Banner Health (Phoenix): $200 million

While America collectively wants COVID-19 to go away, it is not. Further, decisions made while pretending or hoping that COVID-19 is going away are counterproductive and irrational. Essential employees such as nurses – and society’s most vulnerable such as the elderly – deserve the most-elevated efforts and the very-best practices regarding protection.

The nursing  home industry have received nearly a $4.9 billion distribution of funds to deal with the COVID-19 epidemic.  Much of this funding is with no strings attached to an industry that has demonstrated years of fraud, labor violations and poor patient care. Not that this money is not needed for better patient care, but the Washington Post reports that two large publicly traded nursing home corporations have continued paying out dividends to its shareholders.

To add to the dangers of under staffing and poor patient care, in Florida, politicians want to open nursing homes back up for the public to enter them:

“It’s been more than four months since Florida halted all outside visits to nursing homes and assisted living facilities in an effort to protect residents from COVID-19,” states an NPR story titled “As COVID-19 Numbers Improve, Florida Considers Nursing Home Visits.” “The policy has helped keep elderly residents safe, but [Gov. Ron] DeSantis said he’s heard from many who were distressed that they couldn’t be with family members in their final moments. DeSantis said he wants to begin allowing people who test positive for antibodies to visit family members in long-term care facilities. People with antibodies, he said, aren’t at risk of catching or further spreading the virus.”

That is just plain wrong, too, and the Centers for Disease Control and Prevention (CDC) agrees. Guidance on the agency’s Web site says to restrict visitation at all nursing homes and instead implement alternate methods such as FaceTime, Skype and / or Zoom. The CDC also advises nursing homes to post signs on the doors prohibiting visitors from entering the premises. The reason for the restrictions is clear: Nursing homes are ground zero for the virus.

“Older people are at higher risk for COVID-19, the disease caused by the new coronavirus,” notes an AARP story titled “AARP Answers: Nursing Homes and the Coronavirus.” “So are people with chronic medical conditions such as heart disease, diabetes, kidney disease and respiratory illness. Both groups are heavily represented among the nation’s 1.3 million nursing home residents. That concentration is a key reason why 2 in 5 U.S. deaths from COVID-19 have occurred in nursing homes and other long-term care facilities…but it’s not the only one.”

Among the conditions that exacerbate the contagion are shortages of PPE, which is a major problem at hospitals, and understaffing, which is a major problem at both hospitals and nursing homes. The bottom-line-focused owners of nursing homes prefer minimal staff-to-patient ratios and certified nursing assistants (CNAs) rather than registered nurses (RNs). The average annual income of a CNA is $28,550. RNs make $71,730 a year.

“These factors make nursing homes potential breeding grounds for viral and bacterial diseases, especially given chronic problems with infection control that predate the pandemic,” the AARP story points out. “According to a recent federal report, 4 in 5 nursing homes surveyed between 2013 and 2017 were cited for deficiencies in infection prevention and control. Half were cited more than once during that time.”

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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