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| Trump Administration Is Relaxing Oversight of Nursing Homes | Trump Administration Is Relaxing Oversight of Nursing Homes |
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| 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 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 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. | 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.” | 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.” |
| Critics say the proposed requirement is so vague that it would be essentially meaningless — and dangerous. | 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.” | “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.” | 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.” | 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.” |
| “We have to make sure that our regulations are not so burdensome that they hurt the industry,” she said. | “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. | 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. | 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. | 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 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. | 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. |
| 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. | 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. | 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. | “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. | 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. | 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. | 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. | 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. |
| “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.” | “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.) | 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.) |
| Updated June 2, 2020 | |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said. | More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said. |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| 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. | 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.” | 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. | 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. | 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. | 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. |
| “I want to thank Eli Scheiner for doing such an incredible job,” Mr. Trump said. | “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, 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. | 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. | 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. | 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. | 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. | Matthew Goldstein and Robert Gebeloff contributed reporting. |