As COVID-19 engulfs nursing homes, these reporters keep pushing for answers

Almost everywhere you look nursing home deaths are a big story! Ninety-six deaths at a nursing home in Salisbury, N.C.; 102 at one in San Antonio; 104 at another in western Pennsylvania at the beginning of last week. People with relatives at that facility said they couldn’t get any answers — nobody would answer their calls.

Nursing homes have always been rife with problems, and over the years journalists have exposed countless cases of neglect, abuse, and deaths. These accounts almost always include the promises made by staff, owners, and state and federal regulators that conditions would improve. In reality, little changes. This time, though, the pandemic and the ensuing pile-up of nursing home deaths­ — like the dumping of 17 bodies in the morgue at a New Jersey nursing home that has now had 70 deaths — has seared the vulnerabilities of America’s nursing homes in the public conscience as nothing else has. The story is indeed everywhere. The media have been on the case, pushing these stories to the top of list of horrors the virus has brought.

The coverage has gotten the attention of the Trump White House that disclosed Sunday night that the Centers for Medicare and Medicaid Services, which provides federal oversight of the country’s nursing homes, will be taking a more active role in providing much-needed information to the public.

CMS announced that sometime in the future — it didn’t say when — it would be “reinforcing” an existing requirement that nursing homes report health care associated infections and potential outbreaks to state and local health departments and to the CDC. Failure to report such cases involving staff and residents with COVID-19 could result in enforcement action. The agency also said it would be “previewing” a new requirement for facilities to disclose such cases to residents and their families and keep them updated as conditions change.

One of the first news outlets to propel the story forward earlier this month was the Wall Street Journal and reporters Anna Wilde Matthews and Jon Kamp, who in early April reported at that point the virus had struck more than 2,100 nursing homes and other senior living facilities. The story is notable for first-rate, old-fashioned shoe leather reporting, rare these days. Matthews told me the paper was trying to shed light on outbreaks in elder care facilities, “but there wasn’t good national data out there.”

At the end of March, the CDC said that 400 nursing homes had COVID-19 cases, Matthews said, but that was a “snapshot” and there was no sense of national scope. So the Journal reached out to all state agencies that regulate nursing homes and got 37 of them to respond with some data after following up repeatedly. “Some couldn’t supply details,” she added. “Since our story, more states are disclosing more information.”

On April 17, The New York Times reported that that at least 7,000 virus-related deaths had occurred in nursing homes nationwide, but the paper did not discuss how it arrived at that number. In the same story, the Times also noted that New York state was now releasing the names of long-term care facilities that had at least five deaths. At that point the number stood at 72 including one in Brooklyn where 55 residents had died. In neighboring New Jersey, the state said there were infections in nearly 400 of the state’s long term care facilities, about two-thirds of all the state’s nursing homes.

“The nursing home industry is one of the most powerful and has had its way with regulatory agencies for decades.”       

                               — Carol Marbin Miller, deputy investigations editor, Miami Herald

A week ago in Michigan the Detroit Free Press ran a fine lengthy expose of nursing homes, reported COVID-19 deaths, and their lack of communication with families trying to learn the fate of their loved ones. The recalcitrance of local officials refusing to disclose even the numbers of residents who died was stunning. The health department in Oakland County said it wouldn’t name names, citing “protected health care information.” In neighboring Macomb County, officials declined to disclose names “based on the advice of our county corporation council.” The Detroit Department of Health said releasing names of nursing homes “could place undue stress on these businesses,” and in Washtenaw County, home of the University of Michigan, a spokesperson for the county health department said, “Talking about those in terms of the numbers is gonna be too identifying for those individuals and facilities.”

A few days after the paper’s expose, Gov. Gretchen Whitmer issued an executive order requiring the state’s nursing facilities to report all positive cases to the state health department as well as up-to-date information on the nursing home’s supply of personal protective equipment for staff.

The Miami Herald has been on the verge of legal action in its effort to force the state to release the names of long-term care facilities and numbers of residents with COVID-19. Florida has one of the best public records laws in the country, but the problem is that “recent administrations have been contemptuous of our favorable laws,” said Carol Marbin Miller, the paper’s deputy investigations editor. Gov. Ron DeSantis has refused to talk about what facilities are affected by the virus and the state’s two health regulators have also refused to discuss it, Marbin Miller told me. “The nursing home industry is one of the most powerful and has had its way with regulatory agencies for decades,” she added.

Her point was driven home several days ago when the governor’s general counsel called the law firm representing the Herald in a bid to quash a public records lawsuit that would force the state to divulge the names of facilities that had positive tests for the virus. The state has so far released a list of facilities with COVID-19 infections, but not the number of cases or fatalities, two crucial pieces of information. The Herald’s law firm lawyer told the paper it could not file the suit on behalf of the paper. The paper then hired another lawyer, and Marbin Miller said this week that other news outlets — including Gannett, the Tampa Bay Times, AP, The Washington Post and The New York Times — will join the Herald in a potential suit to get more detailed information on COVID-19 cases in nursing homes.  “We’re still hoping to resolve this without having to file the suit. But it may be necessary.”

Revealing what is happening in real time in the nation’s nursing homes can be one of the media’s finest contributions to this crisis.  

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy and one of the county’s leading experts on nursing home regulation, told me the new CMS guidance is “too little and very late.” For example, she says there is no federal requirement that nursing home facilities report infection control problems to the state health departments, but states may require such reporting. CMS has said it will write new regulations requiring facilities to report COVID-19 cases to the CDC, but it’s not clear when that will happen, Edelman said.

The CMS announcement Sunday is an invitation to the media to keep digging into the nation’s long-term care facilities, fulfilling the Fourth Estate’s watchdog function on this most important of federal agencies. A good place to start is to ask how the agency plans to put meat on the bones of the announcement it made last night. Reporters should also continue to follow the number of cases and deaths at their local nursing homes. And when states disclose the names of nursing facilities and the number of cases at each,  as California has done, make sure the public knows about them.  

At a minimum, families with relatives in long-term care facilities want to know if their loved ones are safe or not. Figuring out which homes have COVID-19 cases is the most basic piece of consumer information they need to determine whether to keep relatives in a problematic facility or move them out — if that’s possible. Says Marbin Miller, “We have heard from people who have the capacity to take a relative out and would do that if they knew their relative was at risk in their current placement.” Exposing the industry’s harmful secrecy, along with the uncertainty of federal policy surrounding disclosure and enforcement going forward, seems to be a perfect story for the media to cover in-depth for months to come.

Revealing what is happening in real time in the nation’s nursing homes can be one of the media’s finest contributions to this crisis.  

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.