9Wants to Know found nursing homes were fined for doing a poor job and earned bonus payments during the pandemic. We want to know why, and Congress won’t answer us.
COLORADO — Rock Brekhus was a man who loved to tinker — a skilled carpenter who could build anything.
There was the time he and his older brother, Kit Brekhus, were in the midst of a road trip to Alaska when their Baja Bug conked out near Edmonton, Alberta. It was 1977.
“Rock decided we were going to overhaul the engine right there,” Kit Brekus told 9NEWS. “We hitchhiked into town — into Edmonton — got the parts, hitchhiked back out to the KOA campground, rebuilt the engine, and we were on our way again to Montana from Alaska. That’s what Rock could do. Amazing. It was amazing.”
But eventually, multiple sclerosis overtook Rock Brekhus — and ultimately, he needed professional help and ended up living at Cherry Creek Nursing Center in Aurora.
Rock Brekhus would die there on May 6, 2020, after being infected with COVID-19.
A 9Wants to Know investigation found that Cherry Creek Nursing Center was one of 117 nursing homes with COVID-19 outbreaks that got both fined for poor response to the pandemic and paid for good response to the pandemic. In all, 1,103 people died of COVID-19 at those 117 nursing homes.
“Here we went from a man who could do anything with his hands, you know — a skilled artist and a craftsman who gradually lost the full use of his hands, and his vision went bad,” Kit Brekhus said. “But what I was amazed (at) during that time was that [Rock] never complained. You know, I could see where he was frustrated not being able to do what he wanted to do, because he loved to tinker, he loved to create things, he loved to invent little things.
“But as time went on with the disease, he wasn’t able to do those things.”
The above map shows all 117 facilities that were paid, punished and had an outbreak. Created by Zack Newman.
The $22,700 fine and the $229,222.84 payment to Cherry Creek — made by different offices within the U.S. Department of Health and Human Services — came last November, 9Wants to Know found.
Cherry Creek: Paid and punished in the same month
Cherry Creek was one of 22 facilities both paid and punished in the same month, according to the 9Wants to Know analysis.
This map shows the 22 facilities that were fined and paid for good performance in the same month. Created by Zack Newman.
Cherry Creek was fined after inspectors found staff members weren’t washing their hands properly or wearing the correct masks. At the same time, it qualified for the payment because it had fewer cases than the surrounding community and fewer deaths than a federal benchmark.
A spokesperson for Cherry Creek Nursing Center did not immediately return repeated requests for comment.
Those 117 Colorado nursing homes split $12,760,505.92 in payments for protecting residents from COVID-19 — even though they all had outbreaks of the disease and got fined for poor response to the pandemic.
It’s a situation not one member of Colorado’s congressional delegation was willing to discuss — 9Wants to know requested interviews with U.S. Reps. Jason Crow, Diana DeGette, Joe Neguse and Ed Perlmutter, all Democrats, and Republicans Lauren Boebert, Ken Buck, and Doug Lamborn, as well as the state’s two U.S. senators, Democrats Michael Bennet and John Hickenlooper. Despite repeated requests, not a single one would answer questions from 9Wants to Know.
Two — Bennet and Perlmutter — issued statements.
Perlmutter said the convergence of payments and fines could be one of the things the Select Subcommittee on the Coronavirus Crisis within the House of Representatives looks into as it examines how money from stimulus legislation was spent.
“I appreciate 9News looking into this matter,” Perlmutter wrote in his statement. “This is clearly something we need to gain a better understanding of so Congress can ensure HHS applies metrics consistently across its various programs.”
Bennet wrote that 9Wants to Knows’ findings make sense based off of the structure of both programs.
“This incident demonstrates just how bad this pandemic was, especially for our seniors in nursing homes,” he wrote in the statement. “The pandemic was so severe that in some areas nursing homes could be doing better than their surrounding communities and still be overwhelmed by the situation and fined for lack of compliance.”
The fact that 117 nursing homes got fined for poor pandemic performance and rewarded for good pandemic performance baffled Kit Brekhus.
“Either they were doing a really good job, or they weren’t,” he said.
Kit Brekhus said that during his time at Cherry Creek Nursing Center, his younger brother was well cared for. But it didn’t matter — his MS continued to worsen. And then he got the call that Rock Brekhus had been diagnosed with COVID-19.
“We had a family conference and my family members called in,” Kit Brekhus said. “We sang some songs, and we prayed some prayers, and we shared stories. And we laughed, and we cried.”
Eight hours later, Rock Brekhus died. He was one of 35 deaths at the site of the deadliest outbreak in a Colorado nursing home.
But he wasn’t alone.
“Immediate jeopardy” at Pioneer Health Care Center
Mildred Jimenez was a woman of faith who adored her family — and showed that love.
“She was a great cook,” her daughter, Carolyn Jimenez, told 9NEWS. “Always had an open door — come in — the smell of fresh tortillas, the smell of beans. … If you walked in the house, it was always come on, sit down, you know, are you thirsty? Are you hungry?”
She was living at Pioneer Health Care Center in Rocky Ford, struggling with dementia when she was infected with COVID-19. That was July 24th. Carolyn traveled to Rocky Ford to say goodbye.
“I didn’t want her to be alone,” she said. “She needed to have her hand held. She needed to have a kiss. She needed to have a hug. … I touched her hands with gloves. I couldn’t really kiss her — just held her hand and she could see me through a shield.”
Four days after that diagnosis, Mildred Jimenez died.
The day after Mildred Jimenez died, inspectors visited Pioneer Health Care — and they found infection control was so bad that the residents there were in “immediate jeopardy.” Staff members did not follow-up with those that reported symptoms or properly put protective equipment on or off.
“Observations, record review and interviews revealed the facility failed to conduct active screening of staff in a manner to prevent the spread of COVID-19,” the July 2020 inspection said.
As a result, Pioneer was fined $88,354.50.
Devin John, Pioneer’s administrator, called the incident an “unfortunate anomaly” in a statement to 9NEWS. The facility declined a chance to do an interview.
“We are confident that our screening practices are safe and compliant with protocols,” John wrote.
Pioneer also got paid $147,711.60 for it’s pandemic response.
The fact the same nursing homes were rewarded and penalized stunned Carolyn Jimenez — like it had Kit Brekhus.
“It’s almost rewarding a child for bad behavior,” she said.
John wrote the money was used towards “pandemic-driven demands” like purchasing protective equipment and staffing.
Pioneer is in Rep. Ken Buck’s district. Cherry Creek is in Rep. Jason Crow’s district. Neither responded to multiple requests for comment.
The above map shows all 117 facilities that were paid, punished and had an outbreak combined with the Congressional districts. Created by Zack Newman.
The statement of U.S. Sen. Michael Bennett:
Nursing homes and assisted living facilities in Colorado were disproportionately impacted by COVID-19, only building on existing quality concerns in our long-term care system. It’s clear nursing homes and other health providers were not prepared for the pandemic and the lack of swift response and rollback of regulations that would have assured quality from the previous administration led to too many avoidable deaths.
Our office looked into your request and found that during the pandemic, Centers for Medicare and Medicaid Service (CMS) did its job to assure quality in nursing homes, which led to fines . Additionally, legislation that Congress passed included funding to nursing homes that were doing better on COVID-19 infection control relative to the community they were located in. The fines and the awards were not tied to one another, which led to many nursing homes receiving both fines and awards.
This incident demonstrates just how bad this pandemic was, especially for our seniors in nursing homes. The pandemic was so severe that in some areas nursing homes could be doing better than their surrounding communities and still be overwhelmed by the situation and fined for lack of compliance.
Over the long term, Senator Bennet believes that we need to reform how this country cares for our seniors. That’s why Senator Bennet is working with his colleagues on the Senate Finance Committee to pass reforms to our nursing home and long-term care system and continue to hold the bad actors accountable, including shutting them down if necessary. He has also requested a review on a number of issues related to COVID-19, including nursing homes, from the Government Accountability Office (GAO) to provide an assessment and recommendations, which we will address once the reports are released. The first GAO report was released on May 19, 2021 which showed the frequency and duration of COVID-19 outbreaks in nursing homes from May 2020 through January 2021. Additionally, the Senate Finance Committee held a hearing on nursing home issues in March and intends to support legislation that addresses the concerns that were seen during, and even prior to, the pandemic.
The statement from U.S. Rep. Ed Perlmutter:
“I appreciate 9News looking into this matter. This is clearly something we need to gain a better understanding of so Congress can ensure HHS applies metrics consistently across its various programs. Nursing homes and long-term care facilities were particularly vulnerable to COVID-19, which is why Congress directed additional support to these facilities in the CARES Act to support their patients. Congress acted swiftly with the CARES Act to stabilize a cratering economy and support our healthcare system, which is why the House later created the Select Subcommittee on the Coronavirus Crisis to conduct oversight of the federal government’s response to the coronavirus crisis and ensure taxpayer dollars were spent responsibly and effectively. The Select Subcommittee has launched a sweeping investigation into coronavirus deaths and distribution of funds to nursing homes, and I hope the Select Subcommittee will continue its work to ensure federal agencies are held accountable for all the funding Congress directed to combat the COVID-19 pandemic.”
Statement from Devin John, administrator at Pioneer Health Care Center:
I’m circling back on your inquiry here and am providing this statement. First and foremost, Pioneer is a great facility with fantastic staff. They are, and have truly been heroes this past year. As we’re all well aware now, June and July 2020 was when the SARS-coronavirus-19 was making its initial wave through facilities across Colorado. Our facility was no exception to its path. While privacy regulations prohibit us from commenting specifically on residents who were diagnosed with and/or passed from covid-19, as is very public information now Pioneer can say based on experience we know that covid-19 does complicate care for residents with pre-existing comorbidities—such as advanced age, etc.
The CDC, the Colorado Department of Health and all regulatory agencies were scrambling along side facilities like Pioneer to determine best protocols as the pandemic ramped up. As you also note, Pioneer—as well as almost all other facilities in the state and country—received funding to assist with escalating PPE, staffing, and other pandemic-driven demands.
With respect to the one screening deficiency noted on the July 29 survey, that is accurate in that there was a staff member whose pre-shift screening was not verified that day. We were fined for this. This was an unfortunate anomaly, as a concurrently conducted Covid-19 Emergency Survey found zero deficiencies (including staff screening). We are confident that our screening practices are safe and compliant with protocols.
All in all, we are heavily regulated by various health agencies and we are confident we are compliant with those agencies’ regulations and dynamic pandemic protocols.
Ways to contact your federal representatives:
Take a look at the data
117 facilities paid, punished and with a outbreak:
22 facilities were paid and punished in the same month: