Nursing Home Hot Spots

Quality of Care

The COVID pandemic has disproportionately affected nursing home residents and staff. They account for 40 percent of deaths in the U.S. More than 75,000 residents and employees of America’s nursing homes and other long-term care facilities have died from COVID-19.

Why are nursing homes hot spots in the pandemic? They combine numerous risk factors for transmission: congregate living, vulnerable population, unsafe staffing, and inadequate PPE. Nursing homes have always struggled with infection control.

“There were very few geriatricians around the country that didn’t know what was about to happen,” Dr. Michael Wasserman said. He is president of the California Association of Long Term Care Medicine. On March 10, Wasserman warned “This is the greatest threat to nursing home residents that we have seen in many years, if not ever.”

National Disgrace

Katie Smith Sloan is president and CEO of LeadingAge. She said the pandemic is a “Category 5 emergency bearing down on millions of older adults in Florida and across the United States.”

Nancy LeaMond of AARP wrote: “What is happening in America’s long-term care facilities is a national disgrace and an ongoing tragedy that must be addressed now. We are strongly urging Congress and the Administration to provide dedicated funding and strong policy to protect the residents of long-term care facilities, paired with transparency and accountability to ensure that funds are being used to save lives.”

Tony Chicotel is an attorney for the nonprofit California Advocates for Nursing Home Reform. Chicotel’s organization recently released a report concluding that the state’s COVID-19 infection control surveys have not led to meaningful enforcement. “My guess is there’s lots of terrible neglect going on that is harming people to levels that are akin to the virus, but we just don’t know. I can’t think of any other time like this, where all of the layers of oversight are missing.”

Is Help Coming?

Steve Bahmer is head of LeadingAge Florida. Bahmer noted that Florida is an epicenter citing statistics in a situation report. Nonprofit providers in Florida requested their senators to advocate for relief for Florida’s long-term care community. Bahmer even wrote a letter to Sens. Marco Rubio (R) and Rick Scott (R) begging them to help older adults. Marco Rubio and Rick Scott refuse to help.

Inadequate supplies of PPE have increased nursing home infection control problems. Jordan Rau reported that Trump failed to deliver on the promise to “deploy every resource and power that we have” to protect older Americans.

If you don’t have PPE, it’s game over,” Wasserman said. “That is number one. Number two is testing, because we know that asymptomatic staff can bring the virus into the facility.”

Costs for testing are of particular concern to Florida providers. The ability to test staff and residents on demand would stop the spread of COVID-19 when you isolate those who test positive.

To keep the virus out of a nursing home, you need to be able to test staff regularly, every time they come in for a shift,” Sloan told the Atlantic. “You need to get results within minutes, not days.”

Safe Staffing and Living Wages

Additionally, nursing homes are chronically short staffed. This leads staff to cut corners with infection control, hand-washing, and personal hygiene. Staff are underpaid with no benefits, 15% of direct-care workers live below 100% of the federal poverty line. Nearly half live below 200% of poverty, according to PHI. These workers need multiple jobs to survive. This increases the risk of exposure to the coronavirus. Underpaid staff will work through illness to get paid.

It’s not too late to mitigate the harm. We can support frontline workers and residents with increased testing, PPE supply, and hazard pay. Facilities need assistance with infection control with proper data reporting.  Industry needs to train and enforce safety rules for the health, safety, and well being of the residents and the caregivers.