While untold Americans tried to do right by older and more vulnerable friends and family members by taking extra precautions and even canceling Thanksgiving gatherings, the nation crossed a ghastly threshold for the aged, sick, and injured in late November: The coronavirus has killed at least 100,000 residents and staff in nursing homes and other long-term care facilities.
The number of deaths is likely under-reported in federal and other data sources, as several states lag in providing information about problems in the facilities. The deaths of those institutionalized also is spiking as Covid-19 cases have, too, from coast-to-coast. “Community spread” poses grave risks to those in institutions.
If these figures are not already bleak, the Wall Street Journal reported that its research finds that there also are “more than 670,000 probable and confirmed Covid-19 cases in long-term care, affecting both residents and staff members.”
Not all these cases will advance to severe stages, including requiring hospitalization. Clinicians have gotten better at caring for those infected with the novel coronavirus. But those who have become so frail and health compromised to require institutional care are among those at highest risk, including with poor outcomes, when stricken with Covid-19.
The worsening news about long-term care facilities and the coronavirus was unsurprising to experts — and the shambolic response by federal regulators at the Centers for Medicare and Medicaid Services (CMS) should be regarded as shameful and unacceptable.
Tamara Konetzka, a professor of health-services research at the University of Chicago, told the Wall Street Journal that, “Sadly, nothing has changed,” with federal and state regulators, and facility owners and operators claiming they are doing the best they can, while clearly failing to safeguard the vulnerable.
The newspaper spoke with CMS and got this response:
“A CMS spokesman said the agency ‘is extremely concerned about increased community spread of Covid-19 going into this holiday season, which we believe has contributed to the rising number of Covid-19 cases in America’s nursing homes.’ The spokesman said CMS has taken steps to help nursing homes, but that homes haven’t accessed a national infection-control training program CMS helped set up. Inspections have shown some nursing homes still aren’t following proper infection-control procedures, he said.”
To be clear, advocacy and watchdog groups have ripped CMS for its flawed efforts, for example, to order increased coronavirus testing in long-term care facilities and sending dubious equipment and limited test-kits to do so. The agency — and, indeed, the Trump Administration as a whole — has turned a deaf ear to pleas, in the meantime, that facilities lack the staff and personal protective equipment (PPE) they need. As facilities struggle to patch together the low-paid workers to tend to nursing home residents, it defies common sense to demand that these stressed and over worked individuals put in yet more time for federal online courses, critics say.
As the nonpartisan, independent Kaiser Family Foundation reported:
“While early action to prevent the spread of coronavirus in long-term care facilities led to strict protocols related to testing, personal protective equipment (PPE), and visitor restrictions, several of these measures have been reversed in recent months, and some long-term care facilities continue to report shortages of PPE and staff. The disproportionate number of Covid-19 deaths in long-term care facilities serves as a reminder that residents and staff in these places continue to bear a high burden of the uncontrolled pandemic. Post-Thanksgiving surges in cases are unlikely to spare this community and will likely lead to an even higher death toll in long-term care facilities, raising questions about whether nursing homes and other facilities are able to protect their residents and, if not, what actions can be taken to mitigate the threat posed by the virus.”
The Washington Post reported that taxpayers for a long time now have footed the bill for the sketchy business model for long-term care that has imploded in the coronavirus pandemic. Owners and operators, seeking to maximize their profits and exploit fees they get paid for individual services, have flitted from one kind of specialized care to another to take advantage of the most enriching treatment or therapy. They have learned, for example, to pull down big bucks by claiming to provide rehabilitative care or post-surgical support.
In the meantime, the federal funding for nurses, infection-control, and basics like building maintenance or improvement — these baseline functions haven’t seen increases in support. This has helped to explain why fundamentals that would better have protected residents — and staff — were lacking and overwhelmed by the fast-spreading coronavirus, the newspaper reported.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by abuse and neglect in nursing homes and other long-term care facilities. More than 1 million frail Americans are under care in 15,600 licensed nursing homes in this country, according to federal data.
That makes the rising coronavirus toll ever more stunning and unacceptable: The nation is approaching the point where Covid-19 has killed roughly 1 in 10 of the vulnerable and institutionalized. Can it be that slightly more than half of that population also is infected with the disease? Yes, there’s a lot of give in these statistics, because they reflect the toll in all long-term care institutions, not just nursing homes but also assisted living and other types of facilities. The infection numbers also include staff as well as residents.
Still, this kind of a nightmarish numeric snapshot of such a drastic health problem cannot prompt the persistent, sluggish, and rote responses from regulators and politicians.
It will be an imperative of the post-pandemic era, which the nation eventually will get to, to investigate and hold accountable politicians, regulators, owners, and operators of long-term care facilities for the suffering and death that has occurred in nursing homes during the pandemic. Some of the harmed — residents and their loved ones — may seek justice in the civil system. Their claims may be gaining legal viability by the hand wringing “poor me” claims of regulators, owners, and operators whose pandemic reaction has been far too much inaction. It is looking more and more like a reckless or intentional disregard for the well-being of facilities’ residents and staff.
This must stop. We have much work to do to battle the pandemic and protect the aged, sick, and injured in our institutions.