Other states crack down after COVID nursing home deaths. Indiana not so much.
Advocates for nursing home residents have criticized Indiana officials for failing to crack down on nursing homes despite the large COVID-19 death toll in those facilities.
The criticism comes after the state disclosed more than 600 unreported nursing deaths last week. State health officials have blamed nursing homes for failing to properly report the deaths, but so far they have no plans to sanction violators, IndyStar reported.
‘Continually cutting them slack’:Advocates criticize handling of unreported nursing home deaths
While many states have launched investigations or implemented reforms, Gov. Eric Holcomb and other Indiana leaders have been largely deferential to the industry, which has historically had significant political influence in the state.
Indiana’s approach stands in stark contrast to the more aggressive actions of other leaders across the country. Here’s how officials in other states have responded to the COVID-19 crisis in nursing homes.
Unreported deaths prompt investigations in New York
In New York, the state’s Attorney General and the U.S. Department of Justice are reportedly investigating the administration of Gov. Andrew Cuomo for dramatically underreporting nursing home deaths.
The revelations of more than 6,000 previously unreported deaths have led to a major scandal, while Cuomo has personally come under fire for how the state handled the data. There have been suggestions the death numbers were downplayed for fear the Trump administration would use them against Cuomo and the state, but Cuomo’s staff has denied that was the case.
The scale of the problem in Indiana appears to be much smaller, with about 600 deaths going unreported. And it was Gov. Eric Holcomb’s administration — not outside investigators — that first disclosed the unreported deaths.
In Indiana, according to the state health commissioner, the reporting failure appears to be on the part of individual nursing homes. But advocates for nursing home residents say the state’s reluctance to levy fines or other consequences hints at a long-standing, cozy relationship between Indiana regulators and the deep-pocketed nursing home industry.
Indiana Attorney General’s office also has stayed out of the matter, even as complaints about nursing homes and other healthcare providers have increased during the pandemic.
“Death investigations are based on evidence obtained following a complaint and subsequent investigation or through investigations resulting from tips or inspection reports,” a spokeswoman for Rokita said in an email response to IndyStar questions. “We have not received an evidence-based complaint, so no investigation is open at this time.”
Connecticut and other states launch independent assessments
In Connecticut, Gov. Ned Lamont ordered an independent assessment of COVID-19 impact on the state’s nursing homes. That was in June, just months into the pandemic. Among the goals: Compare the impact of COVID-19 in Connecticut nursing homes with those in other states, examine the preparedness and response of Connecticut’s long-term care facilities, and identify “immediate and achievable steps” the state and industry could take to prepare for a second wave of COVID-19.
An interim report was issued in August and the final version was made public in September. It included 45 recommendations to help prevent and prepare for future infectious disease outbreaks in nursing homes and long-term care facilities. One called for increasing minimum staffing ratios.
That’s something that Indiana doesn’t have, despite some of the worst nursing home staffing levels in the nation.
The Connecticut report produced by Mathematica, a non-partisan policy research firm, also revealed that many other states — including Arizona, Colorado, Michigan, New York, New Jersey and Virginia — had undertaken similar assessments.
One state notably missing from that list: Indiana, where the only action state lawmakers have taken was to rush through legislation protecting nursing homes from lawsuits over poor and negligent care.
New Jersey institutes minimum staffing ratios
New Jersey, where about 40% of the state’s coronavirus deaths have been tied to long-term care facilities, recently passed legislation aimed at improving quality at the homes.
In October, Gov. Phil Murphy signed two reform bills aimed at the long-term care industry. The first requires a minimum direct care-to-staff ratio of one nurse aide for every eight residents on the day shift, and additional minimums for the evening and night shifts.
The bill also establishes a special task force to understand longstanding shortages of nursing home workers.
Researchers, advocates and the federal government have long identified adequate staffing as the most critical means to improving care in nursing homes. Preliminary research has also found better staffing is tied to fewer COVID-19 deaths.
Indiana has no staffing standard for total nursing staff or for nursing aides. State law mandates that facilities have a “sufficient nursing staff” to maintain “the highest practicable physical, mental, and psychosocial well-being of each resident.” Before the pandemic struck, Indiana ranked 48th in the nation for average total nursing staff hours when adjusted for resident needs. New Jersey ranked better at 37th.
Several prior attempts by Hoosier lawmakers over the last decade to set staffing standards have died in the General Assembly without even getting a committee hearing. No such bills were filed this year, despite nearly 6,000 coronavirus deaths tied to Indiana long-term care facilities.
Massachusetts criminally investigated individual facilities
High death counts at individual facilities have prompted investigations in some states.
By May, Massachusetts Attorney General Maura Healey had launched investigations into at least two individual facilities amidst accusations that the homes were not following COVID-19 procedures and after dozens of residents died at the home.
Healey’s office announced criminal charges in September against a Holyoke, Mass. state-run veterans home. The attorney general alleges that, citing staffing shortages, the facility moved 42 residents from two units together, even though the residents had different COVID-19 statuses, among other allegations. A superintendent and former medical director for the facility face a combined 20 charges for their role in the deaths of at least 76 residents, according to a press release.
Indiana facilities have been accused of similar transgressions, though none have prompted any known investigations by the state. In April, officials at South Bend’s Cardinal Nursing and Rehabilitation told state inspectors that the facility did not have the staff to test residents and didn’t know which residents were positive for the virus. Twenty-two residents have died at the facility to date.
In December, Health and Hospital Corp. of Marion County, which owns the home, did not respond to questions about the facility, but defended the quality of its homes broadly.
State investigations into individual facilities also have been launched in Arizona, Louisiana, California and Connecticut.
Contact IndyStar reporter Tony Cook at 317-444-6081 or [email protected] Follow him on Twitter: @IndyStarTony.
Contact Tim Evans at 317-444-6204 or [email protected] Follow him on Twitter: @starwatchtim.
Contact IndyStar data reporter Emily Hopkins at 317-444-6409 or [email protected] Follow them on Twitter: @indyemapolis.