Trump Administration Is Relaxing Oversight of Nursing Homes
A proposal would loosen federal rules meant to control infections, just as the coronavirus rips through nursing homes.
By Jesse Drucker and
The Trump administration has been working to relax regulations governing America’s nursing homes, including rules meant to curb deadly infections among elderly residents.
The main federal regulator overseeing nursing homes proposed the rule changes last summer, before the coronavirus pandemic highlighted the vulnerability of nursing homes to fast-spreading diseases. The push followed a spate of lobbying and campaign contributions by people in the nursing-home industry, according to public records and interviews.
The coronavirus has killed 13 residents at a nursing home in Washington State; dozens more residents and employees there have fallen ill. Seeking to prevent further contagion, some states, including New York, have banned most nonmedical personnel from setting foot inside nursing homes and other long-term care facilities, which nationally have about 2.5 million residents.
Last July, the federal Centers for Medicare and Medicaid Services, or C.M.S., set in motion a plan to weaken rules imposed by the Obama administration that required every nursing home to employ at least one specialist in preventing infections. The proposed rules — which the agency is completing and has the power to enact — eliminate the requirement to have even a part-time infection specialist on staff. Instead, the Trump administration would require that anti-infection specialists spend “sufficient time at the facility.”
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Critics say the proposed requirement is so vague that it would be essentially meaningless — and dangerous.
“It adds up to less time, less infection control,” said Anthony Chicotel, a staff lawyer for California Advocates for Nursing Home Reform. He said the proposed change was “alarming.”
Attorneys general in 17 states have called the proposed rules a threat to “the mental and physical security of some of the most vulnerable residents of our states.”
The White House referred questions to the Medicare and Medicaid agency. In an interview on Saturday, the agency’s administrator, Seema Verma, said the proposed rule changes were not about easing up on nursing homes but “about not micromanaging the process.” The proposed changes to the infection-prevention rules, she said, could actually result in a “higher level of staffing.”
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“We have to make sure that our regulations are not so burdensome that they hurt the industry,” she said.
Ms. Verma emphasized that the rules were still in the proposal stage and not yet complete. “We have to make sure that we get it right for the sake of patients,” she said.
Infection-prevention specialists are supposed to ensure that employees at nursing homes properly wash their hands and follow other safety protocols. They are widely considered the front line for stopping infections, among the leading causes of deaths in nursing homes.
Each year, about 380,000 residents are killed by infections, according to the Medicare agency. Failure to prevent them is also the leading cause of citations that state inspectors bring against nursing homes.
The coronavirus has laid bare such problems, most starkly at the Life Care Center of Kirkland, Wash., where 13 residents have died after being infected with the virus, and more than a third of the facility’s roughly 180 employees have contracted the illness.
The Kirkland facility, which scored a top quality rating of five stars from the federal government, has had problems before. In April 2019, the Medicare agency wrote it up for failing to “consistently implement an effective infection control program.” In its report, the agency described the concerns of a resident’s daughter, who said that nurses allowed her mother’s heel, which had an open wound, to touch the ground, calling the practice “unhygienic.” The agency found that the facility’s shortcomings put residents “at risk for harm and transmitting/acquiring infections.” The agency, which levied a $67,000 fine, said the problems were quickly fixed.
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In recent weeks, nursing home operators nationwide have been cracking down on visitors. Ronald Silva, whose company manages two dozen nursing homes in Indiana and Georgia, said his facilities began screening all workers and vendors three weeks ago.
The Centers for Medicare and Medicaid Services provided new guidance for nursing homes this month, telling inspectors to scrutinize whether employees were following key safety precautions, like regularly washing their hands. Vice President Mike Pence echoed that guidance, emphasizing that all federal inspectors should focus, at least for now, on making sure that facilities are working to prevent and control infections.
“We’re going to put all inspection resources, at the state level, focused on infectious disease, looking at nursing homes being a focal point of vulnerability and a vulnerable population,” Mr. Pence said at a press briefing on March 3.
Mr. Pence did not mention the Trump administration’s proposals to relax the Obama-era rules. The proposed changes are part of a broader effort by the Trump administration to unfetter businesses from regulations. In the case of nursing homes, relaxed regulations are projected to save the industry about $640 million a year, according to estimates from the Centers for Medicare and Medicaid.
In its first year, the Trump administration changed how nursing homes were fined when they violated rules. Previously, they were typically penalized for every day in which a violation persisted. But the agency changed the guidance for inspectors, encouraging them to hand out a single fine — rather than a series of daily penalties — for most infractions. Under the Trump administration, the average fine imposed on a nursing home has dropped more than 30 percent from $41,260 to $28,405, according to an analysis of federal data by Kaiser Health News.
Ms. Verma said the changes to how nursing homes are fined were meant to increase consistency across the industry.
The agency also weakened a rule that would have made it easier for nursing home residents and their families to sue over claims of elder abuse, sexual harassment and wrongful death.
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“Together these changes gut enforcement,” said Toby Edelman, a senior lawyer at the Center for Medicare Advocacy, a nonprofit legal assistance group for the elderly. “They are a gift to the industry.”
The administration’s moves came after intense lobbying by the nursing home industry, including by the firm run by Brian Ballard, Mr. Trump’s friend and a fund-raiser. Parlaying his personal connections to Mr. Trump, Mr. Ballard has become one of the most powerful lobbyists in Washington, with the most clients of any registered lobbyist last year, according to an analysis by the Center for Responsive Politics. His firm has lobbied on behalf of nursing homes in his home state, Florida, for years, according to public records. (He was also a lobbyist for Mr. Trump’s Florida golf course, the Doral.)
After Mr. Trump was elected, Mr. Ballard was retained by a leading trade group for the nursing home industry, the American Health Care Association. His firm, Ballard Partners, has earned $930,000 in lobbying fees from the group since Mr. Trump took office, records show.
Ms. Verma, who emphasized that she didn’t even know Mr. Ballard, said she didn’t like to hear from lobbyists. “I tell folks I am not going to meet with D.C. insiders,” she said. “I want to meet with people on the front lines.”
A spokeswoman for the nursing home trade group said that loosening the requirement to have an infections specialist on staff would allow facilities to “provide greater flexibility to meet” to thwart infections.
In November, Mr. Trump was honored by a group of nursing home operators at a fund-raising event at a packed ballroom at the InterContinental hotel in Midtown Manhattan. The event drummed up more than $3 million for his re-election campaign through a political action committee called America First Action.
Flanked by two American flags onstage, Mr. Trump singled out one of the executives, Eliezer Scheiner, who donated $750,000, the most of any attendee.
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“I want to thank Eli Scheiner for doing such an incredible job,” Mr. Trump said.
Mr. Scheiner, who owns 22 nursing homes across the country, received a round of applause.
Mr. Scheiner’s nursing homes have received subpar ratings from federal regulators. Since 2017, they have been cited more than 40 times for slipshod infection control. In 2018, inspectors at one of Mr. Scheiner’s nursing homes in Balch Springs, Texas, spotted a staff member who failed to wash or sanitize her hands before cleaning a resident’s anal area. During the same inspection, another staff member was written up for allowing a resident’s feeding tube to touch the inside of a bathroom trash can.
Two years ago, Mr. Scheiner was accused of fraud by a federally appointed bankruptcy court trustee in Connecticut. The trustee accused Mr. Scheiner and his partner of transferring more than $1 million of assets out of one of their nursing home companies into other entities they controlled, a few months before the nursing home company filed for bankruptcy.
Mr. Scheiner didn’t respond to requests for comment. He and the bankruptcy trustee agreed to a settlement this year.
In addition to no longer requiring nursing homes to designate at least one part-time “infection preventionist,” the Trump administration also has proposed adjusting a requirement that facilities must assess what they might need for patient care, from staffing levels to medical equipment. Under the proposal, facilities would have to do such assessments every two years instead of every year.
Matthew Goldstein and Robert Gebeloff contributed reporting.
Jessica Silver-Greenberg is an investigative reporter on the business desk. She was previously a finance reporter at the Wall Street Journal.
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