Throughout the pandemic, we have heard from family members of nursing home residents who were upset that they were not able to get in to see their loved ones. They were worried about their family member suffering from isolation and depression. They were also concerned that they could not see for themselves the care their mother, father, sister or brother was receiving. As a CNHI investigation into nursing home oversight found, the pandemic worsened a system of oversight that already had issues. And by locking out family members, one of the most valuable forms of insight into the care at nursing homes was lost.
Compared to other states, Alabama does a good job of caring for nursing home residents. Prior to the pandemic, Alabama was one of 10 states with the least amount of complaints. In 2018, the U.S. Office of the Inspector General found Alabama investigated 18 immediate jeopardy complaints. All but three were investigated within two days. In that same year, 39 high priority complaints were filed and all were investigated within 10 days.
It is also important to note that none of Cullman’s nursing home facilities appear on the Centers for Medicare and Medicaid Services (CMS) list of Special Focus Facilities or One-Star Nursing Homes, nor are any of them included in the 135 Alabama nursing homes that are more than 18 months overdue on their annual inspections.
That doesn’t make family members’ concerns any less valid, however.
Nursing home visitors play an important role in oversight. They submit the majority of complaints that lead to investigations into nursing homes. When nursing homes shut down, families and friends were locked out. “That left nursing home residents completely at the mercy of the facilities,” said Richard Mollot, the director of New York advocacy group Long Term Care Community Coalition.
During the pandemic, from March 23 to May 30, only 31 percent of nursing homes nation-wide had onsite inspections. The previous year, 53 percent of nursing homes received on onsite inspection, or “survey.” Alabama surveyed less than 10 percent of its nursing homes following CMS’s directive to conduct only inspection control surveys or complaints of immediate jeopardy.
Even though immediate jeopardy complaints were prioritized for inspection, fewer incidents were reported. This is likely a result of having fewer family members observing care. According to the Inspector General, in 2019, family members reported 6,000 incidents from March 23 to May 30. In 2020, during that same time period, there were 2,000 complaints.
One advocate quoted in the CNHI story, Wes Bledsoe, said, “There were no watchdogs.The watchdogs (used to be) the family, your legal representatives, the state ombudsman’s office … friends of residents. All (of) those people were providing outside eyes and reporting what was going on.”
This legislative session, Sen. Garlan Gudger sponsored legislation that would allow family members and advocates to continue visitation during a coronavirus pandemic. On Thursday, the House approved a final version of the bill, which was supported by nursing homes and hospitals.
This is good news, especially as the coronavirus is likely to be with us for a while; even though most nursing home residents have been vaccinated, how long the vaccines last and how well they work against emerging variants is not yet known. Hopefully, the worst of this virus is behind us, but it’s good to know families will still be able to have in-person visits with their loved ones if it is not.