Three clear themes emerged at the February 17 hearing held by the Senate Finance Committee – “A National Tragedy: COVID-19 in the Nation’s Nursing Homes” – understaffing, health equity and the disparate impact of the pandemic on communities of color, and private equity ownership of facilities. Although problems of understaffing and health equity both predated the coronavirus pandemic, the pandemic exacerbated these issues and made them more visible to the entire country. Private equity ownership of nursing homes is a relatively new phenomenon that raises concerns about the need for more transparency in how facilities spend the reimbursement they receive from the Medicare and Medicaid programs. More complete data about COVID-19 cases and deaths among nursing home residents and staff at the beginning of the pandemic are also needed.
Witnesses at the hearing were:
- Adelina Ramos, Certified Nursing Assistant, Rhode Island
- Denise Bottcher, State Director, AARP Louisiana
- Quiteka Moten, State Long-term care Ombudsman, Tennessee
- R. Tamara Konetzka, Professor, University of Chicago
- John Dicken, Director, Health Care, Government Accountability Office
- David Gifford, Chief Medical Officer, American Health Care Association
Senators returned repeatedly to the powerful testimony of Ms. Ramos, who described the consequences of too little staffing – having to choose which of two residents to help to the bathroom and whether to feed one resident or help another – when all residents deserve and need care. She described a starting salary of $12.34 an hour for aides in Rhode Island, which results in aides working multiple jobs in order to meet their own basic needs. The Centers for Disease Control and Prevention (CDC) has reported that employees working in multiple nursing facilities helped spread coronavirus.
Professor Konetzka and especially Dr. Gifford contended that the prevalence of COVID-19 in the community is key to the virus’ infecting residents and staff and that facility-based measures, such as the federal government’s star ratings, are not relevant to infections. Dr. Gifford’s written testimony, in particular, sought to shift responsibility from nursing homes, citing the nature of the virus, “changing and conflicting government guidance,” lack of testing and personal protective equipment, and community spread as circumstances beyond facilities’ control and responsibility. While understanding these factors, the Center for Medicare Advocacy has written multiple reports and CMA Alerts over the past year documenting the significance of staffing levels, ownership, and unionization in containing the impact of COVID-19.
The nursing home industry’s argument that Medicaid underfunds nursing homes is inconsistent with the widespread acknowledgement at the hearing that little is known about how facilities spend the reimbursement they receive and that, at the least, more transparency and accountability about facility spending practices are essential.
Importantly, Senator Sherrod Brown (D-OH) included for the record a recent analysis showing that private equity acquisition of nursing homes between 2000 and 2017 resulted in more than 20,000 additional residents deaths and increased costs to the Medicare program. Senator Elizabeth Warren (D-MA) noted that Genesis Healthcare, which received $665 million in COVID-related federal and state grants and loans in 2020, paid its CEO $8 million in salary and bonuses in 2020, just before he retired in January 2021.
The Subcommittee on Oversight of the House Committee on Ways and Means has announced a hearing for March 25, 2021, “Examining Private Equity’s Expanded Rule in the U.S. Health Care System.”
 The hearing video, opening statements of Chairman Ron Wyden (D-OR) and Ranking Minority Member Mike Crapo (R-ID), and written statements of the six witnesses are available at https://www.finance.senate.gov/hearings/a-national-tragedy-covid-19-in-the-nations-nursing-homes.
 CDC, “COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020,” Morbidity and Mortality Weekly Report (Mar, 18, 2020), https://skillednursingnews.com/wp-content/uploads/sites/4/2020/03/mm6912e1-H.pdf
 See, e.g., “New Report Documents Causes and Cures for COVID-19 Crisis in Long-Term Care Facilities” (CMA Alert, Feb. 18, 2021), https://medicareadvocacy.org/new-report-nursing-homes-and-covid/, linking to Cinnamon St. John, “Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic,” https://medicareadvocacy.org/wp-content/uploads/2021/02/CMA-NH-Report-Geography-is-Not-Destiny.pdf; “Staffing is Key to Determining Whether Covid-19 Affects Nursing Home Residents” (CMA Alert, Feb. 4, 2021), https://medicareadvocacy.org/nursing-home-staffing-is-key-to-covid-deaths/; “Nursing Home Residents and COVID-19: Staffing and Quality of Care Matter” (CMA Alert, Dec. 3, 2020), https://medicareadvocacy.org/nursing-home-residents-and-covid-19-staffing-and-quality-of-care-matter/; “Nursing Facilities and COVID: Staffing Matters” (CMA Alert, Nov. 5, 2020), https://medicareadvocacy.org/nursing-facilities-and-covid-staffing-matters/; “Nursing Facilities and Covid-19 – it’s not Inevitable” (CMA Alert, Oct. 8, 2020), https://medicareadvocacy.org/nursing-facilities-and-covid-19-its-not-inevitable/; “Study Finds Lower Mortality Rates in Unionized New York State Nursing Facilities” (CMA Alert, Sep. 17, 2020), https://medicareadvocacy.org/study-finds-lower-mortality-rates-in-unionized-new-york-state-nursing-facilities/; “Nursing Facilities Owned by Private Equity Firms Have Higher Rates of Covid Infections than Other Facilities” (CMA Alert, Aug. 13, 2020), https://medicareadvocacy.org/nursing-facilities-owned-by-private-equity-firms-have-higher-rates-of-covid-infections-than-other-facilities/; “Studies Find Higher Nurse Staffing Levels in Nursing Facilities Are Correlated With Better Containment Of Covid-19” (CMA Alert, Aug. 13, 2020), https://medicareadvocacy.org/studies-find-higher-nurse-staffing-levels-in-nursing-facilities-are-correlated-with-better-containment-of-covid-19/; “COVID Does Not Have to Lead to Deaths in Nursing Homes” (CMA Alert, Jul. 23, 2020), https://medicareadvocacy.org/covid-does-not-have-to-lead-to-deaths-in-nursing-homes/
 Atul Gupta, Sabrina T. Howell, Constantine Yannelis, and Abhinav Gupta, “Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes,” Becker Friedman Institute, Working Paper No. 2021-20 (Feb. 2021), https://bfi.uchicago.edu/wp-content/uploads/2021/02/BFI_WP_2021-20.pdf
 “Warren Releases New Details on Genesis Nursing Home Company’s Massive CEO Payout” (Press Release, Mar. 17, 2021), https://www.warren.senate.gov/newsroom/press-releases/warren-releases-new-details-on-genesis-nursing-home-companys-massive-ceo-payout (including links to correspondence with Genesis).