The Nursing Home Business Model is Deadly

Health Care Labor Organizing

Pearl River     Nursing homes have been a huge source of deaths in the United States during the coronavirus pandemic.  Local 100 represents a number of private and public homes, as well as other healthcare facilities, so has been with our workers at the razor edge.  On a monthly basis, we continue to deliver PPE to facilities generally and where our members worth throughout Louisiana, Mississippi, Arkansas, and Texas, thanks to NOLAPPE Last Mile Every discussion we have with employers is contentious about everything from hazardous pay to PPE to frankness in sharing information on patient and consumer tests to OSHA health and safety standards.  We win some, and we lose some from company to company.  That’s been the way it has been 35 years, but this time the stakes are higher than the pay envelope, and the story is sometimes front-page news.

For all of those years, I’ve been telling our leaders, members, and organizers, that they needed to understand that in the eyes of our for-profit, corporate home ownership we were as much a real estate enterprise, not as a health care endeavor.  For most of them, as long as reimbursement rates from the government were good enough to break a bit better than even and they were able to lard their salaries and expenses onto the cost reports, they were hoping the appreciation of the real property in buildings and land underneath the hospital beds would be enough for them to make their killing.  Often, they would roll their eyes, because it seemed too cynical and hyperbolic for many.

With the pandemic death count, the corporate business model is being exposed.  Andrew Cockburn wrote a devastating piece in Harper’s called “Elder Abuse:  Nursing Homes, the Coronavirus”, and the bottom line, confirming in most ways our decades of experiences.  He noted that by late June there were 55,000 deaths in such homes, not counting that “one in five homes didn’t bother to report the numbers at all,” and none of them were required to report before May 8th.  That’s the effect.  The cause, as Cockburn documented, is often found in some of the 21st century adaptations of their basic business model thanks to REITs and private equity, which have stripped the assets, made sure that wages for the same work in hospitals were significantly lower in homes, stretched staffing past care standards, and stripped costs past the bone on everything from supplies to food for clients.  All true.  In one of our Shreveport homes they only had two face shields for the entire home until we delivered more, so they washed them as best they could to share from worker to worker, shift to shift.  We had an ownership change in recent years when a REIT holding other homes in the same area essentially foreclosed on the management company unable to make their predatory leasing terms.

Cockburn is critical but can hardly hide his amazement at the prowess of their lobbying skills in the states and with the Trump administration that they have been able to spin their way to getting billions rationalizing the pandemic for their slash and burn nursing home business model.  More than 20 states have already absolved them of liability for the deaths and inadequacies of care, and the Senate is trying to do the same for them and others.  The Wall Street Journal reported recently that the handpicked commission they had wheedled from the Trump team was preparing to report on more of the companies’ woes, while letting them tap into another $5 billion until they can get more in the next stimulus package.

The Journal also updated the reported death count in homes at over 70,000 accounting for 40% of US deaths from the virus now.  It turns out we do have death panels, as the Republicans argued in opposing the Affordable Care Act, but instead they are called commissions, and rather than demand reform in the homes and advocate regulations to put an end to the killing fields inherent in this business model, they just ask for more supplies and money without looking at the causes behind this catastrophe in name of healthcare.