The Trump administration called out Maryland Gov. Larry Hogan in a harshly worded letter Wednesday for a lack of coronavirus pandemic-related inspections of nursing homes, deeming the state’s effort a “failure.”
The letter said the state not only missed federally mandated deadlines, but with just over half of the facilities inspected, had the worst record in the country by far. That was jeopardizing the safety of particularly vulnerable seniors.
“I write today to express my extreme concern for the health and safety of Maryland’s aged population due to your state’s failure to conduct federally required infection control inspections of Maryland nursing homes,” began the letter signed by Seema Verma, head of the federal Centers for Medicare and Medicaid Services.
“To prevent transmission of the 2019 novel coronavirus (COVID-19), I urge you to immediately complete inspections of all of your state’s nursing homes as soon as possible,” it said.
Hogan officials disputed the letter, saying 169 nursing homes in the state — nearly 75% — had been inspected according to the federal process. The Maryland Department of Health also said it’s already informed the federal agency that the remaining surveys will be completed in the next two weeks.
But even with three-quarters of homes inspected the state would still be the worst in the nation, according to information in the letter.
Hogan officials said the letter came as a surprise because of the recent contact about finishing inspections. Michael Ricci, a spokesman for Hogan, there had even been notes of approval.
“It was the White House and Administrator Verma that praised Maryland for our early and aggressive actions to address nursing home outbreaks, including first-in-the-nation strike teams which they recommended that other states emulate, and even emulated themselves at the federal level,” he said. “With Maryland reporting its lowest positivity rate on record today, we suggest the administration focus its time and energy on states experiencing spikes and outbreaks instead of launching inaccurate and baseless attacks.”
Hogan has run afoul of the Trump administration before, particularly since the pandemic’s beginning when the governor sought tough restrictions to stem the virus’ spread as federal officials took a largely hands-off approach and President Trump himself dismissed the seriousness of the situation.
That made the stern rebuke “more disturbing,” said state Sen. Clarence Lam, a Democrat from Baltimore and Howard counties and a physician.
“The Trump administration, of all people, coming down on the state, pointing out that we are deficient when it comes to completing these tasks is disturbing,” he said.
“It’s especially disappointing since the Hogan administration, with great fanfare, said it was sending strike teams into nursing homes,” he said. “They said delays were due to lack of PPE, but there are nationwide shortages. This just shows a real lack of follow-through.”
In July, Hogan administration officials blamed a lack of protective gear for initial delays in inspections, but they have not explained why the state has not caught up. Some state legislators said Maryland’s Office of Health Care Quality doesn’t have adequate staff or resources to proactively oversee the state’s nursing homes. State reports show there have been perennial staffing shortages at the regulatory agency.
Verma’s letter says the state submitted a corrective plan but doesn’t detail what was included in it. The letter also said Hogan officials requested federal assistance with inspections.
The inspections are a federal requirement, though they are conducted by states. Federal officials ordered immediate inspections on March 23 to ensure the nursing homes were compliant with infection control practices. But by June, states including Maryland hadn’t done enough inspections and federal officials set a deadline at the end of July.
Only Maryland and two other states missed the deadline, the letter says.
“Alarmingly, Maryland ranks last and far behind the other states, having inspected only 54.9 percent of its nursing homes,” the letter says.
“To illustrate the extent of Maryland’s failure to complete the required inspections, it is notable that the next lowest state has inspected 80 percent of its nursing homes,” it says. “It is absolutely critical that you immediately prioritize the health and safety of your state’s nursing home residents by completing the Trump Administration’s required inspections for all certified nursing homes in Maryland and confirm facilities are in compliance with federal infection control requirements.”
The letter notes that 4,596 Maryland nursing home residents tested positive for COVID-19 and 1,133 have died. That places the state seventh in the nation for cases per 1,000 residents and ninth for deaths.
And those numbers are significantly lower than what the Maryland Department of Health is reporting for elder care facilities. As of Wednesday, the state reported 14,215 cases and 2,046 deaths among residents and staff at nursing homes, group homes and assisted living facilities.
As the pandemic swept through Maryland, the state’s nursing homes have been particularly hard hit compared with elsewhere.
Joseph DeMattos, president and CEO of the Health Facilities Association of Maryland, which represents long-term care facilities, called in-person inspections “very important but not the only oversight or safety measure in place.”
He said there have been checks by phone or using telehealth technology all along during the pandemic by the state.
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In late April, Hogan ordered testing of all residents and staff, though the Maryland Department of Health said recently that it would stop paying for the weekly staff tests after Aug. 15 and ordered the facilities to use emergency federal funds. Groups representing the facilities, including DeMattos’ association, called the latest decision a burden because the facilities already have higher costs for protective gear and staff pay.
The added attention to nursing home and long-term care facilities is due to the disproportionate number of cases in seniors, many of whom have underlying health conditions.
Seniors have been at particular risk for death from the virus across the country, and in Maryland they represent about 60 percent of all COVID-19 deaths.
DeMattos said he had no information on why inspections in Maryland may be behind other states, though he agreed with state health officials that the federal inspections data might lag behind the actual inspections.
“I think there have likely been more inspections than that,” he said. “But while these and other inspections are important and valued by the sector, they are by no means the only quality oversight in place.”
Anna Palmisano, who heads the rights group Marylanders for Patient Rights, said the lack of inspections is indicative of troubles.
“The slow rate of inspections of Maryland nursing homes is a huge issue for the safety of nursing home residents, and our abysmal ranking is extremely alarming,” she said. “We in Maryland have miserably failed our vulnerable nursing home residents and their dedicated caregivers by neglecting to provide the tools and information they need to stay safe. This situation is compounded by the impending de-funding by Gov. Hogan of weekly testing for nursing home caregivers.”