Adventures in Inadequate Governance, part 2

Just tryin’ to keep up…

In part 1, I brought your attention to some appalling facts about Vermont’s lack of oversight for rental housing. Today we turn to three separate articles concerning nursing homes and the coronavirus that reveal further inadequacy in governance. The first is about an apparently toothless settlement with a for-profit senior facility. The second and third detail the toll Covid-19 is taking on some of our most vulnerable Vermonters.

The Intercept, where Glenn Greenwald used to hang his hat before he went batshit, has shone a fresh light on last spring’s worst outbreak in Vermont — at Burlington Health and Rehab, owned and operated by the troubled Genesis HealthCare chain.

Turns out that only weeks before the pandemic struck, Attorney General TJ Donovan had reached a settlement with Genesis over “allegations of neglect” that led to three injuries and one death. That settlement did little or nothing to improve the situation, and within months, 12 BH&R residents had died of Covid-19.

Under terms of the settlement, proudly announced in the customary AGO press release, three Vermont-located Genesis facilities were to pay a fine and hire a Patient Care Coordinator for the three locations plus an independent monitor to oversee quality of care. Was it enough?

“It’s really baffling that the settlement did not include some type of staffing requirements,” said Brian Lee, the executive director of Families for Better Care, a nonprofit advocating for tighter regulation of nursing homes. “Has [Donovan] arrested anybody? Has he prosecuted anybody? Has anybody gone to jail? No. The settlement should have included a requirement for RN staffing. They were short-staffed prior to the incidents and short-staffed after. It’s pretty negligent on the AG’s office to not include that,” said Lee. “The quality of nursing homes is dependent on staffing.”

You can probably guess the next bit. According to federal regulatory records, Genesis failed to increase staffing to recommended levels. Donovan agreed to let Genesis do the hiring, and there was apparently no follow-through by the state to ensure full compliance. This is a problem with Donovan’s negotiating tactics, and also an issue for state regulators. When a facility is enough of a bad actor to trigger enforcement action, shouldn’t the Human Services Agency perhaps provide some extra scrutiny?

I guess not. Well, I can’t say for sure. But what I can say is that whatever Donovan and AHS did, it wasn’t enough. Let’s remember that, the next time Donovan puts out a self-congratulatory press release.

Next, we turn our attention to two stories from VTDIgger. The first reports that “growing outbreaks in nursing homes” is a major driver in our recent surge of cases. The second focuses on the Elderwood facility in Burlington, which has seen 78 cases in less than two weeks. That number includes nearly half the resident population plus a few dozen staffers, which has left “an eviscerated workforce [caring] for patients battling infection>’ And trying to prevent further spread.

In response, the state has put nursing home residents and staff at the front of the line for the new Covid vaccine, which should arrive in a couple of weeks. But in the meantime, one must ask if senior care facilities have done enough to prevent Covid outbreaks — and if the state has done enough to keep those facilities on the straight and narrow.

The Genesis case would suggest that the state has failed.

It must be said that the coronavirus is an extreme stress test for senior facilities and state officials. But we are now seeing the consequences of failing to pass the test. The victims are our seniors and the people who care for them. And whenever we finally claw our way out of this Godforsaken hole, one thing that shouldn’t be overlooked is a thorough review of how Vermont regulates nursing homes and other places that care for our most vulnerable.

From my family’s exposure to nursing homes, which is quite extensive, I can tell you that regulatory oversight tends to be heavy on paperwork and form-filling. It’s quite a burden on providers, and it’s a lot for regulators to keep track of. But in a very fundamental way it misses the point. All the forms and check-boxes in the world don’t assess the quality of care on the ground. You can’t assess compassion or dedication that way, or the true motivations of actors like Genesis, which dominate the industry.

Something ain’t working. And once we’re out of the shit, we need to figure out what it is.


2 thoughts on “Adventures in Inadequate Governance, part 2

  1. Kathryn Trudell

    Bureaucrats in government (and some in the private sector) want to be judged solely on what they tell us are their intentions, but never on the actual results. The same is true of politicians.


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