Investigating the Facts Behind Nursing Home Failures of the Pandemic

The onset of COVID-19 outbreaks that began in October 2020 led to a pandemic and over 150,000 nursing home resident deaths. However, it was the initial surge of the virus, resulting in an unprecedented number of deaths in a single wave, that inspired USA Today to take a closer look. What followed next was a year-long investigation of every U.S. nursing home during that first five-month wave of COVID-19 deaths to try to learn more about the prevalent failures at these facilities.

Just how well or poorly did each of these facilities fare during that initial wave of COVID-19 deaths? Why did some of America’s 15,000 plus nursing homes have far better outcomes, even at the onset of the novel coronavirus, than others?

PKSD shares the highlights of USA Today’s unprecedented year-long investigation to get answers to these questions and what they found.

Why Another Study on Nursing Homes During the Pandemic?

While there has been a lot of research, papers and even some documentaries on nursing homes during the pandemic, there are still many unanswered questions. When considering the project, Dying for Care, USA Today wanted to try to get answers to these questions.

To get to the truth, investigative reporters on the project researched and analyzed data and documentation from every nursing home in the country. They also interviewed industry experts, nursing home staff, government overseers and the families of those who died.

What Was the Main Goal of This Project?

Nursing homes reported 71,000 resident deaths due to COVID-19 just between October 2020 and March 2021. While this was not the only wave of COVID-19 deaths, it was the first and biggest wave of fatalities at any one point during the pandemic. Yet during those same five months nearly a third of U.S. nursing homes that reported outbreaks had no fatalities. Why were there such contrasting outcomes?

USA Today set out to gain more insight and transparency about each of these nursing homes to:

• Discover how each nursing home fared between October 2020 and March 2021
• Compare each of the facilities and their day-to-day operations, staffing numbers and more
• Assess why some nursing homes did so well and others performed so badly
• Provide the public with an overall rating of each facility, as well as key points of impact to care

Four Key Takeaways of the USA Today Investigation

The investigation took a surprising turn when reporters discovered one for-profit nursing home chain that stood out. In state after state, this chain had significantly more fatalities than any other U.S. facility.

Significantly Higher Fatality Rates Compared to 15,000 U.S. Facilities

Initially, USA Today looked at mortality rates for every U.S. nursing home. However, that investigation revealed a trail of deaths that all led back to Trilogy Health Services. Trilogy, a for-profit nursing home chain with 115 campuses spread across Ohio, Michigan, Kentucky and Indiana, held the highest number of deaths, by far, nationwide.

More specifically, 45 percent of the 104 Trilogy facilities with sufficient COVID-19 data reported double the national average of nursing home fatalities during this  time period. Given these outcomes, USA Today decided to look more closely at day-to-day operations of this chain to see what may be impacting care at their facilities.

Day-to-Day Operations Impacted Resident Care

Why was the reported number of deaths at Trilogy’s nursing homes so much higher than every other facility in the country?

A closer look revealed that Trilogy drastically cut caregiver hours to patients more than any other major nursing home chain in the country. When the pandemic hit in 2020, Trilogy’s residents were individually getting about 45 minutes less daily care than the federal government’s recommended minimum daily care per patient.

Certified nursing assistants, or CNAs, were the hardest hit by staffing reductions. This is surprising since CNAs are the frontline hands-on caregivers. They do the bathing, feeding, toileting and dressing of residents. CNAs are also responsible for turning patients regularly to reduce the risk of bed sores.

The academic assessment of this decision is that reducing staff may initially lessen the risk of spreading infection. However, having more caregivers not only improves the quality of resident care, it also helps to reduce the risk of mortality of those who become ill.

Multiple Overlooked Warnings and Violations at Trilogy Facilities

Half of Trilogy facilities received multiple citations for violating COVID-19 safety rules in 2020. At one of the facilities, Trilogy Waterford Place Health Campus, 88 residents became infected with the virus. In the nine weeks that followed this outbreak, 29 of those residents died.

These were a few of the safety violations health inspectors observed:

• Nursing aids who, without properly washing their hands, administered eye drops, helped toilet patients and then fed them
• Another aide at a nurses station who stood chatting with a face mask down
• A resident without a mask who wandered from room to room without being stopped before grabbing and putting on a used mask from the trash bin

When reviewing the data, Trilogy’s fatalities did not seem to be solely because many residents are older or more fragile. These outcomes also did not seem to be due to facilities being in states hard-hit by outbreaks. In fact, academic studies suggest that, based on the data, Trilogy’s facilities should actually have been safer.

An Elder Care Business Model That Puts Profit Over People

Despite the high number of deaths, Trilogy has continued to prosper. The reason for this ongoing profitability could be due to pressures placed on the facilities by a Real Estate Investment Trust (REIT), purchased not Trilogy properties. While REITs are not new, previously these organizations kept the real estate venture separate from the care happening within the facility. However, with Trilogy, that is not the case. The REIT that purchased Trilogy also invested in its daily health care operations.

This latest business model provides the opportunity for increased profits. However, there is also the potential for greater risk if there is an economic downturn. Keeping this risk in mind, Trilogy’s REIT may continue to impose pressures to cut corners in order to maintain or increase profitability.

Today, the real estate venture behind Trilogy boasts a $4 billion portfolio. The next step? This REIT is preparing to launch a stock listing later this year.

Ashvin Gandhi, a UCLA health economist who studies private investment of nursing homes said, “The financial pressures coming from the industry’s real estate landlords clearly need more scrutiny.” Gandhi further noted how these business arrangements can “affect people’s life and death.”

“It really tells us that we need to know a lot more about what is going on in nursing homes,” he said.

Last month, USA Today presented their in-depth findings to Trilogy. After reviewing the figures, Trilogy said their original self-reported numbers were incorrect and provided revised figures that reduced its original death toll figures by 42 percent. USA Today reporters attempted to set up an interview to learn how they substantiated these new figures. However, despite repeated requests, Trilogy declined to respond.