Legislature Opts for Deliberation — Not Haste — in Tackling Nursing Home Reforms After Wave of COVID Deaths

With about 60 percent of 4,338 COVID-19-related deaths in Connecticut occurring in nursing homes, the need for reform in the industry and the potential for increasing penalties for health code violations have become commonplace talking points among state legislators.

That said, the issues are not expected to be addressed by legislators in summer or fall special sessions.

“Changing penalties is not at the level or urgency for the special sessions,” said State Sen. Jonathan Steinberg, D-Westport, co-chair of the Public Health Committee. “My job is to make sure we take our time and look at all the possibilities.”

Steinberg said that once the Governor’s independent review of nursing homes and assisted living facilities is completed in September, then the committee should take the time to listen to feedback and take the steps necessary to make sure that this never happens again.

“People are frustrated that the fines seem relatively low compared to the citations. With inflation and everything the fines seem out of step,” Steinberg said. “But, I favor the attitude of the Department of Public Health. Their focus is on correction and making sure it does not happen again instead of making it extremely punitive.”

The statute governing civil penalties available to the Department of Public Health to be levied on nursing homes – between $3,250 and $10,000 – was last revised in the 1980s, roughly halving the penalties when accounting for inflation.

As of June 26, the Department of Public Health had issued just 6 citations with civil penalties during routine COVID-19 inspections, said Barbara Cass, chief of Healthcare Quality and Safety Branch at the state agency.

Although that number appears low given that many more nursing homes have received citations for poor infection control during the COVID-19 pandemic, Steinberg said that solely blaming nursing homes for the more than 2,500 COVID-19 deaths is too easy.

“It’s very easy to blame them,” he said. “But if we do and we increase the penalties say five-fold, would that be effective? Are there other underlying reasons why nursing homes are having trouble?”

Steinberg said that he wants to know whether the way that facilities are built and laid out is part of the problem and whether cohorting residents with the current air-circulation systems is even helpful in preventing the spread of the virus.

“Every fatality that we had that was related to negligence or maleficence needs to be corrected and we should consider increasing penalties,” he said. “But there is a lot more to this and a lot more we don’t know yet.”

Steinberg said that although the issue will not be address in special session, it could come up in the 2021 session.

Meanwhile on the national level, Centers for Medicare and Medicaid Services is increasing penalties in an effort to prevent further harm to nursing home residents. According to a June 1 press release, the federal agency is “ratcheting up penalties for noncompliance with infection control to help prevent backsliding, improve accountability and ensure prompt compliance.”

The increased penalties — including denial of payment for new admissions and up to $20,000 in daily fines for each violation — are focused on penalizing facilities that have repeated infection-control deficiencies and ensuring the violations are corrected within 30 days.

“CMS has started to increase fines and shorten the enforcement period meaning that facilities need to get back into compliance a lot quicker than before,” Cass said. “It is something that we could consider here in the state as well.”