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| Pandemic’s Costs Stagger the Nursing Home Industry | Pandemic’s Costs Stagger the Nursing Home Industry |
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| Even before they became deadly petri dishes for the worst pandemic in generations, many nursing homes were struggling to stay afloat and provide quality care. | Even before they became deadly petri dishes for the worst pandemic in generations, many nursing homes were struggling to stay afloat and provide quality care. |
| But since the start of the coronavirus outbreak, nursing home operators have had to spend more money on protective equipment for staff and technology to connect residents with relatives who are no longer allowed to visit. Their revenues have shrunk because they are admitting fewer new residents in hopes of reducing the risk of infection. | But since the start of the coronavirus outbreak, nursing home operators have had to spend more money on protective equipment for staff and technology to connect residents with relatives who are no longer allowed to visit. Their revenues have shrunk because they are admitting fewer new residents in hopes of reducing the risk of infection. |
| The result is that some nursing homes, which often run on razor-thin profit margins, may be unable to pay their rent and other bills without government help. | The result is that some nursing homes, which often run on razor-thin profit margins, may be unable to pay their rent and other bills without government help. |
| “It could be a huge economic mess,” said Charlene Harrington, a professor emerita of nursing at the University of California, San Francisco. “It is possible that many nursing home chains could go bankrupt with the virus.” | “It could be a huge economic mess,” said Charlene Harrington, a professor emerita of nursing at the University of California, San Francisco. “It is possible that many nursing home chains could go bankrupt with the virus.” |
| Presbyterian Homes and Services, a Minnesota-based nonprofit operator of 16 nursing homes, estimates that the average 72-bed nursing home is spending an additional $2,265 a day on personal protective gear and an additional $1,500 a day on extra nursing staff. | Presbyterian Homes and Services, a Minnesota-based nonprofit operator of 16 nursing homes, estimates that the average 72-bed nursing home is spending an additional $2,265 a day on personal protective gear and an additional $1,500 a day on extra nursing staff. |
| At Meadow Ridge, a retirement community in Redding, Conn., with 62 nursing-home beds, executives have been forced to use Amazon or outside vendors to buy protective gear, said Kimberly Held, the community’s director of nursing. | At Meadow Ridge, a retirement community in Redding, Conn., with 62 nursing-home beds, executives have been forced to use Amazon or outside vendors to buy protective gear, said Kimberly Held, the community’s director of nursing. |
| “The pricing is unbelievable,” Ms. Held said. “I did have to order ponchos as a backup plan if we ran out of gowns. When we received our N95s, it felt like Christmas,” she added, referring to a type of mask that has been in short supply. | “The pricing is unbelievable,” Ms. Held said. “I did have to order ponchos as a backup plan if we ran out of gowns. When we received our N95s, it felt like Christmas,” she added, referring to a type of mask that has been in short supply. |
| Nursing homes care for about 1.5 million people in the United States, and 70 percent of the 15,400 facilities are run for profit. While the financial picture for the industry, which also includes homes run by government agencies and nonprofits, was hardly rosy before the virus struck, it was especially precarious for many for-profit nursing homes. | Nursing homes care for about 1.5 million people in the United States, and 70 percent of the 15,400 facilities are run for profit. While the financial picture for the industry, which also includes homes run by government agencies and nonprofits, was hardly rosy before the virus struck, it was especially precarious for many for-profit nursing homes. |
| Reimbursements from government programs like Medicaid are a main source of revenue for nursing homes, but operators have long complained those payments have not kept pace with the cost of care. | Reimbursements from government programs like Medicaid are a main source of revenue for nursing homes, but operators have long complained those payments have not kept pace with the cost of care. |
| The industry is increasingly relying on the government for another form of support: The Department of Housing and Urban Development guarantees $20 billion in mortgages to more than 2,300 nursing homes — about 15 percent of the country’s total, up from about 5 percent a quarter-century ago. (Last year, the $146 million collapse of Rosewood Care Centers was the biggest default in the history of the mortgage-guarantee program.) | The industry is increasingly relying on the government for another form of support: The Department of Housing and Urban Development guarantees $20 billion in mortgages to more than 2,300 nursing homes — about 15 percent of the country’s total, up from about 5 percent a quarter-century ago. (Last year, the $146 million collapse of Rosewood Care Centers was the biggest default in the history of the mortgage-guarantee program.) |
| It can by pricey just to keep the doors open. | It can by pricey just to keep the doors open. |
| For-profit nursing homes often rent their properties under long-term leases from real estate investment trusts, known as REITs; investment firms; or private equity shops. A review of regulatory filings found that six major health care REITs — Sabra, Welltower, National Health Investors, Omega Healthcare Investors, LTC and CareTrust — had a business interest in more than 1,500 nursing homes. | For-profit nursing homes often rent their properties under long-term leases from real estate investment trusts, known as REITs; investment firms; or private equity shops. A review of regulatory filings found that six major health care REITs — Sabra, Welltower, National Health Investors, Omega Healthcare Investors, LTC and CareTrust — had a business interest in more than 1,500 nursing homes. |
| The ownership structure has proved lucrative to investors in major health care REITs, which typically own a mix of nursing homes, elder care facilities and medical buildings. But those long-term leases can be problematic during an economic slowdown, because many include clauses to increase their rent every year, according to regulatory filings. | The ownership structure has proved lucrative to investors in major health care REITs, which typically own a mix of nursing homes, elder care facilities and medical buildings. But those long-term leases can be problematic during an economic slowdown, because many include clauses to increase their rent every year, according to regulatory filings. |
| “There wasn’t a lot of wiggle room in these lease deals,” said David Stevenson, a professor of health policy at the Vanderbilt University School of Medicine who has studied the nursing home industry. Mr. Stevenson was talking broadly about the industry and not any specific company. | “There wasn’t a lot of wiggle room in these lease deals,” said David Stevenson, a professor of health policy at the Vanderbilt University School of Medicine who has studied the nursing home industry. Mr. Stevenson was talking broadly about the industry and not any specific company. |
| Advocates for the elderly say care inevitably suffers when nursing homes face financial trouble. More than a half-million nursing home residents lived in facilities rated below average or much below average in the federal government’s five-star rating system. | Advocates for the elderly say care inevitably suffers when nursing homes face financial trouble. More than a half-million nursing home residents lived in facilities rated below average or much below average in the federal government’s five-star rating system. |
| Some of the details in the current crisis have been grim: An anonymous tip led to the discovery of 17 bodies in the on-site morgue of one complex in New Jersey, and the death toll has since risen to 70 people. That facility, the Andover Subacute and Rehabilitation Center I and II nursing homes, is part of small chain in New Jersey and Pennsylvania operated by Alliance Healthcare, which rents the properties from affiliates of a Chicago-area firm, Altitude Investments, according to regulatory filings. | Some of the details in the current crisis have been grim: An anonymous tip led to the discovery of 17 bodies in the on-site morgue of one complex in New Jersey, and the death toll has since risen to 70 people. That facility, the Andover Subacute and Rehabilitation Center I and II nursing homes, is part of small chain in New Jersey and Pennsylvania operated by Alliance Healthcare, which rents the properties from affiliates of a Chicago-area firm, Altitude Investments, according to regulatory filings. |
| Altitude has had “more frequent communication” with the operator over the past month and has offered to provide assistance, said William Rothner, the firm’s president. He said Alliance had not requested any. | Altitude has had “more frequent communication” with the operator over the past month and has offered to provide assistance, said William Rothner, the firm’s president. He said Alliance had not requested any. |
| The lowest-rated homes were disproportionately operated for profit. Nearly half the residents of for-profit nursing homes lived in ones where the federal government found below-average staffing levels, compared with 23 percent of the residents of government or nonprofit facilities, according to a New York Times analysis of government data. | The lowest-rated homes were disproportionately operated for profit. Nearly half the residents of for-profit nursing homes lived in ones where the federal government found below-average staffing levels, compared with 23 percent of the residents of government or nonprofit facilities, according to a New York Times analysis of government data. |
| Genesis HealthCare, one of the country’s largest for-profit operators, exemplifies many of the pressures. | Genesis HealthCare, one of the country’s largest for-profit operators, exemplifies many of the pressures. |
| It rents the property for more than 70 percent of the 357 nursing homes it operates in the United States. Genesis’ shares trade for under $1, in part because of investor concern over its $1.6 billion in debt and the $5 billion outstanding on the value of its long-term leases. And nearly half the properties operated by Genesis scored two stars or lower in the government rankings. | It rents the property for more than 70 percent of the 357 nursing homes it operates in the United States. Genesis’ shares trade for under $1, in part because of investor concern over its $1.6 billion in debt and the $5 billion outstanding on the value of its long-term leases. And nearly half the properties operated by Genesis scored two stars or lower in the government rankings. |
| Updated June 12, 2020 | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Lori Mayer, a company spokeswoman, did not address Genesis’ financial situation and said any update would come when Genesis reports earnings next month. The company, she said, has taken a number of precautions to limit the spread of the highly contagious virus, which has torn through nursing homes from Washington State to New York. | Lori Mayer, a company spokeswoman, did not address Genesis’ financial situation and said any update would come when Genesis reports earnings next month. The company, she said, has taken a number of precautions to limit the spread of the highly contagious virus, which has torn through nursing homes from Washington State to New York. |
| The Times has tallied more than 4,000 nursing homes and other long-term care or elder facilities across the United States with coronavirus cases, based on reports by states and counties. More than 36,500 residents and staff members at those facilities have contracted the virus, and more than 7,000 have died. The names of most of those facilities have not been made public, but The Times has been able to identify at least 1,700 nursing homes on that list of facilities, which have reported 4,000 deaths. | The Times has tallied more than 4,000 nursing homes and other long-term care or elder facilities across the United States with coronavirus cases, based on reports by states and counties. More than 36,500 residents and staff members at those facilities have contracted the virus, and more than 7,000 have died. The names of most of those facilities have not been made public, but The Times has been able to identify at least 1,700 nursing homes on that list of facilities, which have reported 4,000 deaths. |
| In hopes of avoiding devastating outbreaks, nursing home operators have had to admit fewer residents. The pandemic has rippled in other ways, too: Many hospitals are postponing elective procedures that usually require short rehabilitation stints, taking away another source of clients. | In hopes of avoiding devastating outbreaks, nursing home operators have had to admit fewer residents. The pandemic has rippled in other ways, too: Many hospitals are postponing elective procedures that usually require short rehabilitation stints, taking away another source of clients. |
| “A very large fraction of their most profitable business is post-surgical rehabilitation,” said Howard Gleckman, a senior fellow at the Urban Institute. “And most of that business is gone.” | “A very large fraction of their most profitable business is post-surgical rehabilitation,” said Howard Gleckman, a senior fellow at the Urban Institute. “And most of that business is gone.” |
| Nursing home advocates have said the industry may need $15 billion from the federal government to ride out the crisis. The Centers for Medicare and Medicaid Services, a federal regulator, filled in some of that gap by advancing payments to nursing homes and providing up to $1.5 billion in aid. But industry executives said it was not enough. | Nursing home advocates have said the industry may need $15 billion from the federal government to ride out the crisis. The Centers for Medicare and Medicaid Services, a federal regulator, filled in some of that gap by advancing payments to nursing homes and providing up to $1.5 billion in aid. But industry executives said it was not enough. |
| “I do think there will need to be more money,” said Rick Matros, chief executive officer of Sabra Health Care REIT, which holds the leases on 296 nursing homes and several hundred other senior living centers. “The financial stress is real.” | “I do think there will need to be more money,” said Rick Matros, chief executive officer of Sabra Health Care REIT, which holds the leases on 296 nursing homes and several hundred other senior living centers. “The financial stress is real.” |
| Mr. Matros said his firm was prepared to provide rent relief to operators if necessary. Most of Sabra’s tenants should not need that help, but that could change if the crisis continues for several more months. | Mr. Matros said his firm was prepared to provide rent relief to operators if necessary. Most of Sabra’s tenants should not need that help, but that could change if the crisis continues for several more months. |
| “We are looking at each tenant individually, and some are stronger than others,” Mr. Matros said. | “We are looking at each tenant individually, and some are stronger than others,” Mr. Matros said. |
| But Ms. Harrington, the professor who has written about the impact of for-profit nursing homes on resident care, is concerned about operators’ taking federal money to stabilize their balance sheets or pay Wall Street landlords at the expense of taking better care of residents and staff. | But Ms. Harrington, the professor who has written about the impact of for-profit nursing homes on resident care, is concerned about operators’ taking federal money to stabilize their balance sheets or pay Wall Street landlords at the expense of taking better care of residents and staff. |
| “I am hoping that nursing homes will use some of their money for hazard pay to workers and also to bring in and train a lot of additional care providers,” she said. | “I am hoping that nursing homes will use some of their money for hazard pay to workers and also to bring in and train a lot of additional care providers,” she said. |
| Reporting was contributed by Mitch Smith, Karen Yourish, Sarah Almukhtar and Danielle Ivory. | Reporting was contributed by Mitch Smith, Karen Yourish, Sarah Almukhtar and Danielle Ivory. |