Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for low-income people, only 15 were 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less. While the statewide average decline was 15%, the number of residents in 19 nursing homes has plummeted to 55% and below since January. The number of empty beds has more than doubled.
That 70% occupancy level grabs lawmakers’ attention. Last year, the state budget targeted nursing homes for steep one-time cuts in Medicaid payments if they didn’t fill at least 70% of their beds or, equally serious, have three years of the lowest grades from the federal “Nursing Home Compare” website. “We called it the occupancy penalty,” said Matt Barrett, president and CEO of the Connecticut Association of Health Care Facilities/Connecticut Center for Assisted Living (CAHCF/CCAL).
iStock Photo.
The statewide average of occupancy in nursing homes has declined 15%, the number of residents in 19 nursing homes has dropped to 55% and below since January.
Nine nursing homes affected by the budget policy appealed their payment cuts, which were suspended until the matter could be resolved, according to the state Department of Social Services (DDS), which oversees the state Medicaid program. Discussions continue and include the possibility of downsizing by eliminating empty beds, said DSS spokesman David Dearborn.
Elderly, chronically ill adults are the most vulnerable to COVID-19, the disease caused by the coronavirus. In Connecticut, nursing home residents are roughly 100 times more likely to die from the virus than are other residents. Compared with other states, Connecticut’s 102 deaths per 1,000 nursing home residents ranks third behind Massachusetts and New Jersey, according to federal data. Nearly 3,000 have died, or 64% of the state’s death toll.
“That’s a huge number of nursing home residents, and it’s heartbreaking,” said Mairead Painter, the Connecticut long-term care ombudsman, a consumer advocate for nursing home residents. By comparison, COVID-19 fatalities among nursing home residents nationwide account for about 40% of the nearly 196,000 Americans who have died from the virus.
Although increasing numbers of Connecticut seniors have opted for long-term care in their own homes, nursing homes are the only option for those with complex medical needs. Owners say the state and federal governments aren’t doing enough to shore up their industry and protect residents during the pandemic. And in some cases, policies intended to control the virus can make things worse.
New Rules Deter New Residents
Another reason people are avoiding nursing homes is the restriction on visitors, Painter said. Gov. Ned Lamont recently revised the state’s visitation policy to allow private, indoor visits under certain conditions unless residents or staff test positive for COVID-19. Just one positive test puts an entire building off-limits. Outdoor visits or video chats are a poor substitute and impossible for some residents with dementia or severe physical disabilities. About a dozen consumer and legal advocacy groups claim that the rules are discriminatory and have asked Lamont for additional changes.
Map by Susan Jaffe Source: Connecticut Department of Social Services
“We’re seeing people make other choices because they know they’re not going to be able to see their loved ones,” Painter said. She and her staff have received thousands of complaints about these restrictions, which she said causes social isolation, the loss of essential services visitors provide and an increased risk of abuse and neglect.
Another factor affecting nursing home occupancy was created by the crisis COVID-19 imposed on hospitals. Nursing homes have long depended on hospital patients recovering from joint replacements and other procedures for a large part of their population but not during the pandemic. Hospitals canceled most elective surgeries in order to treat COVID-19 patients, said Tim Brown, director of marketing and communications for Athena Health Care Systems’ 44 nursing homes in New England, including half in Connecticut. The lack of hospital patients seeking short-term rehabilitation services at nursing homes “has translated to a decrease in our census,” he said. Elective surgeries have resumed, but “it is going to be a while before we’re back to normal occupancy,” Brown said.
In addition to Medicaid, the Medicare program for older or disabled adults pays for nursing home care following a hospital admission of at least three consecutive days. (Time spent in observation care doesn’t count.) Medicare suspended that rule during the pandemic, but Brown said the change has had little effect. “It didn’t help that much because people weren’t coming into the hospital in the first place.”
Two Athena facilities dedicated to COVID-only patients through the end of June under an agreement with the state are still well below capacity, Brown said. Occupancy at Northbridge Health Care Center in Bridgeport was 36% in August, compared with 92% in January, according to state records. Occupancy at Athena’s Sharon Health Care Center declined to 36% in August from January’s 88%. Even though Athena received extra payment for caring for its COVID-19 patients, Brown said the company lost “a significant amount of money.”
In addition to the loss of residents seeking short-term rehab services, nursing homes have had to reserve beds in isolated areas for COVID-19 residents to keep the virus from spreading. Under state and federal requirements, residents must be separated into three groups: those infected with the virus, those not infected and one more for those whose status is unknown. Each group should have its own staff to avoid cross-contamination.
“The problem is you have three units, and none of them are full,” said Paul Liistro, who owns Vernon Manor Health Care Center, which has 120 beds, and 126-bed Manchester Manor. If he could consolidate, he could close a unit. “I can turn the air conditioning off, turn the lights off, and I don’t have to staff it,” he said. “If you have a partially filled building, you go broke.”
At his Manchester facility, occupancy dropped to 64% in August from January’s 97%. Occupancy at the Vernon facility dropped to 83% in August from 92% in January.
Consequences
Liistro predicts some nursing homes in Connecticut may default on their mortgages because they don’t have enough cash in reserve and don’t have enough residents to generate the income to pay for protective equipment, tests and staffing, plus utilities and other fixed expenses.
As occupancy declines, Painter fears nursing home operators will make more cuts in staffing. The number of direct-care workers, such as nursing assistants, social workers and recreation staff, depends on the number of people in the building, she said. According to the union that represents nursing home staff, between 300-500 of its 7,000 members in Connecticut permanently lost their jobs and another 1,500 had their hours reduced.
Nursing homes in the state received $23 million in extra Medicaid payments to help them respond to the pandemic in March and April. That was followed by another aid package of $48 million that Lamont decided to allocate from federal coronavirus relief funds.
“Overall, the state has substantially increased support to nursing homes through Medicaid, federal coronavirus relief funding and related funding,” Dearborn said.
And yet, this aid may not be enough, especially if there’s a second wave of the virus.
“These are absolutely unprecedented times,” said Brown, the Athena spokesman. In a natural disaster or another emergency, he said, facilities can help each other by sharing staff and managers, but now such mutual aid raises the risk of spreading the virus.
Liistro’s two facilities have received hundreds of thousands of dollars in federal and state financial assistance, but it doesn’t stretch very far. “It’s been helpful to keep us breathing air through a straw for another 90 days, and then we will be running out of money.”
Below is a list of nursing homes with 70% or less occupancy. Scroll down to see full list.
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]]>Painter, the state’s long term care ombudsman, who works for the state Department of Aging and Disability Services, launched live chat sessions on Facebook that quickly evolved into a real-time information pipeline for families.
“I was trying to think about how we can reach people. Normally, residents and family members are sometimes the last people to get information,” said Painter, whose office is independent of the state Department of Public Health. “I wasn’t sure anybody would join [the chats]. It was kind of an experiment to see if it would work.”
In mid-March, after the first cases of COVID-19 were reported among nursing home residents, the state barred all visitors except emergency personnel. Families became more anxious as the number of cases and deaths rose in these facilities.
Contributed Photo.
Mairead Painter, the state’s long term care ombudsman, hosts weekly live chats to answer questions about nursing home care.
To date, nursing home deaths account for about 60% of all COVID-19 deaths. As of May 20, nursing home cases total 7,875 and deaths 2,190. Although the weekly number of deaths rose by 263, that was fewer deaths than the prior week.
Nursing homes are “playing catch-up,” trying to keep pace with the day-to-day changes the pandemic brings, Painter said. Some now are making stronger efforts than others to communicate with families, she said.
Painter, who has been ombudsman since May 2018, hosts hour-long Facebook Live sessions at 5:30 p.m. every Monday, Wednesday and Friday on the Connecticut Long Term Care Ombudsman Program Facebook page.
“It’s a blessing, a lifesaver and calming voice during a trying time,” said Carol Zenczak of Enfield, who heard from Painter when she posted a social media comment concerned that her mother’s nursing home was becoming a COVID-19 recovery home. As it turned out, the facility did not become a COVID-19 recovery facility.
The questions posed to Painter run the gamut. In recent sessions, family members have asked: how and when more widespread COVID-19 testing will be available, when facilities might reopen to visitors, whether facilities can add cameras to allow family members to virtually check in on residents, why some facilities are allowing outside “window” visits and others aren’t, whether residents can receive flower deliveries, and how they can get summer clothes to their loved ones.
The chats usually draw between 400 and 600 participants, with one generating close to 1,000 views. They have created a new dynamic, Painter says, where family members sometimes get information from the state even before it’s trickled down to nursing home administrators. A recent chat featured Barbara Cass, who oversees inspections and quality control measures at nursing homes as chief of DPH’s health care quality and safety branch.
The sessions provide more than just a venting session for family members; they have generated some results. After Painter and DPH officials received complaints that family members couldn’t communicate with nursing home residents via video chat, the state distributed 800 iPads to nursing homes May 9. DPH ordered facilities to devise schedules so residents can have 20-minute video chats once a week.
Typically, the ombudsman’s office focuses largely on responding to and investigating complaints by residents, family members and others against long-term care facilities.
Zenczak said, “I have always known about the ombudsman program, but thought you came to use them only in cases of abuse or neglect. Little did I know. With very little communication, although it is getting better, between my mother’s nursing home and those of us on the outside, we are now able to ask for things like window visits, virtual visits, sending care packages through the mail–things I don’t think we would have known we could do if not for people like Mairead.”
Karen Foley of Waterford says she feels lucky that during the 10 years her mother has been at Bayview Health Care Center, she’s never felt the need to contact the ombudsman’s office. “However, I have discovered that this office provides much more than problem resolution,” she said.
“It is a great source of information and support,” she said. “There is a great deal of good collaboration happening, and knowing this has made a difficult situation easier. Mairead’s dedication is so appreciated.”
Liz O. Stern of Stonington, whose mother is in a nursing home, agrees. She spearheads a council that supports families at her mother’s facility.
“She’s a gift,” Stern said of Painter. “What she is doing is beyond what I can put into words, the fact that she can build trust in this climate. I watch her demonstrate genuine empathy but also laced with a lot of realism. She understands what she can do and what she can’t do, and she is not apologetic about what she can’t do. To know her is to have a friend.”
The chats also let family members learn from and exchange information with each other, Painter said. Many are realizing, for instance, that policies can vary widely from facility to facility. Painter hopes her office is giving families knowledge that empower them and hold nursing homes accountable.
“You have to be part of the solution,” she said of her work.
]]>In 2017 alone, the state Department of Social Services (DSS) received 11,123 reports of elder abuse and decided that 7,196 warranted an investigation. That year, self-neglect—when adults are unable to provide for their own basic care—was the most common type of elder abuse reported to DSS, at 30 percent, followed by neglect by others, financial exploitation, emotional abuse, physical abuse, sexual abuse and abandonment.
“It’s all trending up,” Dorian Long, DSS director of social work services, said.
Some of the recent cases investigated by DSS Protective Services for the Elderly are chilling. A 74-year-old man who was frail, thin and prone to falling was living alone in a home infested with cockroaches and mice. The in-home care of a woman over 90 was stopped for nonpayment because her niece had spent her aunt’s money on her own household. An 87-year-old man confused about his finances had his utilities shut off after his son had spent his money instead of paying the bills.
Long’s 68 social workers helped all the seniors find in-home care, a new conservator or better housing—whatever they needed to escape the neglect or abuse.
Sexual abuse of the elderly is also on the rise, Long said. In the past, DSS would investigate three or four cases a year, working with police, and now it typically handles 40 cases a year. Scams targeting the elderly are also increasing, she said. Seniors can avoid becoming victims by staying involved in their communities. “The more you are isolated, the more vulnerable you are,” Long said.
The Justice Department estimates that 1 in 10 American seniors are abused, and state officials say the problem is likely to grow as the population in Connecticut—already the sixth oldest state—rapidly continues to age.
Complaints about abuse in Connecticut nursing homes, residential care homes and assisted living facilities rose by nearly 15 percent between 2015 and 2017, said Mairead Painter, the state Long Term Care Ombudsman.
Experts say the numbers of elder abuse complaints may be rising due, in part, to greater awareness, but still, many cases are never reported.
“Sometimes individuals are too embarrassed to report it,” Painter said. “Sometimes people are fearful that if they report abuse, they may have to stay longer at a nursing home.”
From Physical Abuse To Romance Scams
The cases of elder abuse seem to be all over the news. In January 2018, the live-in caregiver of an 81-year-old man with dementia was arrested after going on a rampage, breaking a TV and burning papers on a stove, in the man’s apartment in the Rockville section of Vernon.
This January, a Rockville couple in their 70s had several thousand dollars in cash and jewelry stolen when they let in their home men posing as utility workers.
Sometimes the abuse is physical. When she was 69 and living in Meriden, Rita Pompano said, she endured seven months of physical abuse from her husband, Ralph Pompano.
Each day when he told his wife to grab a pillow, the pain would soon follow.
“I knew that was time for my daily beating,” said Pompano, now 76 and living in West Haven. “He’d have me put my face into the pillow so nobody would hear me screaming.”
She escaped with her son Anthony’s help in 2011, only to have her husband threaten him three months later to find out where she was hiding. Ralph Pompano, 74, pulled a gun and fired a shot at Anthony that day before fleeing to Virginia. Two years later, he died in prison.
Bonnie Brandl, director of the National Clearinghouse on Abuse in Later Life, said she has encountered cases like the Pompanos’.
“The abuser may decide their life is being cut short and will become threatening,” Brandl said. “It’s the ultimate act of power and control.”
State Sen. Tony Hwang, R-Fairfield, and four state representatives have proposed legislation to create an elder abuse registry. Similar to the state sex offender registry, it could keep people convicted of such crimes from doing it again, he said.
“We need to be sure our seniors are protected,’’ he said. The bill has been approved by the state legislature’s Committee on Aging and referred to the Senate.
The AARP Connecticut holds workshops across the state to alert seniors about scams, ranging from IRS and sweepstake scams to fake Nigerian princes, said Erica Michalowski, the organization’s associate state director for community outreach.
“We say that the scam artists have gotten the senior into their ether,” she said. “They’re keeping the senior off-balance in a heightened emotional state.”
Betty Bajek, 66, of Prospect, volunteered to educate seniors about fraud for AARP after someone stole her credit card number and charged $1,200. She said romance scams are on the rise as criminals befriend seniors, show a romantic interest in them and then ask for money.
“These con artists prey on lonely people,” she said.
Nationally, financial exploitation and neglect are the most common types of elder abuse. Some states, including Connecticut, count self-neglect as abuse. Julie Schoen, deputy director of the National Center on Elder Abuse, said that is appropriate so those seniors get help. Brandl, of the national clearinghouse, agrees that they need help, but said, “For me, it’s not elder abuse when there’s no perpetrator.”
Unlike children who are abused, seniors can decline help. Long said DSS social workers do encounter some elderly people living in squalor who refuse their services.
“We put on the charm and try to convince them, but as an adult, you have a right to make choices—even bad choices,” Long said. The caseworkers may go back a few weeks later to try again. If the person says no, they have to close the case.
Help Is Available
One of several agencies in Connecticut assisting elders is the CHERISH program in Ansonia, which counseled Rita Pompano after she left her husband. It provides a hotline, court advocacy, safe housing and counseling for victims of domestic violence who are over 60 statewide.
Its coordinator, Mary Jane Liddel, stayed close by as Pompano recounted her story of her husband’s violence. Tearing up briefly, Rita said CHERISH helped her heal. Now, she enjoys freelance writing, cooking for friends and taking road trips with friends.
“I’m just happy that I’m free,” she said.
CHERISH’S 24-hour hotline: 203-736-9944 or 203-789-8104.
To report cases of suspected elder abuse, neglect or exploitation in Connecticut, call the toll-free referral line at 1-888-385-4225; after business hours, or weekends, or state holidays, call 211.
For information about Protective Services for the Elderly, click here.
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