Kelly Raises Transparency Concerns Related to CT Nursing Homes & State Response to COVID-19

Article as it Appeared in the Fairfield County Business Journal

As cases of COVID-19 continue to decline and Connecticut goes about reopening its economy, a significant amount of attention is now being focused on how the state’s nursing homes and long-term care facilities performed — or, according to some, underperformed — during the height of the crisis.

While Gov. Ned Lamont continues to tout what his administration did to mitigate the virus’ spread in those facilities, and has issued a call for an independent, third-party review of what took place, several Republicans, including state Sen. Kevin Kelly (R-Stratford), believes that the review must include an analysis of the state’s response.

“Quite frankly, this review should have started in March or April,” Kelly told the Business Journal.

Nationally, more than 45,500 residents and staff have died from coronavirus outbreaks at nursing homes and other long-term care facilities — about 40% of the country’s roughly 116,000 virus-related deaths, according to a running count by the Associated Press.

Even given that their patient population is among the most vulnerable to COVID-19, and that residents live in close quarters, the fact that nursing home residents make up less than 1% of the U.S. population makes those numbers especially troubling.

As of June 10, Connecticut’s nursing homes had recorded 8,669 confirmed COVID cases and 2,106 deaths, with another 542 classified as “probable.” As of June 9, its assisted living facilities had recorded 1,051 positive cases and 285 deaths, with another 64 listed as “probable.” If the probable cases are not included, the cumulative 2,391 deaths represent nearly 57% of the state’s total; including the probable cases raises that figure to over 71%.

Throughout the crisis, Lamont’s response to the worsening situation at those facilities was criticized as agonizingly slow, as his administration wrestled with questions about turning certain nursing homes into “conversion” facilities — either all COVID-positive or COVID-negative populations — along with what seemed a never-ending lack of personal protective equipment (PPE) for staff.

In April, the state’s COO Josh Geballe confirmed that the state would begin inspections of all such facilities to confirm whether they were in compliance with the latest guidelines from the Department of Public Health (DPH) and the national Centers for Disease Control and Prevention. By the end of that month medical professional members of the Connecticut National Guard were helping with that effort.

But even that action was hampered by a decision to allow some “on-site visits” to take place via FaceTime, leading to the filing of a grievance by New England Health Care Employees Union, SEIU 1199, which represents 6,000 workers in 30% of the state’s nursing homes. Mandatory testing of all residents and staff also got out to a rough start, with reports that the latter had to wait longer to be tested at several facilities.

Not all the blame lies with the state, however, with a pair of Fairfield County facilities among three that have recently been fined. The 120-bed RegalCare at Southport was fined a total of $3,000 for improper distribution and use of PPE — RegalCare is appealing both the citations and fines. The 161-bed Bethel Health Care Center was fined $2,520 for similar mishandling of PPE and for keeping a recovered coronavirus patient in its COVID-positive ward for several days beyond the three recommended by the CDC.

On June 8, Lamont ordered an independent, third-party review to be conducted of the preparation and response to the pandemic inside of Connecticut’s nursing homes and assisted living facilities. The review, which the governor said he wants completed before autumn to prepare for a potential second wave, will incorporate a top-to-bottom analysis of all elements of the pandemic and how it was addressed in those facilities.

During the governor’s daily briefing on June 16, Geballe said the third party — which has yet to be named — would be expected to deliver interim recommendations and other feedback by mid-August, with its final report due by the end of September.

The Lamont administration is soliciting proposals from third-party experts to conduct the review. Before it begins, the administration plans to meet with legislative leaders to develop a scope that ensures the review provides the state with meaningful information that can best improve the safety of patients and staff in these facilities.

Lamont also noted that the Connecticut DPH took several steps to contain outbreaks in those facilities, including:

• Becoming one of the first states to discontinue visitation in early March;
• Establishing dedicated COVID-recovery facilities to prevent COVID-positive patients from re-entering nursing homes;
• Delivering millions of units of PPE through the state’s mutual aid program;
• Providing a $125 million financial aid package for nursing homes to support staff payment, infection control, PPE costs and other pandemic-related expenses; and
• Establishing a new category of worker, the Temporary Nurse Aide, to assist with staffing shortages.

“We must take this opportunity to learn from the pandemic and the experience of our nursing homes to ensure we are using the best available science and quality improvement techniques to protect these residents,” acting DPH Commissioner Deidre Gifford said. “We must study the epidemiology, protocols, staffing and overall preparedness of all our facilities to provide clarity and understanding of what happened over the course of this pandemic.”

NURSING HOME ASSOCIATIONS APPROVE
Connecticut’s two nursing home associations — LeadingAge Connecticut and the Connecticut Association of Health Care Facilities and the Connecticut Center for Assisted Living (CAHCF/CCAL) — issued a statement welcoming Lamont’s move.

“We must gain clarity and understanding of what happened over the course of this pandemic,” the organizations wrote. “It is essential that we thoroughly evaluate our state’s response in a nonbiased and inclusive way so as to learn from the science and help to prepare for a potential second wave of the virus.

“The state’s experience is part of a national pandemic and in such, our preparation and response were influenced not only by our state’s efforts, but also by the federal response,” they continued. “As such, the nursing home associations recommend that the analysis include the role of the changing CDC’s guidance, the inadequate PPE supply and the delay in testing.”

However, Kelly, the ranking Republican of the legislature’s Aging Committee, said he believes the state has seriously fumbled the ball.

“He (Lamont) prohibited family members from going in to nursing homes, but allowed staff — many of whom work at additional facilities — to go in and out,” Kelly said. “Why didn’t testing take place then?”

Kelly also objects to the movement of residents between facilities as the health crisis grew.

“Most of these individuals have diminished capacity,” he said. “When you start shuffling a dementia patient around, it becomes a very stressful situation and they can lose further capacity. They’re already in a frail condition, so you’re just setting them up for more COVID-related problems.”

“This governor doesn’t like transparency”

The PPE issue also weighs on the senator’s mind. “When did the state get it? Did they ever change their approach to trying to get it? What were, and are, the procurement policies of the state of Connecticut?”

Underlying it all, Kelly said, is what he views as Lamont’s lack of transparency. The administration’s hiring of the Boston Consulting Group — “they don’t even live in Connecticut,” Kelly said — which will be paid up to $2 million to augment the work of the Reopen Connecticut Advisory Group, is just one example.

Outgoing Senate Republican Leader Len Fasano (R-North Haven) blasted that news, maintaining the group had been “hired in the dark to be the state’s ‘control tower’ on one of the most significant issues ever to face our state,” and lamented Lamont’s “lack of transparency,” accusing Lamont of implementing a “strategy of ignoring the people, and perhaps even his staff, and working with high paid consultants behind the scenes.”

Kelly, who acknowledged his interest in succeeding Fasano as Republican leader, also cited the Partnership for Connecticut – the multimillion-dollar private-public initiative between the state and Ray and Barbara Dalio, which was recently disbanded among questions over its transparency – and the Reopen Connecticut group itself as evidence of Lamont’s preference for working around the legislature.

“The Reopen Connecticut Group was made up of 50 individuals whose opinions he valued,” Kelly said. “I’m the ranking member of the Aging Committee and we weren’t called in.”

The advisory group was exempted from Freedom of Information laws, a move that Carol Platt Liebau, president of The Yankee Group, called a “damaging mistake. …Hiding the information and decision-making process that inform the advisory group’s recommendations from those it affects most is insulting, counterproductive and treats the people of Connecticut like subjects rather than citizens.”

“The governor is expected to collaborate with the legislative leaders,” Kelly said. “Like it or not, this is a government of the people, by the people and for the people. This governor doesn’t like transparency or Freedom of Information rules.”

Kelly sent a letter to Lamont on June 10 listing his objections and imploring the independent review to include an analysis of the state’s response.

“Just as nursing homes and assisted living facilities had an obligation to do everything in their power to protect residents, the state had an equal if not greater role to ensure that Connecticut’s vulnerable elderly residents were protected,” he wrote.

“This investigation cannot be about making one party a scapegoat,” he continued. “It needs to be a truly comprehensive review of all those who had a responsibility to protect the state’s most vulnerable residents so that we can make sure what happened over the last few months never happens again.”

Asked if he had heard back from the governor, Kelly laughed drily.

“I haven’t received any invitation to come and meet with him, or a phone call or a letter,” he said.