SC long-term care homes decry mounting fines tied to new COVID reporting rule
As COVID-19 cases in South Carolina surged over the past year, many of the state’s long-term care facilities adopted an all-hands-on-deck approach to counter staffing shortages and manage disease outbreaks.
Patient care, not paperwork, took precedence, their leaders say.
So when the state’s health director issued a public health order last October mandating that nursing homes and assisted living facilities begin submitting visitor reports to the Department of Health and Environmental Control every Monday by 5 p.m., not all long-term care administrators made strict compliance with the new requirement a priority.
Then the fines started pouring in.
Over the past six months, DHEC has fined long-term care facilities a combined $155,550 for failing to submit visitor reports on time. The majority of the state’s nearly 700 facilities have been hit with at least one fine, and more than 100 have received multiple fines, according to state health department data.
The state’s long-term care facilities, which include nursing homes and assisted living facilities, have a combined bed count of about 40,000. The often elderly, chronically ill populations they serve have been disproportionately impacted by the coronavirus pandemic, which has ravaged countless facilities in South Carolina and across the country and greatly limited visitor access until relatively recently.
The visitation reports are intended to keep DHEC informed about whether facilities are complying with the state’s guidance, which requires that nursing homes and assisted living facilities permit all visitation with limited exceptions, and used to compile an online visitation status list that serves as a public resource for anyone planning a visit.
But long-term care administrators say the requirement is just one more thing for them to worry about during extraordinarily trying times.
”It’s a waste of time,” said Linda Walker, administrator at Midway Residential Care Facility in Spartanburg County. “When we close down the facilities, we close them down. When we open them up, we open them up. To me, it’s just something more to do. And then if you forget, heaven forbid, it’s thousands upon thousands of dollars.”
The six assisted living homes Walker operates on a single property in Moore have been fined a combined $6,300 for 18 total violations of the visitor reporting requirements, records show.
A form ‘the least of my priorities’
Completing the visitation form is far from burdensome — as of last month, it asks only a single yes or no question — but remembering to submit it on time amid the crunch of so many other pressing needs can prove challenging, administrators said.
“During the time that these weekly visitation forms went into place, my building had its first COVID outbreak,” said Heather Turnage, a registered nurse who serves as administrator of Wesley Court, a 70-bed assisted living facility in Spartanburg County.
Focused on the crisis at hand — more than 50 Wesley Court residents and staff tested positive for COVID-19 over the course of about a month starting in late November — Turnage missed the visitor reporting deadline three times in a four-week span.
“I’m working 12 to 16 hours a day, 26 days straight on the floor,” she said. “That visitation form is the least of my priorities. I’m trying to handle my building and trying to handle the residents.”
DHEC fined Wesley Court $1,050 total for the infractions — $250 for the first, $350 for the second and $450 for the third. A fourth violation would have cost the facility $1,000, the maximum allowed under the public health order.
To date, six facilities have been hit with $1,000 fines for racking up a fourth violation of the visitor reporting requirement. Oakridge Community Care Home in Spartanburg County is the only long-term care facility in the state that has been cited five times and received two $1,000 fines. That facility’s administrator did not return a request for comment.
Some long-term care administrators said they just paid the fines and moved on, even if they thought they were unfair. Others said they asked DHEC for an exception, but were not granted one.
“It’s frustrating,” Turnage said. “I think that there could have possibly been some more leniency with it. Because I’ve gotten reports in probably at 6 p.m. and, of course, I’m still going to get fined.”
Lula Etheridge, a registered nurse who operates the Lemonaide House, a 15-bed facility in Hopkins, said she wasn’t even granted a reporting reprieve while laid up in the hospital.
“(A DHEC employee) told me she had no control over it,” she said. “They had to collect the money.”
Etheridge is one of several long-term care administrators who said they’d set up reminders on multiple devices and asked their staff to do the same to ensure they don’t forget to file the report.
“I put a reminder on my phone to remind me. I put a reminder on my little Alexa thing in the house. I tell everybody, y’all, don’t let me forget,” she said. “But I’ve got a business I’m trying to run by myself now because I just lost my partner and we have a lot of paperwork to do for DHEC as it is.”
DHEC: Mandate came after homes failed to comply
Laura Renwick, a DHEC spokeswoman, said the agency began requiring the reports last fall because not all facilities were keeping them in the loop about their visitation status, despite repeated communications and outreach efforts.
The agency gave facilities one week to get up to speed on the new reporting requirement before levying fines and continues to send all long-term care operators twice-weekly reminders about the report that include a telephone number to call if they experience technical difficulties, she said.
Facilities are strongly encouraged to report each week between 5 p.m. Sunday and 5 p.m. Monday, but may report any time during the week before the Monday deadline.
DHEC commissioner Rick Lee raised concerns with the agency’s enforcement of its visitor reporting requirements at this month’s board meeting and asked if they could be abolished or at least suspended.
“It’s been the source of considerable aggravation and fines and all sorts of things,” said Lee, who questioned whether the value of the collected visitation information was worth the headache it caused for long-term care administrators.
“What is it that we’re getting out of this report that justifies this level of activity by our staff and this amount of citations?” he asked DHEC director Edward Simmer.
Simmer said he hadn’t realized facilities were struggling to comply with the reporting requirements and said he believed they were important to maintain, at least for the time being.
DHEC has long pushed facilities to open for indoor visitation, citing the emotional and mental health benefits residents derive from seeing their loved ones.
“I think we’re early enough in the improvement that I’d like to track that for a little bit longer yet,” Simmer told Lee. “Although certainly I think if we start to emerge from this COVID crisis, there will be a time when we no longer need that.”
The director credited information gleaned from the visitor reports as a crucial factor in DHEC’s decision to ask federal authorities permission to modify the state’s long-term care visitation policies.
The agency last month received federal approval to require that facilities use its own COVID-19 positivity calculation rather than the U.S. Centers for Medicare and Medicaid Services’ rate when determining whether to restrict visitation. The agency also sought permission from the feds to consider long-term care resident vaccination rates in visitation decisions.
“I don’t know if our entreaties to them made a difference or not, but certainly those changes have been made,” Simmer said. “I think that’s been a big positive.”
He said the agency also used the visitor reports to confirm that some long-term care homes were not offering visitation when perhaps they should have been.
“We were getting a lot of anecdotal reports from families saying ‘Hey, I can’t go see my loved ones,’” Simmer said. “But when you have hard data to back that up, we were able to take that to these facilities and say ‘Look, you need to do better.’”
He said he didn’t think more than 95% of long-term care facilities in the state would currently be offering indoor visitation if DHEC wasn’t tracking it so closely and expressed concerns that some homes might shut out visitors if the reporting requirement were lifted.
Nearly 660 of South Carolina’s 684 long-term care facilities are currently offering indoor visitation, 19 are not and seven have not filed a report this week, according to the health department’s website.
“I don’t want to lose that progress and I think without that report that’s a risk,” Simmer said.
DHEC board member Sonny Kinney said he didn’t have a problem with the agency requiring the report, but took issue with fining long-term care facilities that don’t submit it on time.
“I think we, as an agency, need to look at the fining component,” he said. “If the governor wishes to leave the reports in place then I don’t have a problem with that. All we can do is what DHEC can do.”
Renwick said the agency has no plans to cease assessing monetary penalties at this time, but could relax the practice down the road.
“DHEC’s Public Health Order will remain in effect as long as it’s needed for the health and safety of the residents and to inform the public,” she said in an email.