Coronavirus Has Killed Thousands at U.S. Nursing Homes
The numbers are staggering: More than 3,600 nursing home and long-term care residents have died due to COVID-19 infections, with a huge number occurring in just the past two weeks.
The stories are tragic:
- A California nursing home with more than a third of residents infected with COVID-19 had to be evacuated when fearful staff didn't show up to work.
- Almost nine in 10 residents of a Massachusetts nursing home had COVID-19 infections.
- The National Guard was deployed to two New Jersey nursing homes hit especially hard with COVID-19 infections.
- A Pennsylvania nursing home believes all 450 residents, and its staff, have been infected with the virus.
What is it about nursing homes and long-term care facilities that makes them uniquely susceptible?
Dr. Richard Baron, president of the American Board of Internal Medicine, said, "There are multiple reasons. The first is that they are effectively enclosed communities -- kind of like a cruise ship.
"There are two patients in a room, staff goes from patient to patient, and residents share meals and entertainment together. Practicing social distancing is challenging in this setting, and this virus spreads from person to person with some ease," he explained.
Another important reason is that the immune system in older people just isn't as "vigorous or effective," Baron said.
Older people also don't have the same reserves that someone younger has. "As we age, we lose the reserve our organs have. If you're just sitting still and breathing, you don't use much lung capacity. But in somebody with pneumonia, the lung is infected and filling with fluid, which takes some lung capacity offline. If your reserve is already low, you may be making a demand that your body can't meet -- like being overdrawn from the bank," Baron explained.
Given the vulnerability of older people, preventing infections becomes even more important.
To that end, the U.S. Centers for Medicare and Medicaid Services moved aggressively to try to limit the spread in nursing homes by advising facilities to restrict visitors and nonessential workers on March 13. The agency is expected to advise nursing homes to disclose any infections in their facilities to loved ones of residents, the Associated Press reports.
Shortages of staff and protective equipment
But bigger problems facing nursing homes and long-term care facilities right now are a lack of personal protective equipment (PPE) and sufficient staff. PPE includes face masks, disposable gowns and gloves.
"We desperately need more PPE in nursing homes and assisted living communities, priority testing for our health care workers and residents, and the ability to quickly recruit and hire more staff," the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said in a statement.
"Long-term care facilities acted early on in this pandemic on those things we can control, such as limiting visitation ahead of social distancing containment measures implemented in many states. We are doing everything we can with the resources we've been given to slow the acceleration of the virus for our residents who are the most vulnerable, but without PPE, tests and [a] healthy workforce, beating this virus will be very difficult," the trade group said.
'Dire' situation in nursing homes
Matthew Yarnell, president of Service Employees International Union (SEIU) Healthcare Pennsylvania, said the situation in nursing homes and long-term care facilities is dire.
"The long-term care living system has been underfunded for many years, and the virus is highlighting the kinds of long-term systemic problems we have. As a society, we do a really bad job of caring for our seniors," he said.
Right now, Yarnell said there is a "total shortage of PPE and a staffing crisis."
He said many people are working extra shifts to try to help, but many are getting sick. And not all have paid sick leave.
Baron pointed out that people working in long-term care facilities often have lower incomes, may be taking public transportation to work, may live in more densely populated homes and may live with people who have jobs such as grocery store clerks and delivery drivers that expose them to a lot of people. That means health care workers may spread infections in the community, and they may bring infections from the community into the nursing home, particularly if they don't have paid sick leave.
"The workforce who tends to do this work are typically low-wage, often women, often people of color. These are the soldiers we're sending into what's essentially a war zone. We need to make a commitment to them -- if you get sick, we'll have your back," Yarnell said.
And, he added that people working in long-term care facilities should be getting hazard pay.
"The focus has been on the hospitals, but every sector of caregiving should be staffed and supplied appropriately. People need to feel supported in this moment," Yarnell said.
"It's a value question for our society. Right now, our health care institutions are motivated by tight budgets that mean we don't have the supplies we need to fight this invisible enemy," he said.
The AHCA/NCAL agreed. "We desperately need PPE and priority testing. We are now at the point we are calling on the public for donations for PPE to long-term care providers," they said.
Despite doing everything they can to conserve PPE, providers are still struggling to get supplies. The AHCA/NCAL said they're worried that some facilities may exhaust their PPE supplies.
"That is why we are calling for everyone to assist, including partners in other industries and the public, to do everything they can to assist us at this time. We cannot beat this virus alone, and we appreciate everything the Administration, Congress, states, our partnering manufacturers, and members of the public can do right now," the organization said.
Should loved ones come home?
All of these problems have left families in a difficult situation. Should they take their loved ones out of nursing homes to keep them safe?
"That's a very challenging question," Baron said. "Presumably, there's a reason they were in the nursing home in the first place. It's likely that their care needs were overwhelming for the family. If it was for specific health care reasons that likely hasn't changed for the better, the nursing home may still be the safest place for them to be."
But, he noted, if it was because no one was home to care for them, and now people aren't working, it might be an option.
"Each situation is individual. It's important to remember the risks involved with moving anyone from one environment to another," Baron said.
Learn more about the impact of COVID-19 on nursing homes and other long-term care facilities from the U.S. Centers for Disease Control and Prevention.
SOURCES: Richard Baron, M.D., president, American Board of Internal Medicine; April 10, 2020, AHCA/NCAL statement; Matthew Yarnell, president, Service Employees Union International Healthcare Pennsylvania