ABSTRACT
In April 2021, New York's "Safe Staffing" law capped Long-Term Care Facility (LTCF) profits. LTCFs with "excess profits" are now challenging the law in court. This study examined how LTCFs involved in the lawsuit differed from other NY state LTCFs before and during the COVID-19 pandemic. LTCF "Safe Staffing” lawsuit data were obtained from Long Term Care Community Coalition, then linked with Centers for Medicare and Medicaid Services COVID-19 and Small Business Association Paycheck Protection Program (PPP) data. First, we tested for differences across quality measures. We found that, compared to LTCFs not involved in the lawsuit, LTCFs in the lawsuit were more likely to be located outside of a hospital, report more certified beds and higher occupancy rates, and have higher overall quality scores. LTCFs in the lawsuit also reported lower staff ratings and staffing hours, which have previously been identified as a determinant of higher mortality in LTCFs. To create valid comparisons given these systematic differences, we specified "Doubly Robust” Augmented Inverse Probability Weighted regression models and tested if lawsuit involvement was associated with COVID-19 outcomes. Despite finding higher rates of admitting patients infected with COVID-19 in "excess profit” LTCFs, we did not find that COVID-19 deaths differed by lawsuit involvement. Finally, lawsuit involvement was associated with a higher probability of receiving a PPP loan. Before and during the pandemic, LTCFs with "excess profits" appeared fundamentally different than other NY LTCFs. How these differences impact the health of older adults receiving long-term care beyond the pandemic remains unknown.
ABSTRACT
Background: During the COVID-19 Public Health Emergency, states were authorized to waive Pre-Admission Screening Resident Review (PASRR), a federal regulation requiring all individuals be evaluated before admission into a federally qualified nursing facility. We suspect states waived PASRR to reallocate resources from admission towards infection control and outbreak mitigation. However, by waiving PASRR and fast-tracking admissions, vulnerable elders may have been exposed to COVID-19 and unexpectedly placed at substantial risk for increased morbidity. Methodology: We reviewed all COVID-19 Medicaid emergency waiver requests to identify states waiving PASRR. We then analyzed daily, state-level COVID-19 deaths with a panel regression model, controlling for state and time fixed effects, and daily case rates. Finally, we expanded the model to identify heterogeneous effects shaped by market and administrative oversight factors. Results: Suspending PASRR led to significant declines in state COVID-19 deaths (–2.3 deaths per 100,000 population, p < 0.001). However, the effect waiving PASRR varied by excess nursing bed capacity (7.3 deaths per 100,000 population, p = 0.024) and historical PASRR deficiencies (0.9 deaths per 100,000, p = 0.009). Implications: Within the first month of the COVID-19 emergency invocation, nearly all states suspended PASRR, which our estimates suggest averted 7,600 deaths nationwide. However, we found that greater pre-emergency bed availability and less administrative oversight may have reduced the effectiveness of a PASRR waiver. While future research should aim to understand the mechanisms for such heterogeneity, immediate concerns relate to the variation, both between and within states, for adhering to a critical regulation protecting older adults. © 2022 The Author(s).