The case revolves around National Fire & Marine Insurance’s attempt to have individual COVID claims considered separate healthcare events for legal purposes. A late 2022 interpretation by the US District Court for the Eastern District of Pennsylvania would have forced Genesis to pay $3 million in self-insurance fees in each case related to COVID before getting any relief from its insurer. 

Genesis, which court records described as having aout 400 nursing homes and assisted living facilities in the US, quickly escalated that decision to the US Court of Appeals for the Third Circuit.

On Monday, a three-judge panel ruled that the lower court had erred in even considering National’s request for a quick, summary judgment, saying the full extent of possible payouts by Genesis hadn’t become clear yet.

In legal terms, that made the case “not ripe” for review.

“That is because Genesis is far short of meeting its $3 million threshold on a single SIR [self-insured retention] — let alone on multiple SIRs,” write judges Kent A.Jordan, Stephanos Bibas and David J. Porter.

In late 2022, Genesis said it had paid $1.3 million in covered expenses and anticipated an additional $300,000 over the ensuing five months for all COVID claims against the company. In an update requested by the appeals panel, Genesis put its to-date costs at just over $2 million, which the judges noted was still “far short” of the $3 million threshold.

“At this stage of the case, we fail to see how there is any ‘real and substantial threat’ of harm if a declaratory judgment is not entered,” the judges wrote. “Many COVID-related claims against Genesis already are barred by the statute of limitations in many states. So the likelihood of Genesis’ costs exceeding $3 million any time soon — if ever — does not constitute a substantial threat of real harm.”

A request for comment from a Genesis spokeswoman was not immediately returned Tuesday.

The judges ruled that the District Court lacked subject-matter jurisdiction over the controversy and erred in its earlier ruling for National. It vacated that judgment and returned the case to the lower court for further proceedings.

Genesis faced at least 46 COVID-related claims, according to court documents. It took out its additional policy with National Fire & Marine in the fall of 2020, with a coverage period that was supposed to be retroactive to December 2019. While Genesis agreed to pay the first $3 million in defense costs, settlements or judgments for each healthcare event up to $160 million total, it viewed COVID as a single event.

Had National been victorious, it would have covered none of the costs associated with claims against Genesis during the policy period.

As it is, the insurer may remain virtually unaffected by Monday’s ruling.

Before the 2022 ruling, Genesis was subject to 41 unsettled lawsuits and would have to incur about $41,000 in costs each to cross the $3 million total at the heart of the case. But National conceded that only 17 of those 41 lawsuits were currently in litigation.

A call seeking comment from the National Indemnity Company, which owns National Fire & Marine Insurance Company, was not returned Tuesday.

The organization, the Post Acute Wound Skin Integrity Council, or PAWSIC, was granted nonprofit status Sept. 15. While it will primarily be an educational organization, President Jeanine Maguire, PhD, MPT, CWS, told McKnight’s Long-Term Care News Wednesday that she hopes to eventually work with federal officials to develop better national guidance around wound care and related topics.

“There’s a major gap in wound management, particularly for post-acute care,” said Maguire, who was previously vice president of Skin Health & Wound Care Integrations at Genesis.

“The gap that exists is an interprofessional team, teamwork between all different professions, for all different wound types through the lens of the regulations that are very nuanced in post-acute care,” she added. “There are not necessarily national guidelines to guide this sector. If you’re an operator, you’re maybe not sure if what you’re doing is appropriate for all wound types in regards to care delivery.”

Origins and first goals

That struggle, Maguire said, is why she started what would become PAWSIC about three years ago with a small group of like-minded wound care professionals. The organization now has a 19-member board made up of clinicians from across long-term care settings and health professions, including wound care experts, therapists, dieticians, pharmacists and operators.

To begin with, they are focused on determining what information clinicians and others need and shaping content to help move the sector’s efforts forward. Staying up to date on which methods to use for which wound types and choosing emerging technologies and treatment approaches are challenges, but innovations could reshape how care should be delivered. 

“It really is a struggle, which is why I believe [missing guidance] is one of the major reasons for federal tags, one of the major reasons for litigation. It’s not because of lack of good intentions. We have a lot of that,” Maguire said. “But seldom are any of us really prepared to work at the level that’s really expected in post-acute care because we haven’t necessarily been trained in team work or academia, or even wound management the way evidence is directing us to practice today.”

In announcing its establishment, PAWSIC noted that pressure injury rates range from 7.9% to 28% in various long-term care settings, with two of every three ulcers in those 70 or older. Chronic wounds can alter a patient’s quality of life, and they’re also costly. Regulatory fines and litigation are rising, PAWSIC added, with the average settlement at $250,000. 

PAWSIC’s work will center on comprehensive interprofessional approaches to address significant chronic wounds and skin issues, including pressure injuries and and diabetic foot ulcers. 

Resources and guidelines to come

Resources and tools will be designed for a gamut of post-acute providers, from nursing homes to hospice and home care providers to independent living facilities. Families, patients and certified nurse aides are invited to join the organization for free to help further understanding of wounds and expected practices.

“In time, as we build up this organization, and gain strength in numbers with our membership and our sponsors, we want to develop special interest groups, where everybody has a voice,” Maguire said. “As we develop resources and guidelines of care, we can then perhaps work with CMS, lobby CMS and try to develop standards for this space that operators can use, providers can use and patients can expect.”

Already, PAWSIC has developed a Wound Provider Group Checklist designed to help clinicians and skilled nursing facilities or other long-term care providers forge smart partnerships. There’s also a free webinar, “Navigating the CMS Regulations for Skin and Wound Care in Skilled Nursing and Long-Term Care.”

The organization will launch widely Nov. 2 at the Symposium on Advanced Wound Care in Las Vegas. Membership is available now at PAWSIC.org.

While the end of the nationwide healthcare worker requirement comes as good news to many who saw it as an obstacle to hiring during a crippling labor shortage, experts are warning that the policy’s end could lead to new and potentially costly concerns.

The Centers for Medicare & Medicaid Services has told surveyors not to enforce the vaccination requirement since June 5, but the government’s hard-won mandate officially expires this weekend. Given the nation’s still-divided take on COVID shots — and a bevy of new state laws that prohibit employers from mandating vaccination as a condition of employment — keeping staff up-to-date could be a challenge in many places.

The stakes remain high, with CMS tracking the percentage of up-to-date staff through its Quality Reporting Program and continuing to post related data on Care Compare. If numbers sag, regulatory experts predict new rules could come into play.

And in the meantime, consumer attorneys will no doubt be watching too.

“If you have a really low vaccination rate and you have an outbreak among patients, and let’s think of the worst — a situation in which you have residents die as a result of COVID-19 — I do think the plaintiffs’ bar is going to come back and potentially allege that the nursing home was negligent in their practices and procedures and their negligence resulted in the death of these residents,” predicted Erin McLaughlin, an attorney and shareholder for Buchanan Ingersoll & Rooney who specializes in healthcare labor and employment.

The lifting of the mandate, she added, is a double-edged sword for nursing homes and other healthcare providers.

“On one hand, the staff has been pushing back as to whether or not they want to be vaccinated based on religious beliefs and disability status,” McLaughlin told McKnight’s Long-Term Care News. “But at the same time, these nursing homes have the obligation to protect those patients. And if they are enacting policies and procedures that can be challenged as not adequately protecting patients …. I do think a creative plaintiff’s attorney might make that claim.”

Tougher to adopt internal mandates

Some states have hamstrung providers from keeping their own rules in place, with 26 limiting vaccine mandates by public entities and 11 limiting any such requirements by private businesses, according to a National Association for State Health Policy tracker last updated June 30. In Texas and Utah, for instance, all entities must exempt vaccination for individuals for almost any reason, including personal conscience or beliefs.

And given the competitive landscape of the current healthcare hiring environment, providers who do enact an internal mandate even in vaccine-friendly states may find themselves at a recruiting disadvantage.

Few if any major nursing home organizations have announced their intentions to adhere to a strict requirement moving forward. Experts have said it’s more likely providers will have to attempt to get employees vaccinated as they did pre-mandate, most likely by using educational campaigns and, potentially, incentives.

Genesis Healthcare, one of the nation’s largest owner/operators, adopted a voluntary vaccination program in December 2020, relying on “communication, engagement and trust-building” to push rates to 65% among staff. The following summer, Genesis announced its worker mandate, which was then made redundant by the federal mandate when the Supreme Court cleared that to stand in January 2022.

After reviewing company policies and state regulations, Genesis is keeping up strict requirements in the few states that still have mandates. But in other states, it hopes the incentive of working mask-free is enough to entice new hires to get their shots.

Spokeswoman Lori Mayer said the company was leaning on an existing universal influenza vaccination policy to help shape its new COVID vaccine strategies in states without blanket healthcare mandates.

“All personnel who work in patient/resident buildings, or whose job requires them to routinely be in a building where patient care is provided, are required to be immunized against COVID-19,” she told McKnight’s in an email Wednesday. “If the staff member has never received any COVID-19 vaccine, they will be required to wear a: well-fitted surgical mask if the county hospital admission level is low and/or there is no center COVID-19 outbreak; or N95 respirator if the county hospital admission level is high and/or there is a center COVID-19 outbreak.” 

In New York, ArchCare is relying on continuous education to promote vaccination of new staff, of which there are many.

“As of May 23rd it is no longer a condition of employment and we haven’t experienced any adverse effects, while at the same time have approximately doubled our hiring in our nursing homes of direct caregivers during those same months,” Jason Hutchens, senior vice president of residential services told McKnight’s Thursday.

“The increased hiring is due to high occupancy and a renewed hiring approach to replace slots previously filled by agency,” he said. “Our approach for current care members has been continuous education regarding vaccines provided by our infectious disease medical director, CMO and center level infection prevention nurses. We have offered incentives to team members and have monitored progress closely as an executive team.”

Low-hanging fruit for plaintiffs’ bar?

Some patient advocacy groups, including AARP, have raised concerns that the mandate has been lifted too soon, especially given that comparatively few nursing home staff members have received boosters — which have remained voluntary throughout the pandemic.

While the requirement for an initial series of shots pushed staff coverage to above 89%, just 26% of nursing home workers were considered up-to-date as of July 16, the date of the most recent CMS data available. By comparison, 63.5% of residents were up-to-date then.

If that sagging staff vaccination rate persists or falls in coming months, especially if combined with a new variant that causes a resurgence of severe COVID cases, CMS could reconsider revoking its rule, McLaughlin told McKnight’s on a podcast earlier this summer.

But even if things don’t get that bad nationally, low staff vaccination rates could be bad news for individual providers whose residents get sick, warns Florida-based attorney Donna Fudge, a member of Nationwide Insurance Company’s National COVID-19 Defense Counsel.

“I believe the plaintiff’s bar will use this as another weapon in their arsenal to sue nursing homes that are complying with guidance and laws set out by the federal government and its agencies,” Fudge told McKnight’s. She noted that providers could face court time and high defense costs even though they are following provided rules, akin to concerns about how courts have handled liability claims the government sought to protect them from.

“Now that COVID-19 is considered endemic, it seems logical to drop the vaccine mandate,” she added. “COVID-19 has been, is now, and will be impossible to prevent in long-term care settings. The plaintiff’s bar will continue to exploit this as another reason to sue the long-term care providers, who work tirelessly providing good care to this county’s most vulnerable residents.”

Investigators followed residents of 202 Genesis HealthCare facilities and 128 Veterans Health Association community living centers to determine the effectiveness of an mRNA vaccine booster in preventing infection, hospitalization and death.

The cohort study included 10,000 nursing home residents and 4,321 VHA center residents. Participants completed a two-dose series of an mRNA vaccine and were eligible for a booster dose between September and November, 2021. Health outcomes were followed until March 8, 2022. The study period covered times when the delta and/or omicron variants were circulating.

Fewer infected, hospitalized

When compared to their peers who did not get a booster shot, nursing home residents who did get a booster shot were significantly less likely to become infected, hospitalized or to die during the study period.

Boosted VHA center residents were also less likely to be infected or hospitalized. But there was little difference in COVID-19-associated deaths between the boosted and unboosted VHA center residents, possibly because only 18 deaths occurred during the study period in that group, the researchers said.

At the same time, although boosted VHA center residents were less likely to be hospitalized than the non-boosted, hospitalization rates were substantially higher when compared to those in the nursing homes. This result may be attributable to differences in resident comorbidity burden and the availability of hospice care, advance care planning and clinician practices regarding hospitalization, investigators wrote.

Overall, however, the vaccines were consistently effective in these two disparate cohorts, suggesting the importance of boosters in the nursing home population, the researchers concluded.

The study was published in JAMA Network Open.

Related articles:

As bivalent booster uptake lags, health officials urge seniors to get vaccinated

National Fire and Marine Insurance took Genesis to court earlier this year, concerned the provider did not intend to spend its own money to defend or resolve COVID claims after it hit a $3 million cap.

The insurer acknowledged that Genesis purchased coverage for losses over $3 million that it incurred while defending or satisfying cases “arising from a single healthcare event.” But National Fire balked when Genesis made a claim in 2021 characterizing its expected COVID payouts as all being part of the same, singular event.

Both sides asked the US District Court for the Eastern District of Pennsylvania to resolve the question of whether a range of COVID claims or possible COVID claims — Genesis has faced at least 43 so far, according to court documents — should be counted as one event or multiple events for insurance purposes. 

In his decision issued Thursday, Judge Mark. A Kearney found that the differences in facts and operating situations made the cases distinct, even in the cases where residents had the same diagnoses.

“These residents’ alleged injuries are all based on very different conditions,” Kearney wrote. “Even those residents who contracted COVID-19 at the different Genesis locations were not subjected to the same general conditions.” 

The Genesis corporate structure and differences in care factored into Kearney’s decision.

“The residents’ alleged exposure to COVID-19 and their resulting injuries arise from their stay at different Genesis facilities, operated by separate and distinct Genesis subsidiaries, at different locations,” Kearney added. “The COVID-related injuries are the result of separate and unrelated acts or omissions made by the thirty-two operating companies and presumably hundreds of their employees.”

He ruled that Genesis must satisfy the $3 million self-insured retention for each event before National Fire is obligated to provide coverage for the underlying lawsuits and pre-suit claims and potential claims. 

That decision could be a costly one for Genesis, and for similarly positioned large providers should other federal judges adopt similar interpretations.

Attorneys for Genesis did not respond to McKnight’s Long-Term Care News’ request for comment on the ruling by deadline Friday.

According to Kearney’s ruling, 29 cases in which claimants cite COVID conditions are still active against Genesis. The company had spent approximately $1.3 million on other cases as of the close of discovery six weeks ago, and leaders projected spending another $300,000 in the next five months. 

The company’s self-insured retention reserves, which includes both anticipated and incurred claims expense and loss payments for the current COVID-related lawsuits and pre-suit claims and potential claims, exceeded $4.8 million at all facilities, court documents show.
One bright spot for providers in the lengthy ruling: Kearney said COVID-related injuries to multiple residents at the same location during a COVID-19 outbreak may be considered a single healthcare event because those injuries would have resulted from the same, related acts by the same operating company and its employees.

Residents at Pine Point Center in Scarborough, ME, got the opportunity to be wild when recreation director Belinda Bantly set up a day of motorcycle rides earlier this month.

On a sunny Saturday, 10 members of the Riders of Southern Maine answered her request to give residents a thrill with sidecar trips from the 60-bed Genesis Healthcare facility to Old Orchard Beach and back, about a half-hour jaunt.

Bantly said a resident told her in January how much he missed the motorcycling of his youth, and she reached out to Nik Rempe, the president of the club.

“If (residents) want it, I’m gonna find out a way to do it,” Bantly said. “One really wanted to go for a ride and didn’t think he’d ever be able to and I told him I’d make it happen, and I made it happen.”

The day of the event, named Ride for the Residents, 19 residents went for the rides, four at a time. There were convoys of 10 riders, four with sidecars, and staff members on the backs of some motorcycles. Bantly provided coffee and doughnuts for the club, and with music playing outside the facility entrance, the vibe was relaxed but busy with transfers of residents by Hoyer lifts.

Bantly said she made sure there were sunglasses and sunscreen, blankets (some heated), bug spray and extra jackets. The residents signed all necessary paperwork the day before.

“We were very lucky it went so smooth,” she said.

Bantly said Rempe is open to repeating the ride annually, and said she might add another club. She said the key to the event was the same as with many efforts like this.

“Communication is a key to everything,” she said. “Residents communicating their needs and wants, and me communicating with the locals. I’m all about the rights of the residents.”

But providers — especially the five large chains singled out for criticism — were having none of it. 

Along with the Centers for Medicare & Medicaid Services, the House Subcommittee of the Coronavirus Crisis singled out the following large chains for withering criticism after examining the companies’ records and interviewing a variety of employees:

• Consulate Health Care 
• Ensign Group
• Genesis HealthCare 
• Life Care Centers of America 
• SavaSeniorCare  

The chains collectively operated more than 850 skilled nursing facilities charged with the care of more than 80,000 residents as of June 2020. Each experienced “significant” coronavirus outbreaks. 

The subcommittee examined the period from March to June 2020, one of the most bewildering, dangerous times in U.S. history.

Some 35% of all COVID-19 deaths and infections disproportionately involved nursing home residents and staff early in the pandemic. The congressional investigators said at least some of the carnage could have been averted had facilities had better infection control plans, practices and products in place. The report also harshly viewed what authors described as convoluted corporate ownership structures.

Report disputed

Companies and their executives told McKnight’s Long-Term Care News that researchers were selective in their reporting, had skewed data and generally revealed a lack of perspective.

“While we appreciate the goal of the subcommittee in their examination of the COVID-19 experience specific to the skilled nursing industry, we are certainly disappointed in what we believe to be an incomplete presentation of the information produced to them from our organization,” said Ensign CEO and Director Barry Port in an email to McKnight’s. “For example, the ‘Selected Reports’ isolated by the subcommittee and attached to its press release are silent on the results of the investigations into the subject allegations involving Ensign-affiliated entities, the majority of which were unsubstantiated. Further, none of the claims of inadequate PPE were validated. While we specifically asked the Subcommittee to disclose the outcomes in conjunction with the allegations, they elected not to do so.”

Ensign has grown by leaps and bounds during the pandemic and how operates in 259 facilities in 13 states.

“We are proud to be part of an industry that is full of kind, committed, competent and caring people who worked tirelessly to serve and protect facility residents and each other during one of the most significant health-related events in our history,” Port said.

Investigators took Genesis to task for its complex corporate structure in particular, even publishing an illustration of its many-layered hierarchy. Genesis spokeswoman Lori Mayer said Wednesday such complexity is natural for a company of its size.

“As the COVID-19 pandemic took siege across the United States, we were on the frontlines providing essential guidance to those heroes who put their own lives at risk to care for their patients and residents,” Mayer said. “We thank them for their dedication and compassion. With that said, as one of the largest providers of skilled nursing care in the country — providing services within more than 200 affiliated locations, it is common practice for large companies to have varied entities and structures.”

Conflicting official advice

A spokeswoman for SavaSeniorCare noted that the Coronavirus Crisis subcommittee formally requested information, including complaint logs, from the five companies in June 2020. She noted that her company’s compliance hotline diligently tried to keep up with responses to family members and others concerns and submitted full copies of call logs, which in some cases included allegations and complaints.

“In each instance, the allegations were investigated and, in many cases, the allegations were not substantiated.  If allegations were substantiated, in whole or in part, the compliance team took steps to ensure that corrective action was taken and monitored,” said Annaliese Impink, spokeswoman for SavaSeniorCare Administrative and Consulting LLC.

“Our compliance team and our center, district and division team members did their best to respond to these calls as quickly as possible,” Pink added. “The [subcommittee] press release that was issued on September 21, 2022, regarding these complaint logs does not acknowledge what steps Sava took to address the noted concerns. Instead, the press release implies that the complaints are factually accurate.”

In fact, this was not always the case, she said, especially in the uncertain days in the first six months of the pandemic, when official guidance varied often.

“For instance, the Committee’s press release highlights allegations from a staff member indicating that they were supposed to wear the same mask for 7 days,” Pink noted. “However, that was, in fact, the guidance that was released directly from the [Centers for Disease Control and Prevention] early on in the pandemic due to severe PPE shortages across the country.  Providers were doing their best to maintain staffing levels, provide necessary PPE, and comply with the array of often conflicting guidance from federal, state and local agencies. Our staff and our leadership gave of their time freely and unconditionally, many times spending hours and days away from their own families to assure that residents were getting the care they needed.”

A spokeswoman for Life Care Centers of America said she expected the company to respond to the subcommitte’s inflammatory report after its accompanying subcommittee hearing Wednesday afternoon. But McKnight’s had not received LCCA’s response by production deadline later that night.

Inquiries to a legal representative and an executive with Consulate Health Care did not produce a response as of late Wednesday.

‘Nearly every nursing home struggled’

Major long-term care associations, meanwhile, defended provider efforts during that period, when PPE shortages around the world were rampant and the first vaccines were still more than six months away.

“This report focuses on the early stages of the pandemic when every long-term care provider in the country was pleading for public health agencies and policymakers to send aid to the frontlines and prioritize our nation’s most vulnerable population,” said American Health Care Association President and CEO Mark Parkinson in a statement Wednesday. “It’s unfortunate that we need to remind lawmakers what those early days were like. No matter the business structure, nearly every nursing home in the country struggled with acquiring personal protective equipment due to supply chain disruptions, testing due to limited supply, and additional staff support due to most government support being directed toward hospitals.”

Circumstances have changed significantly from the early days, when governmental responses were slow or muddled, supply chain difficulties dominated and less was known about COVID-19, Parkinson added.

“Once long-term care received the aid we had been pleading for and public health agencies prioritized our nation’s most vulnerable for life-saving vaccines, we saw tremendous progress in reducing cases and deaths,” he noted. “However, serious challenges remain, including a historic labor crisis. If we want to learn from this pandemic, we need to focus on these larger issues that are faced by all nursing homes.”

LeadingAge, an association for nonprofit providers and housing organizations, did not comment directly on the report ripping its for-profit colleagues. But it did issue a statement Wednesday that addressed related criticisms of the sector from the affiliated House Select Subcommittee’s hearing on the impact of the coronavirus in nursing homes.

“For decades, our country’s long-term care system has failed older adults and the aging services providers who care for them,” said LeadingAge President and CEO Katie Smith Sloan. “Never was that failure more catastrophic than during the COVID public health emergency’s early days.”

Providers “begged” for help with critical resources such as PPE, tests and increased support for staff. Instead, PPE and aid promised by the federal government arrived weeks and sometimes months late, and often it was in disrepair, Sloan said. 

“It’s time to fix our country’s broken system of financing, oversight and support for nursing homes,” she concluded.

Welltower is approaching the finish line in its exit from its relationship with Genesis HealthCare, the company reported Tuesday. 

The Ohio-based real estate investment trust closed on the sale of seven more Genesis properties for a gross purchase price of $75 million during the first quarter of 2022. Welltower also closed on the sale of two other properties for $17 million in April. 

The company also has a forward sale agreement for the properties valued at $182 million. That deal is expected to close “simultaneously with the exercise of Welltower’s bargain purchase option,” executives said. Welltower owns more than 1,800 facilities across the United States, Canada and the United Kingdom, and just 94 of those are long-term/post-acute care facilities. 

“With the completion of these transactions, Welltower has substantially exited its relationship with Genesis,” the company reported in a first-quarter earnings release Tuesday. Genesis has been on the rebound after months of financial uncertainty exacerbated by the COVID-19 pandemic.

“One property remains in the lease between Welltower and Genesis and seven properties that were formerly under a sub-lease from Welltower to Genesis are now leased to a new regional operator.” 

Welltower in March 2021 announced it was cutting most of its ties with Genesis in a massive $880 million deal, which included terminating leases with the nursing home giant on 51 of its properties.

The Ohio-based REIT has since announced plans to develop care homes in the United Kingdom.

Genesis HealthCare’s insurance provider wants the nursing home giant to pay millions before it covers COVID-19 claims being brought by residents. 

National Fire and Marine Insurance Co. on Tuesday filed a complaint for a declaratory judgment in the Eastern District of Pennsylvania asking the court to settle the dispute with Genesis. The filing was first reported by Law360 on Wednesday. 

The two parties disagree on whether Genesis must pay one self-insured retention or multiple self-insured retentions before National Fire is obligated to provide coverage for claims and potential claims against the chain by residents who contracted COVID-19. 

A self-insured retention is a dollar amount specified in a liability insurance policy that must be paid by the insured before the insurance policy will respond to a loss. Insurers across the nation have been looking to limit their liability and even restricting coverage of nursing homes when it comes to COVID claims, though it’s unclear how broadly the retention argument has been used so far. 

Genesis declined a request for comment from McKnight’s Long-Term Care News on the matter. 

Genesis argued with National Fire that all claims and potential claims made by residents and former residents who contracted COVID-19 at any of its facilities raised from the same healthcare event, meaning that it will only have to pay one self-retention, court filings said.  

National Fire, however, said the differences in each Genesis facility may constitute multiple healthcare events “such that more than one self-insured retention applies,” according to court documents.

Genesis’ primary policy for self-insured retentions for loss and claims expenses requires the chain to pay $3 million per event for all locations (except in Kentucky), $5 million per event for all Kentucky locations, and $160 million aggregate for all locations. 

The nursing home provider is currently facing 25 claims or potential claims related to the pandemic, according to court documents. The Pennsylvania-based provider has more than 200 facilities nationwide.

“National Fire respectfully requests that the court enter judgment in favor of [the insurance company] declaring that the known underlying lawsuits and pre-suit claims and potential claims arise from multiple healthcare events and that Genesis must satisfy a self-insured retention for each healthcare event before National Fire is obligated to provide coverage,” the company argued in court documents.

Looking to boost skin health and improve the prevention and treatment of wounds, Genesis HealthCare has launched a new program that will add about 200 wound care experts company wide.

Earlier this month, Genesis began hiring skin-health team leaders for almost all of its skilled nursing facilities. These full-time employees will be responsible for overseeing a multidisciplinary approach to skin health, coordinating care with advanced practice wound specialists and nurse aides, better understanding what leads to wounds, and implementing quality improvement programs.

“The idea of a Band-Aid mentality — that it’s all about the nursing care and the bandage — that’s only one piece of the puzzle,” said Jeanine Maguire, vice president of skin health and wound care integrations for Genesis. “We really need to dive deeper and investigate. This is big. Wound care is really unlike any other disease process.”

While wounds in the aging population are often caused by chronic disease such as diabetes and venous hypertension, Genesis’ holistic approach will take into account internal and external factors that need to be controlled, as well as patient wishes, Maguire said. Having a point person to connect dietary, therapy and other providers; align the right treatments and supplies; and keep frontline staff vigilant will also help facilities spot changes in condition that could first present as a wound.

While Genesis has appointed skin health leads in the past, they were typically nurses with other full-time roles. Maguire said having dedicated staff members at all buildings will be a critical hallmark of the new program, given the increased complexity of nursing home populations and despite other, ongoing staffing challenges dogging the skilled nursing sector.

Genesis did not disclose the cost of its new program, but providers are finding it can pay to invest staff time and other resources in wound care, especially when it comes to preventing pressure injuries. Last November, the Centers for Medicare & Medicaid Services encouraged surveyors to focus on quality-of-care issues, listing pressure injuries as one of several key metrics it was concerned about back-sliding during the pandemic.

COVID-19, with its inflammatory mechanisms and treatments sometimes requiring prone positioning and ventilation, didn’t just affect skin health among those who had it. Infection control measures such as masking and frequent handwashing have also led to increased skin damage.

“COVID devastated skin at a global level,” Maguire said. “As we’re emerging, we hope, there is opportunity now for transformation.”

Maguire credits Genesis’ reorganization and the appointment of new chief operating officer Melissa Powell for helping her bring together a program she’s been working toward for 20 years.

The Kennett Square, PA-based company said last fall that it was implementing a market-focused model to help “grow revenue, reduce costs and streamline the decision-making process.” Maguire said the wound care program fits that mold by adding expertise directly to the company’s centers.

“We were always scratching the surface but couldn’t quite break through,” Maguire said. “Melissa ‘gets’ and really endorses the idea of having this skin lead in every center. … Good skin health and management means better reimbursement under PDPM, it could mean better Five-Star ratings … more patients. It brings this halo effect.”

Job candidates for the new Genesis program are typically nurses or therapists; those who come without wound care certification will have up to one year to earn it. The Genesis training program includes a monthlong residency, regular coaching by long-time clinical wound experts, an internal website packed with wound care resources and research, and a 35-credit course.

The company also has expanded a 50-facility partnership with PointClickCare to use its Swift wound care module at all facilities and is standardizing its preferred wound care provider network to include ReNew Wound Care, a telehealth specialist with advanced practice providers.