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Group calls for urgent nursing home reforms amid COVID-19

A spokeswoman for Pioneer said the state must take immediate steps to control the infection and prepare nursing homes for the duration of the pandemic.Elise Amendola/Associated Press

As the coronavirus pandemic moved through the state’s nursing homes leaving thousands dead, longstanding practices in those facilities and in state government contributed to the number of deaths, a watchdog group calling for reforms said Sunday in a report to state leaders.

The Pioneer Institute called for a series of measures in its report, including tighter oversight and transparency in the care of some of the state’s most vulnerable residents, as well as regular testing and the appointment of a top official to oversee nursing homes’ responses to COVID-19.

The report also called for prioritizing access to any future vaccine for nursing home residents and workers.


“The conditions that led to this tragic outcome appear to have been in place for years,‘‘ said the report. “Such conditions, combined with failure to prioritize the needs of nursing home populations, resulted in the unacceptable lethality of the virus in the state’s long-term care facilities.”

As of Sunday, the state has reported 23,399 cases of the disease in nursing homes and other long-term care facilities, along with 5,086 deaths. Coronavirus cases have been reported in 369 facilities, according to state data.

Barbara Anthony, Pioneer’s senior health care fellow who co-wrote the report, said the state must take immediate steps to control the infection and prepare nursing homes for the duration of the pandemic.

“This is a matter of the utmost urgency,” Anthony said in an interview Sunday. “We’re not through with this virus [because] it’s not through with us.”

Deaths in nursing homes and long-term care facilities account for nearly two-thirds of the statewide death toll due to the virus, according to state data. That’s a rate much higher than the national average of under 40 percent for nursing home deaths, according to the report.

The number of nursing home deaths locally due to COVID-19 “is a severe blot on the public health history of Massachusetts,” the report said.


On Sunday, the state reported 19 new deaths in the general population due to the coronavirus, bringing the death toll to 8,060.

The number of new cases ticked up by 224, reaching a total of 108,667, an increase from 108,443 cases reported a day earlier.

In a statement, Jim Stergios, Pioneer’s executive director, said there was a glaring contrast between the state’s “hypervigilant” closure of schools and its preparations for hospitals, versus steps taken to ready senior care facilities for the coronavirus.

“Given the risk profile of eldercare residents, we hope that lessons learned in the first wave of the pandemic translate to permanent reforms in Massachusetts nursing homes,” Stergios said.

By the time Governor Charlie Baker closed nursing homes to visitors in mid-March, according to the report, it was too late. The virus had already infiltrated most homes through staff or visitors.

Many of those staff or visitors were probably asymptomatic, the Pioneer report said, and community transmission accelerated the spread of the disease.

A lack of testing and personal protective equipment along with shortages of staff who had appropriate infection-control training created dangerous conditions that spiraled out of control, the report said.

“While residents and staff at most homes have now been tested once, there is no publicly available plan for how to ensure sufficient testing and adequate PPE going forward,” the report said.

The Pioneer report said many practices by the state heightened nursing home residents’ vulnerability, including a program offering the facilities additional funding if they admitted COVID-19 patients from hospitals.


Pioneer quoted research from the Massachusetts Advocates for Nursing Home Reform that suggested half of the facilities that participated had signs of “severe operational deficiencies,” according to the Centers for Medicare and Medicaid Services, or CMS.

“It is not clear how facilities with low CMS grades became COVID checklist-compliant so quickly,” Pioneer said in the report. “This incentive structure needs reform to prioritize quality of resident care over monetary gains, with ongoing transparent oversight from state officials prior to placement of COVID patients.”

Another issue was whether nursing homes were being held to state standards for emergency preparedness, according to the Pioneer report. Those plans, which include pandemic flus and diseases, require isolation and protective personal equipment measures.

The report said there was “no clear evidence” that state and federal surveys have applied these standards in a thorough and consistent manner.

The state’s most recent infection control audits revealed that more than one-third of these facilities failed to comply with measures intended to stem the disease’s spread as of May 21, according to the report. The audits were ordered amid public scrutiny of COVID-19′s impact on nursing homes.

In a statement, a spokesman for the Massachusetts COVID-19 Command Center said late Sunday night that the Baker administration took swift action to address the challenges long-term care facilities have faced in response to the pandemic.

”While we have made significant progress in fighting the spread of COVID-19 in these facilities, the painful toll the virus has taken on residents and staff of long term care facilities is an undeniable tragedy for these individuals, their families and friends, and our Commonwealth,” the statement said. “The Administration implemented an accountability and support initiative that has stabilized the impact and will take all steps necessary to protect the residents of our long term care facilities.”


The Pioneer report also called for regular testing of residents and staff; requiring nursing homes to report test results directly to the state Department of Public Health; and preventing employees at a facility with an outbreak from working at other nursing homes.

Nursing homes should also subject workers and visitors to temperature checks, and collect the names, addresses, and phone numbers of anyone who enters, to help facilitate contact tracing, the group said.

Anthony, who oversaw the state Office of Consumer Affairs and Business Regulation under former Governor Deval Patrick, said the scope of deaths among nursing home residents due to the disease shows disrespect for the well-being of the state’s seniors.

“We have been denigrating, or devaluing, the lives of older people throughout this pandemic,” Anthony said.

“This is going to happen again, unless those steps are taken immediately, and with vigor,” she said.

John Hilliard can be reached at