July 02, 2020

Warren, Maloney, Markey Release Findings from First Comprehensive Survey of COVID-19 in Assisted Living Facilities & Introduce Assisted Living Facility Coronavirus Reporting Act

Infections, Hospitalization & Fatality Rates Dangerously High for Assisted Living Residents Congressional Investigation Estimates That Nationwide, Approximately 7,000 Assisted Living Residents May Have Died From COVID-19 Unlike Nursing Homes, Assisted Living Facilities are Largely Unregulated at the Federal Level with No National Reporting Requirements

Investigation Findings | Bill Text | Bill One-Pager | Section by Section | Bill Endorsements 

Washington, DC - United States Senators Elizabeth Warren (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) and Senate Aging Committees, Edward J. Markey (D-Mass.), and Congresswoman Carolyn B. Maloney (D-N.Y.), Chairwoman of the House Committee on Oversight and Reform released the findings from their investigation into coronavirus disease 2019 (COVID-19) outbreaks at facilities run by the nation's 11 largest assisted living operators and the actions these facilities are taking to prevent and mitigate outbreaks when they do occur.  

The lawmakers' investigation, the first comprehensive survey of COVID-19 in assisted living facilities, found high rates of coronavirus infection, dangerously high hospitalization and fatality rates for residents testing positive for COVID-19, inadequate sick leave policies for employees that put people at risk, lack of routine testing and inadequate testing protocols, and shortages of personal protective equipment (PPE). It revealed that more than 30% of the assisted living facility residents that tested positive for COVID-19 died, and estimates that approximately 7,000 assisted living facility residents nationwide may have died from the disease.

Their investigation also found that assisted living facilities are not reporting COVID-19 cases and fatalities directly to the federal government. The lawmakers announced the introduction of The Assisted Living Facility Coronavirus Reporting Act to put in place national data collection and reporting requirements to ensure that assisted living facilities adequately protect residents from COVID-19. 

"Our investigation found assisted living centers are facing a COVID-19 crisis that is almost as bad as the crisis in nursing homes -- but without being subject to the same regulations or oversight, and with no help from the federal government." said Senator Warren. "This first ever comprehensive review makes it clear that Congress must immediately pass our legislation to put in place strict data collection and reporting requirements. Policymakers, public health officials, and assisted living facility residents and their families need to know this information so they can make the right choices about how to save lives during the COVID-19 pandemic."

"The coronavirus pandemic has made painfully clear that the federal government must do more to protect residents of assisted living facilities," said Chairwoman Maloney. "Our investigation has revealed that at the most basic level we need more transparency into the crisis playing out in these facilities-and that these facilities need more federal support to access the testing and PPE they need to keep residents safe.  I thank Senator Warren and Senator Markey for their partnership on this effort, and am pleased to join them in introducing commonsense legislation to bring more transparency and accountability to assisted living facilities."

"We are simply not doing enough to protect our seniors or workers in assisted living homes from this deadly virus. This report confirms that, just like nursing homes, assisted living facilities present significant risks for coronavirus infection and outbreaks of COVID-19. The federal government needs to ensure that these facilities are actively monitored for potential outbreaks and are getting the test supplies and personal protective equipment they need to prevent outbreaks. We need to put in place stricter requirements on these facilities so that they are better prepared to protect our beloved family members. I thank Senator Warren and Chairman Maloney for their leadership on this important investigation and hope this becomes part of a long-overdue national discussion on how to reconfigure long-term care in the United States," said Senator Markey.

The lawmakers' investigation found: 

High rates of coronavirus infection in assisted living facilities. As of May 31, 2020, nearly one in four assisted living facilities in the survey-24%-had at least one case of COVID-19 among residents, and approximately 8% of facilities had wider outbreaks of at least ten cases. Residents of assisted living facilities surveyed tested positive for COVID-19 at over five times the overall national average rate: 2.9% of assisted living residents had tested positive for the disease as of May 31, 2020, compared to a national occurrence rate of 0.5%.  

Hospitalization and fatality rates are dangerously high for assisted living residents that test positive for COVID-19. Overall, among the assisted living facilities surveyed, approximately 43% of residents who tested positive for the coronavirus were hospitalized.  Among all assisted living facility residents who tested positive for COVID-19, 31%-one in three-died.  This fatality rate for diagnosed cases, while highly sensitive to the testing rate, is approximately six times the national average, and is comparable - or even higher than - the fatality rate for nursing home residents with COVID-19. If this rate is representative of assisted living facilities nationwide, the investigation suggests that more than 7,000 assisted living facility residents may have died from COVID-19 as of May 31, 2020-representing approximately one in 15 COVID-19 fatalities nationwide at that time.

Assisted living facilities are not reporting COVID-19 cases and fatalities directly to the federal government. None of the large assisted living providers indicated that they reported any of these COVID-19 cases directly to the federal government, explaining: "Currently, there are no federal requirements for reporting COVID-19 cases within assisted living facilities."  As a result, federal government officials, public health experts, and the public have no comprehensive information on COVID-19 occurrence and fatality rates in assisted living facilities.

Inadequate sick leave policies for employees put assisted living facility workers and residents at risk. Almost all of the assisted living facility operators had inadequate sick leave policies-failing to offer specific sick leave, not offering enough leave, offering it only under the condition that  employees have a positive COVID-19 test, or not offering leave to part-time employees.  These inadequate policies make it more likely that workers in assisted living facilities will come to work when ill, putting assisted living residents and coworkers at risk.

Lack of routine testing and inadequate testing protocols in assisted living facilities place workers and residents at risk of COVID-19 outbreaks. None of the assisted living facility operators reported that they conduct routine daily or weekly testing of asymptomatic staff, residents, or visitors at all their facilities.  Most operators cited the lack of federal guidelines requiring such testing and limited testing capacity as the reasons they do not conduct more routine testing.

PPE shortages imposed significant hardships on assisted living providers.  Although facility operators reported following state and federal guidelines for PPE use and provided PPE to employees at no cost, they also reported facing tremendous financial and logistical difficulties in obtaining adequate PPE for their staff.

The investigation makes clear the need for legislation to address the gap in data collection and reporting at assisted living facilities. The lawmakers introduced the Assisted Living Facility Coronavirus Reporting Act to:

  • Require states to report to the CDC for each assisted living facility in the state, both historic and weekly COVID-19 data, broken down by demographic information; 
  • Require assisted living facilities to notify federal, state, and local health officials; assisted living facility residents; and their loved ones by the next day after the occurrence of confirmed COVID-19 cases and suspected outbreaks in the facility;; 
  • Require the Department of Health and Human Services to apply all future COVID-19 reporting requirements for nursing homes to assisted living facilities, to the extent practicable; and 
  • Require GAO to issue a report, within 2 years, providing recommendations for improving reporting in congregate care facilities 

The Assisted Living Facility Coronavirus Reporting Act has been endorsed by the American Public Health Association, the Long Term Care Community Coalition, the National Consumer Voice for Quality Long-Term Care, Justice in Aging, Social Security Works, Caring Across Generations, Public Citizen, the National Academy of Elder Law Attorneys, SAGE, Latinos for a Secure Retirement, and the National Asian Pacific Center on Aging.

"An overwhelming proportion of our country's COVID-19 mortality has occurred in assisted living facilities - 43 percent of deaths have taken place in these settings despite representing only 11 percent of cases," said Georges C. Benjamin, MD, executive director of the American Public Health Association. "We know that older adults face a higher risk from COVID-19; we also know that the confined, congregate setting of these facilities puts those adults and the workers who support them at a higher risk of transmission. To protect these individuals and limit the community spread stemming from these facilities, it's essential that we exercise additional oversight in how these facilities report COVID-19 data. I applaud the introduction of the Assisted Living Facility Coronavirus Reporting Act by Senator Warren, House Committee on Oversight and Reform Chairwoman Maloney, and Senator Markey. The bill would put this much-needed oversight into place by requiring that states and assisted living facilities be held to a higher standard of reporting COVID-19 data. This data is essential for providing the Centers for Disease Control and Prevention and other public health agencies with insight into how we can limit the spread of the virus."

"Though seniors in assisted living are particularly vulnerable to COVID-19, their well-being has largely been ignored in our nation's efforts to address the pandemic," said Richard J. Mollot, Executive Director of the Long Term Care Community Coalition.  "We applaud Senator Warren, Chairwoman Maloney, and Senator Markey for taking this important step toward ensuring that assisted living residents, their families, and the public have critical information on COVID-19 cases in their facilities and the extent to which those facilities have the resources necessary to safeguard residents now and in the future."

Read more statements of support here. 

Read the bill text, one-pager, and section by section of the legislation. Read the investigation findings here.

The lawmakers launched their investigation on May 1st. That same month during a Senate Aging Committee hearing, 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.