COVID-19 battered NY hospitals, nursing homes over the last year. Here's what's next

After the Ebola crisis in 2014, dire concerns over the deadly disease's threat to New York hospitals prompted staff drills that revealed gaps in pandemic preparedness and foreshadowed how COVID-19 is poised to reshape American medicine.

In Ebola’s wake, mock patients portrayed by actors regularly showed up at dozens of emergency rooms across New York City, reporting symptoms and travel history that should have triggered immediate infection-control measures, such as masking and isolating the patient.

While many hospitals successfully completed the stress tests, about 40% failed at least one drill and it took nearly an hour for some patients to be masked and isolated, federal records show.

As a result, health care leaders boosted staff training, added isolation units and developed a drill toolkit to shore up infectious-disease defenses, which ultimately faced a historic test when a novel coronavirus struck New York last year.

Now, New York has reached the one-year anniversary of its first case of COVID-19, which was confirmed March 1, 2020.

After 1.6 million coronavirus cases and 38,000 confirmed deaths ravaged the state, hospitals and nursing homes face another period of reckoning, spanning the myriad ramifications of a pandemic that is fundamentally changing all aspects of life in New York and across the country.

“We all hope that we’re in the middle of the pandemic and the end is in sight, and I truly think it’s going to change the way we think about health care,” said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York State.

Why COVID could help, harm health care reform

From telehealth expansions and vaccine breakthroughs to personal protective equipment stockpiles and emergency preparedness planning, promising signs are emerging that COVID-19 has sparked efforts to resolve shortcomings and flaws in the health care system.

“People died in hospitals and nursing homes. We must learn the lesson and be better prepared for the next pandemic because, my friends, there will be another pandemic,” Gov. Andrew Cuomo said during a recent press briefing, adding warnings from prior coronavirus outbreaks should have better prepared the country.

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“We ignored it, we didn't learn from it and then COVID happened and the house collapsed,” he said, announcing his plans to improve nursing homes through stricter financial regulation, improved transparency and patient care measures.

Yet concerns about hospitals and nursing homes being hamstrung by the pandemic’s economic fallout are expected to complicate reform debates.

COVID-related costs and lost revenue from elective surgery suspensions, for example, blew a $20 billion hole in the operating budgets for New York hospitals, posing a unique threat to safety net hospitals catering to rural and poor communities, according to a Healthcare Association of New York State study.

Meanwhile, pre-pandemic understaffing issues at many nursing homes statewide helped fuel the spread of coronavirus among the most vulnerable frail and elderly New Yorkers, the state Attorney General’s report last month found, and advocates and lawmakers have since pushed legislation seeking to increase staffing and make other reforms.

“We should not waste this golden opportunity to improve safety and conditions for our mothers, fathers, grandparents, spouses and other loved ones in New York’s nursing homes — and for the staff who care for them,” AARP New York state Director Beth Finkel said in a statement on the legislative debate.

But Stephen Hanse, president and CEO of the Health Facilities Association representing many nursing homes statewide, asserted legislation must be coupled with measures to address other factors impacting staffing levels, including insufficient Medicaid reimbursement rates and wages, as well as limited career pathways.

“We lost staff to illness, we lost staff who stayed home to care for their children and it really impacted our workforce,” he added.

“Now, going forward we are facing an even greater crisis, and the state really needs to focus on recruiting and retaining men and women to work in long-term care.”

What’s next for NY hospitals

The most visible impacts of COVID-19 will involve new health care building construction and renovations, with many hospitals incorporating isolation wards and socially distanced floor plans into projects that have been delayed during the pandemic.

“I imagine grocery stores are doing the same thing for the same reasons; for the ability to distance people not just while they were receiving care but queuing up care,” said Darwell, whose trade group represents some of the largest hospital systems in the country.

Further, timetables for providing more care outside of hospitals as part of a long-standing preventive medicine push have been accelerated due to the broad scale expansion of telehealth amid COVID.

“All of the providers are thinking about other ways they can utilize telehealth that are more cost efficient and in a way that is more appealing to consumers,” Darwell said.

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Other pandemic-related changes to hospitals that are expected to endure include cross-training workers to improve emergency staffing levels and regulations aimed at boosting hospital capacity during crises.

Long-standing efforts by many hospitals to address racial and ethnic disparities in Americans' health are also receiving renewed attention due to COVID-19's disproportionate impact on people of color. 

"Hospitals, as nonprofit institutions, have always had these obligations to be addressing the needs of their community, but it’s hard to address those needs that happen outside of hospitals," Darwell said, adding the pandemic has brought new societal partners to the table. 

Meanwhile, fiscal realities for implementing hospital reform plans in part hinged on the ongoing debates over President Joe Biden's $1.9 trillion coronavirus relief package, which will determine how state and federal lawmakers approach everything from Medicaid funding to emergency aid to various segments of the economy, including health care.

What’s next for NY nursing homes

Under the cloud of scandal and a federal probe into New York state officials’ handling of COVID-19 in nursing homes, Cuomo recently unveiled his plan for avoiding a repeat of the pandemic’s toll on long-term care facilities. More than 15,000 residents of New York long-term care facilities died of the respiratory disease.

Among the proposals:

• Increasing civil monetary penalties to $25,000 for violations of the state’s public health law, up from the current $10,000 cap for serious harm violations.
• Requiring nursing homes would be required to spend a minimum of 70% of revenue on direct patient care and a minimum of 40% of revenue on resident staffing.
• Establishing caps on nursing home profits and compensation for managers and executives, as well as requiring public disclosures of all facility owners and contract details related to Medicaid and Medicare.

“Taxpayers spend a fortune on these nursing homes, and the funding should be going to the facility and the patient care,” Cuomo said, adding nursing homes “are not designed to be businesses and money-making machines” and should be regulated accordingly.

More: How Cuomo's COVID-19 nursing home scandal unraveled over the past year: Timeline, analysis

Some of the governor’s plans were similar to proposals in various legislation passed last week by the state Senate seeking to improve oversight and regulation of the long-term care industry, as well as address issues connected to state officials withholding COVID-related death data for months.

“Absolutely nothing can ever replace the devastating losses that thousands of New Yorkers faced, but we can create a safer future by implementing laws that protect health care staff, residents, and their families,” Sen. James Skoufis, D-Cornwall, Orange County, said in a statement about the legislative push.

Debate over the nursing home reforms is expanding into the Assembly and is expected to be part of the state budget process that concludes in April.

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached atdrobinson@gannett.com and followed on Twitter:@DrobinsonLoHud