What would it take for federal officials to more actively police and demand transparency from U.S. nursing homes?

“If 175,000 deaths doesn’t inspire bold action, then nothing will,” Denise Bottcher, the state director of AARP’s Louisiana office, told lawmakers Wednesday, citing the COVID-19 death toll of long-term care residents and staff.

Bottcher, whose state accounts for nearly 3,000 of the nation’s long-term care COVID-19 deaths, testified during a Senate Finance Committee hearing on nursing homes. It was part of a series of congressional events this week exploring the pandemic’s impact on long-term care facilities and older Americans. Long-term care residents and staff have accounted for more than a third of the country’s pandemic-related deaths, and more than 1.3 million are confirmed to have been infected.

Bottcher joined several industry experts in testifying that long-standing issues related to oversight and transparency contributed to the pandemic’s disproportionate impact on residents and staff. While recent vaccination efforts have contributed to a dramatic drop in nursing home COVID cases and deaths, they said, vaccines aren’t enough to address the industry’s problems. “Much more is needed to protect nursing home residents,” Bottcher told the Senate panel. “The consequence of not acting is that someone’s mother or father dies.”

Bottcher highlighted AARP’s five-point plan to better protect and serve nursing home residents, staff and their family members, including adequate personal protective equipment (PPE) and staffing levels, greater transparency and not granting legal immunity to facilities.

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Adelina Ramos, a certified nursing assistant at the Genesis HealthCare center in Greenville, Rhode Island, who also testified, said that COVID-19 killed 20 residents and one nursing assistant at her facility over a roughly one-month span last year. She described how staffing and PPE shortages continue to plague nursing homes across the country. According to AARP’s Nursing Home Dashboard, an average of 11 percent of U.S. nursing homes reported a PPE shortage during the four weeks ending Feb. 14. More than 25 percent reported a staff shortage over the same period.

Ramos called on Congress to enforce greater oversight over nursing homes and to raise the minimum wage to make jobs like hers more attractive. “Before the pandemic, we had this problem,” she said of staffing shortages. “And with the pandemic, it made things worse.”

Several lawmakers and experts also highlighted disparities in how COVID-19 has disproportionately impacted certain demographic and socioeconomic groups. Tamara Konetzka, a public-health professor at the University of Chicago, cited her own research finding that nursing homes with the highest proportions of nonwhite residents saw more than three times as many COVID-19 cases and deaths as those with primarily white residents.

“These disparities in COVID-19 deaths are the result of generations of inequity in society and in health care,” said Senate Finance Committee Chairman Ron Wyden (D-Oregon). “Undoing it is going to take a lot of hard work by this committee and others.”

But Konetzka and Bottcher said it’s impossible to fully assess how COVID-19 has impacted specific communities and nursing homes because there’s so little publicly available data. Greater transparency would give experts and academics greater insight while making it easier for authorities and watchdog groups to hold bad actors accountable, they argued.

“To disrupt health disparities across the country, including those occurring within nursing homes and other long-term care facilities, we need better data,” Bottcher said. “It is important that the federal government gather data and publicly report on COVID-19 cases, deaths, comorbidities and testing rates, broken down into multiple demographic categories.”

Andrew Soergel joined AARP as a writer in 2020. He was previously a senior economics writer at U.S. News & World Report. Awarded the 2018–19 Economics of Aging and Work fellowship through the Associated Press-NORC Center for Public Affairs Research, Soergel was also selected as a 2017 aging-issues fellow by the National Press Foundation.


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