The coronavirus pandemic’s terrible toll on nursing homes and other long-term care facilities may be much worse than now estimated, as resident advocates, watchdog groups, and experts tally “excess deaths” in the facilities — perhaps one additional casualty beyond any two formally attributed to Covid-19.
These fatalities are unacceptable, resulting from frantic and low-paid health workers’ inability to care for the aged, injured, and chronically ill infected with the coronavirus while also dealing with the needs of people so frail they require institutionalization. It’s tough reading, but here is what the Associated Press reported:
“As more than 90,000 of the nation’s long-term care residents have died in a pandemic that has pushed staffs to the limit, advocates for the elderly say a tandem wave of death separate from the virus has quietly claimed tens of thousands more, often because overburdened workers haven’t been able to give them the care they need. Nursing home watchdogs are being flooded with reports of residents kept in soiled diapers so long their skin peeled off, left with bedsores that cut to the bone, and allowed to wither away in starvation or thirst.
“Beyond that, interviews with dozens of people across the country reveal swelling numbers of less clear-cut deaths that doctors believe have been fueled not by neglect but by a mental state plunged into despair by prolonged isolation ̶ listed on some death certificates as ‘failure to thrive.’ A nursing home expert who analyzed data from the country’s 15,000 facilities for The Associated Press estimates that for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes. Those ‘excess deaths’ beyond the normal rate of fatalities in nursing homes could total more than 40,000 since March.”
Owners and operators of the facilities have insisted since the pandemic began that they have done the best they could in unprecedented bad circumstances. The main federal regulators of long-term care — the officials at the Centers for Medicare and Medicaid Services (CMS) — have done a shambolic job of responding to the death and illnesses in more than 15,000 facilities nationwide.
Watchdogs and residents’ loved ones say they have tried to be patient and to understand the difficulties that all health care facilities have tried to deal with due to the pandemic. But months of growing anger and frustration have led them to tragic insights about the nation’s long-term care: It was a shaky mess before, and the pandemic has exposed deep and dangerous flaws that will require difficult fixes.
Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco, analyzed nursing home data for the AP, finding the extra deaths the facilities are recording are roughly 15% more than what would be expected at homes already facing tens of thousands of deaths each month in a normal year. He also learned that:
“Comparing mortality rates at homes struck by Covid-19 with ones that were spared, Kaye also found that the more the virus spread through a home, the greater the number of deaths recorded for other reasons. In homes where at least 3 in 10 residents had the virus, for example, the rate of death for reasons besides the virus was double what would be expected without a pandemic.”
He told the news service:
“The health care system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope. There are not enough people to look after the nursing home residents.”
Staffing problems at long-term care facilities have been an increasing concern for some time, as owners and operators have slashed at personnel costs to increase institutions’ profitability. The independent, nonpartisan Kaiser Health News Service, prior to the pandemic, embarrassed CMS officials and owners and operators by examining how regulators allowed institutions to self-report their staffing numbers — and how they were inflated, as payroll analyses showed.
KHN said that residents’ loved ones long had complained about skimpy staffing, and facilities relied on them to hide shortfalls. Friends and families visiting on weekends, for example, took care of the needs of the vulnerable when institutions did not. Other news organizations have zeroed in on how staffing problems have worsened coronavirus infections in homes.
Let’s also be clear that staffers at institutions — nurses, as well as poorly paid and little trained health aides — have taken a beating as the coronavirus has ripped through facilities. Many of them get such pittance pay that they have had little choice, not only to keep working in desperate settings but often at several facilities in different shifts. As they have gotten infected in significant numbers — and died of coronavirus — they have spread the disease, notably because they lacked testing and personal protective equipment.
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 neglect and abuse at nursing homes and other long-term care facilities. While the Trump Administration and CMS are shuffling papers and allowing the president to handle minimal official responsibilities while pursuing unfounded and irresponsible claims about his re-election loss, the pandemic is burning across the nation, unchecked, and notably in nursing homes. As USA Today reported:
“New coronavirus cases have surged to an all-time high at nursing homes across the country despite federal efforts to shield residents through aggressive testing and visitor restrictions, a new report shows. Federal data shows 10,279 COVID-19 cases during the week of Nov. 1, the most recent data available. The figures surpassed the previous high of 9,903 cases in late July, according to a report by the American Health Care Association and National Center for Assisted Living. The surge in cases among the nation’s most vulnerable residents comes as cases, hospitalizations and deaths surge nationwide. Industry representatives say that when cases spread in a community, it’s difficult to shield nursing home residents despite rules that restrict visitors. The number of deaths began increasing in October and reached 1,431 during the first week of November. While the deaths remain below levels reached during the summer surge that mainly affected Sun Belt states, [AHCA/NCAL president and CEO Mark] Parkinson said death rates lag new infections so, ‘there will be an increase in deaths over the next two or three weeks.’”
In the DMV — the District of Columbia, Maryland, and Virginia — nursing home infections, likely to be followed by deaths, also are raising concern anew, the Washington Post reported:
“Despite stringent lockdown measures in place since March, widespread community transmission has allowed the highly contagious virus to creep back into facilities through asymptomatic employees, threatening the elderly residents most at risk of dying … ‘We never truly fixed the problems,’ said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. ‘There were just a lot of Band-Aids.’
“In Virginia, at least 200 staff and 380 residents have contracted the virus since the start of November, officials say. A disproportionate number of outbreaks are located in the southwest part of the commonwealth, where cases have been skyrocketing. In Roanoke City, where test positivity is higher than 10%, nine of 11 long-term care facilities have active outbreaks. In Maryland, new weekly infections among residents and staff at long-term care facilities have increased tenfold since the start of October, according to a Washington Post analysis of state data. The state went from reporting 76 new cases in the first week of October to 267 in the first week of November — and 1,012 this week … The District has so far managed to avoid a second spike in cases at nursing homes, a feat that industry advocates attribute in large part to regular, government-funded testing for all employees …”
The newspaper, quoting local officials, says facilities battling outbreaks include the Hebrew Home of Greater Washington. Maryland’s largest nursing home, with 558 certified beds. Rural homes also fear outbreaks that could overwhelm not only their resources but also hospitals with spare capacity nearby.
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. Leaving the frail in filth, or letting them starve or dehydrate, or to wither alone and afraid — these are unconscionable harms and demonstrate a willful neglect and abuse that the law should not shield wrongdoers from.
Even before then, though, we have much work to do to safeguard the elderly, ailing, and injured, and to ensure that they and the facilities they live in do not collapse into worse conditions during the difficult days ahead. We’ve got a lot of work to do.