May 21, 2020

At Aging Hearing, Warren Calls for Consistent Federal Reporting Requirements for Nursing Homes and Assisted Living Facilities Amid COVID-19 Pandemic

Warren, Colleagues Have Launched an Investigation into how Assisted Living Facilities are Tracking Infections & the Preventative Measures in Place

"Assisted living facility residents and their families deserve to know whether their facilities are experiencing a coronavirus outbreak, just like nursing home residents."

Video of Hearing Exchange (YouTube)

Washington, D.C. - In a Senate Aging Committee hearing today, United States Senator Elizabeth Warren (D-Mass.) questioned health experts on the differences in the types of data the federal government requires nursing homes and assisted living facilities to report, despite their fundamental similarities and the vulnerability of their residents to COVID-19.

Senator Warren discussed the severity of COVID-19 outbreaks at long-term care facilities in Massachusetts, and called for consistent reporting requirements for assisted living facilities and nursing homes. She has launched an investigation with Senator Edward J. Markey (D-Mass.) and Congresswoman Carolyn B. Maloney (D-N.Y.), Chair of the House Committee on Oversight and Reform, into what actions assisted living facilities are taking to prevent and mitigate outbreaks when they do occur.

The full transcript and video of her exchange with the hearing witnesses is available below.

Transcript: Warren Questions Health Experts on Federal Oversight of Nursing Homes and Assisted Living Facilities
Thursday, May 21, 2020
U.S. Senate Special Committee on Aging

Video (YouTube)

CHAIRWOMAN COLLINS: Senator Warren, I don't know whether you heard my opening remarks, but I do want you to know that I know I speak for every member of this committee in expressing our condolences to you. You've been touched very personally by this virus, so welcome. 

SENATOR WARREN: Thank you so much, I appreciate it, Madam Chair. You reached out to me personally right after my brother died, and he died in a congregate setting facility, in a rehab, so thank you, I appreciate it. And I very much appreciate that you're holding this hearing today. In fact, what I want to talk about is I want to talk more about how seniors are bearing the brunt of COVID-19. And nursing homes have become the epicenter of the crisis. And it is important that we do everything we can, that there is testing, and that there's contact tracing and that we get a vaccine, and that we develop treatments, but one of the things we need to do is collect more data.

So I want to start by asking Dr. Konetzka, why is it so important that nursing homes collect and report in a timely manner and transparently, data about COVID-19 infections?

DR. KONETZKA: I think it's critical for several reasons. One is just that we need to know where to direct resources, right? Nursing homes need help when they're having an outbreak, and so we need to know that right away. It also gives us a signal about what's happening in the communities in which nursing homes are located. And second, it will enable us to do research that will help us later figure out what worked and what didn't work so that we can perhaps do better the next time. And then finally, it's really critical for consumers, right? So you know we've been encouraging consumers since 2009 to get on Nursing Home Compare and look at information for their nursing homes, but right now they can't easily find which ones have COVID outbreaks. We need to give them that information so they can make good decisions.  

SENATOR WARREN: Thank you. I think that's really important, and you know it's such a serious issue. In Massachusetts, for example, more than half of the COVID-19 deaths are directly linked to long-term care facilities. Now, the Center for Medicare and Medicaid Services, the federal entity that regulates nursing homes, is taking some important steps to ensure better data. And just last month, as you may know, CMS started requiring nursing homes to report new COVID-19 infections, outbreaks, hospitalizations, and deaths directly related, and they have to report it to the CDC. Nursing homes also must notify residents and families of these infections. 

But nursing homes aren't the only facilities--long-term care facilities--that have been hit hard by this pandemic. Roughly 800,000 Americans live in assisted living facilities. In Massachusetts, about two-thirds of assisted living facilities have reported COVID-19 infections. Now, residents in assisted living facilities that serve older Americans require less frequent medical care than those in nursing homes and less help with activities for daily living, but populations in both places are similar: older people who need some help from caregivers in order to conduct daily tasks. 

So, Dr. Mulligan, you've been serving on the front lines of the coronavirus pandemic. When it comes to the patients that you've seen, does coronavirus affect nursing home residents any differently from how it affects assisted living residents? Or are people living in both settings vulnerable to the crisis? 

DR. MULLIGAN: There's no question that they're both very vulnerable. I think the assisted living facility and even the community dwelling seniors are at equal risk. If you think about a third of deaths are nursing home residents, but 80% of deaths are seniors, that means there's an equal number to the nursing home deaths that are outside the nursing home. 

SENATOR WARREN: That's right. 

DR. MULLIGAN: So absolutely, Senator, you are correct. 

SENATOR WARREN: Okay, that is really important. The reality is that this virus doesn't care whether seniors are living in assisted living facilities or living in nursing homes. It can affect them regardless. 

So, let me go back to you, Dr. Konetzka. Are assisted living facilities required to report the same coronavirus nursing---same coronavirus information--as nursing homes, like report on infections or hospitalizations or deaths or outbreaks, to the federal government and to the families and to the people who live there? 

DR. KONETZKA: No, they are not. Just like data collection in long-term care generally, we don't collect much data from assisted living, because they're not as dependent on federal funding, and under the CMS guidance, as I understand it, we're also not collecting information from assisted living facilities, which for all the reasons you mentioned, is unfortunate. 

SENATOR WARREN: Yeah. So, assisted living facilities have similar populations as nursing homes, they face similar infection risks, but they aren't subject to the same regulations when it comes to the coronavirus, and that is why I've launched an investigation with Senator Markey and with Congresswoman Maloney into how assisted living facilities are tracking coronavirus infections and preventive measures at these facilities and whether they have enough preventive measures in place. 

Assisted living facility residents and their families deserve to know whether or not their facilities are experiencing a coronavirus outbreak, just like nursing home residents are entitled to know that. So, I believe we owe it to our seniors to get this done. 

Thank you all for being here today, and thank you again, Madam Chairwoman.