How U.S. Ratings of Nursing Homes Mislead the Public

The pandemic laid bare the flaws in the government rating system.

The state health inspections do little to penalize homes with poor records of preventing and controlling infections. From 2017 to 2019, The Times found, inspectors cited nearly 60 percent — more than 2,000 — of the country’s five-star facilities at least once for not following basic safety precautions, like regular hand washing. Yet they earned top ratings.

In San Bernardino, Calif., inspectors wrote up Del Rosa Villa for four different infection-control violations. It kept its five stars. Ninety residents at the 104-bed facility have contracted the coronavirus, and 13 have died.

Del Rosa Villa officials didn’t respond to requests for comment.

Life Care Centers of Kirkland, Wash., the first nursing home in the United States to have documented coronavirus cases, was found in 2019 to have weak infection controls, despite its five stars. State inspectors wrote it up for failing to “consistently implement an effective infection control program.”

Thirty-nine of the facility’s residents have died from Covid-19. The home has 190 beds.

Leigh Atherton, a Life Care spokeswoman, said that citation was the only lapse in infection control that inspectors had identified over 32 previous visits. She said the home quickly fixed the problem.

If the rating system worked as intended, it would have offered clues as to which homes were most likely to have out-of-control outbreaks and which homes would probably muddle through.

That is not what happened.

The Times found that there was little if any correlation between star ratings and how homes fared during the pandemic. At five-star facilities, the death rate from Covid-19 was only half a percentage point lower than at facilities that received lower ratings. And the death rate was slightly lower at two-star facilities than at four-star homes.

A facility’s location, the infection rate of the surrounding community and the race of nursing home residents all were predictors of whether a nursing home would suffer an outbreak. The star ratings didn’t matter.

View Source

Facing Pressure, Biden Administration Scrambles to Shelter Migrant Children

Republicans are framing the situation as a crisis of Mr. Biden’s making, signaling an aim to use his immigration agenda as a political weapon against him in 2022. Representative Kevin McCarthy of California, the minority leader, is planning to lead other Republicans on a trip to the border to highlight the issue. Representative James R. Comer, Republican of Kentucky, on Wednesday called the increase in migration a signal “to the world that our immigration laws can be violated with little, if any, consequence.”

Mr. Biden, however, has continued to use a Trump-era rule to rapidly turn away most migrants at the border, with the exception of unaccompanied minors. The administration last week directed the shelters designed to hold the children to return to their normal capacity, despite the coronavirus pandemic.

In the scramble to find additional space for the children, the Biden administration is considering housing them at unused school buildings, military bases and even a NASA site, Moffett Federal Airfield in Mountain View, Calif., according to a memo obtained by The Times. The NASA site would “remain unoccupied but available for use if H.H.S. has an urgent need for additional shelter space,” the memo said.

Darryl Waller, a spokesman for NASA, confirmed in a statement that the administration was considering sheltering migrant children at “currently vacant property” at the site. “This effort will have no impact on NASA’s ability to conduct its primary missions,” he said.

The Health and Human Services Department did not respond to requests for comment.

Mr. Biden campaigned on a more humane approach to immigration at the border, one that would prioritize investing in Central America to deter illegal immigration. But it has had the effect of drawing more people who see a better chance to enter the United States than they had under the Trump administration.

“One of the things I think is important is we’ve seen surges before,” Ms. Jacobson said. “Surges tend to respond to hope. And there was a significant hope for a more humane policy.”

One part of the Obama administration’s response was creating the program that allowed Central American children to apply for protection from their home countries.

View Source

President Biden Faces Challenge From Surge of Migrants at the Border

WASHINGTON — Thousands of migrant children are backed up in United States detention facilities along the border with Mexico, part of a surge of immigration from Central Americans fleeing poverty and violence that could overwhelm President Biden’s attempt to create a more humane approach to those seeking entry into the country.

The number of migrant children in custody along the border has tripled in the past two weeks to more than 3,250, according to federal immigration agency documents obtained by The New York Times, and many of them are being held in jail-like facilities for longer than the three days allowed by law.

The problem for the administration is both the number of children crossing the border and what to do with them once they are in custody. Under the law, the children are supposed to be moved to shelters run by the Health and Human Services Department, but because of the pandemic the shelters until last week were limiting how many children they could accommodate.

The growing number of unaccompanied children is just one element of an escalating problem at the border. Border agents encountered a migrant at the border about 78,000 times in January — more than double the rate at the same time a year ago and higher than in any January in a decade.

refused to call a “crisis” but could nevertheless become a potent political weapon for his Republican adversaries and upend his efforts to legalize millions of undocumented immigrants.

The president has proposed overhauling the nation’s decades-old immigration system by making it easier for asylum seekers and refugees, expanding legal pathways for foreign workers, increasing opportunities for family-based immigration and vastly reducing threats of mass deportations. His State Department announced on Monday that foreigners rejected after Jan. 20, 2020, under Mr. Trump’s travel ban could try to obtain visas without paying additional fees.

Hundreds of migrant families are also being released into the United States after being apprehended at the border, prompting predictable attacks by conservatives.

Liberal politicians are denouncing the expansion of detention facilities and railing against the continued imposition of Trump-era rules intended to prevent the spread of the coronavirus from immigrants. And advocates for families separated at the border during Mr. Trump’s administration are pressuring the president to move faster to reunite them.

Together, it has put Mr. Biden on the defensive in the early days of his presidency as he attempts to demonstrate a tone very different from his predecessor’s.

The immigration system Mr. Biden envisions will take months, if not years, to be fully implemented, forcing the administration to scramble to find space for children and rely, for now, on a rule that swiftly returns adults and most families to their home countries.

For now, Mr. Biden has broken from his predecessor in not applying the pandemic emergency rule to children, meaning the United States is still responsible for caring for them until they are placed with a sponsor.

long-term detention facilities within 72 hours.

But for now, using the same pandemic rule the Trump administration did, the Biden administration has continued to turn away most migrants other than unaccompanied children.

And almost as soon as Mr. Biden came into office, top administration officials publicly sought to discourage migrants from traveling north, saying it would take time to unravel Mr. Trump’s policies. Previous public messaging campaigns, including standing up billboards in Central America to encourage migrants to stay home, have failed.

“Realistically, one is addressing a population of people that are desperate,” Mr. Mayorkas said in an interview. “It is not going to work 100 percent, but if it is effective at all, that is of momentous importance not only to what we are trying to do but for the well being of the people.”

Some families are being released into the United States. Border agents have not been able to turn away migrant families in South Texas because of a change in Mexican law that bans the detention of small children.

Administration officials point to a flurry of actions underway aimed at fixing what they say is a broken immigration system: improving communications between the Border Patrol and the health department, including whether the children being transported to the long-term centers are boys or girls; streamlining background checks for shelter employees; and vaccinating border workers against the coronavirus.

They are also accelerating efforts to get new facilities to care for children during the weeks and months that it takes to find relatives or foster parents. They are considering unused school buildings, military bases and federal facilities that could be rapidly converted into places acceptable for children.

And they are restarting a program in Central America that will allow children to apply for asylum without making the dangerous trek to the border. Mr. Trump ended the program, which Biden administration officials said would eventually reduce the flow of migrant children to the United States.

But all of that will take time. Meanwhile, officials say, they recognize that the pressure on Mr. Biden will only increase.

“At every step of the way we’re looking at where are the bottlenecks and then trying to eliminate those bottlenecks and yes it won’t be solved by tomorrow,” said Esther Olavarria, the deputy director for immigration at the White House’s Domestic Policy Council. “But if you don’t start to do each of these things, you are never going to solve the problem.”

Annie Karni and Maggie Haberman contributed reporting.

View Source

Biden Faces Challenge From Surge of Migrants at the Border

WASHINGTON — Thousands of migrant children are backed up in United States detention facilities along the border with Mexico, part of a surge of immigration from Central Americans fleeing poverty and violence that could overwhelm President Biden’s attempt to create a more humane approach to those seeking entry into the country.

The number of migrant children in custody along the border has tripled in the past two weeks to more than 3,250, according to federal immigration agency documents obtained by The New York Times, and many of them are being held in jail-like facilities for longer than the three days allowed by law.

The problem for the administration is both the number of children crossing the border and what to do with them once they are in custody. Under the law, the children are supposed to be moved to shelters run by the Health and Human Service Department, but because of the pandemic the shelters until last week were limiting how many children they could accommodate.

The growing number of unaccompanied children is just one element of an escalating problem at the border. Border agents encountered a migrant at the border about 78,000 times in January — more than double the rate at the same time a year ago and higher than in any January in a decade.

refused to call a “crisis” but could nevertheless become a potent political weapon for his Republican adversaries and upend his efforts to legalize millions of undocumented immigrants.

The president has proposed overhauling the nation’s decades-old immigration system by making it easier for asylum seekers and refugees, expanding legal pathways for foreign workers, increasing opportunities for family-based immigration and vastly reducing threats of mass deportations. His State Department announced on Monday that foreigners rejected after Jan. 20, 2020, under Mr. Trump’s travel ban could try to obtain visas without paying additional fees.

Hundreds of migrant families are also being released into the United States after being apprehended at the border, prompting predictable attacks by conservatives.

Liberal politicians are denouncing the expansion of detention facilities and railing against the continued imposition of Trump-era rules intended to prevent the spread of the coronavirus from immigrants. And advocates for families separated at the border during Mr. Trump’s administration are pressuring the president to move faster to reunite them.

Together, it has put Mr. Biden on the defensive in the early days of his presidency as he attempts to demonstrate a tone very different from his predecessor’s.

The immigration system Mr. Biden envisions will take months, if not years, to be fully implemented, forcing the administration to scramble to find space for children and rely, for now, on a rule that swiftly returns adults and most families to their home countries.

For now, Mr. Biden has broken from his predecessor in not applying the pandemic emergency rule to children, meaning the United States is still responsible for caring for them until they are placed with a sponsor.

long-term detention facilities within 72 hours.

But for now, using the same pandemic rule the Trump administration did, the Biden administration has continued to turn away most migrants other than unaccompanied children.

And almost as soon as Mr. Biden came into office, top administration officials publicly sought to discourage migrants from traveling north, saying it would take time to unravel Mr. Trump’s policies. Previous public messaging campaigns, including standing up billboards in Central America to encourage migrants to stay home, have failed.

“Realistically, one is addressing a population of people that are desperate,” Mr. Mayorkas said in an interview. “It is not going to work 100 percent, but if it is effective at all, that is of momentous importance not only to what we are trying to do but for the well being of the people.”

Some families are being released into the United States. Border agents have not been able to turn away migrant families in South Texas because of a change in Mexican law that bans the detention of small children.

Administration officials point to a flurry of actions underway aimed at fixing what they say is a broken immigration system: improving communications between the Border Patrol and the health department, including whether the children being transported to the long-term centers are boys or girls; streamlining background checks for shelter employees; and vaccinating border workers against the coronavirus.

They are also accelerating efforts to get new facilities to care for children during the weeks and months that it takes to find relatives or foster parents. They are considering unused school buildings, military bases and federal facilities that could be rapidly converted into places acceptable for children.

And they are restarting a program in Central America that will allow children to apply for asylum without making the dangerous trek to the border. Mr. Trump ended the program, which Biden administration officials said would eventually reduce the flow of migrant children to the United States.

But all of that will take time. Meanwhile, officials say, they recognize that the pressure on Mr. Biden will only increase.

“At every step of the way we’re looking at where are the bottlenecks and then trying to eliminate those bottlenecks and yes it won’t be solved by tomorrow,” said Esther Olavarria, the deputy director for immigration at the White House’s Domestic Policy Council. “But if you don’t start to do each of these things, you are never going to solve the problem.”

Annie Karni and Maggie Haberman contributed reporting.

View Source