Last July CMS (Centers for Medicare and Medicaid), acting on orders from the Trump Administration, proposed that the rules that had been put in place by the Obama Administration to curb deadly infections among elderly residents in nursing homes be relaxed. The proposed rules would change a mandate that oversight including assessments of needed staffing and equipment be done every other year instead of annually, and infection specialists that were required to be on site at nursing homes be eliminated. These specialists were there to ensure that employees understood how to properly wash hands and follow other safety protocols. The changes to the rules were proposed before the pandemic was on anybody’s radar and were supported by the industry. According to the New York Times, many nursing homes in the United States are owned by large for profit companies and the owners are individuals who have contributed to large sums of money to Donald Trump’s re-election campaign. They lobbied for these changes. The Times also reported that Attorney Generals representing 17 states called the proposed rule a “threat to the mental and physical security of some of the most vulnerable residents of our states.”
Even before COVID-19, nursing homes were overwhelmed caring for their residents because they are crowded, understaffed and their employees are typically poorly paid workers who move between multiple jobs and return home to communities where disease and infection are common. That put the industry right into the pathway for disaster. When COVID-19 hit, that disaster happened. More than 2 million people live in nursing homes or residential care facilities. They represent just 0,6% of the U.S. population. However residents in such facilities as of June, 2020, accounted for 42% of all deaths in the U.S. from COVID-19, based on a state by state analysis. The reasons include limited testing, lack of person protective equipment (PPE) such as masks and gowns for staff taking care of the residents, and staff who were poorly trained to use PPE when they did have it. Because tests were not readily available, most states’ nursing homes have only been able to test residents with symptoms, even though the disease is known to spread asymptomatically.
Dr. Tom Frieden, the former head of the CDC told CNN on March 8, “One thing that stands out as the virus has spread throughout the United States is that nursing homes and other long-term care facilities are ground zero.” Frieden called on federal authorities to ban visitors from nursing homes to reduce the risk of infection coming from the outside. It was not until April 19 that the head of CMS promised to track all deaths in nursing homes. It then took two more weeks before the tracking went into effect and nursing homes began to ban visitors from the outside. During that two week period alone approximately 13,000 elderly people in the nation who resided in nursing homes died from COVID-19.
What has happened in the care facilities where our most vulnerable members of the population, the elderly, the frail and the handicapped individuals who cannot any longer care for themselves now live is shamful and horriffic. What makes it worse is an attitude by many of “what is the difference, these people will die soon anyways.” Like everything else in our capitalist system, much of the problem in nursing homes stems from money. Nursing home revenue is based on a fragmented payment system where Medicare overpays for short term residents – people who are there for rehabilitation following surgery, and Medicaid underpays for long-term residents. One option that has been proposed is to expand health insurance programs for nursing home residents that combine Medicare and Medicaid coverage into one plan that is the Federal government oversees. This would eliminate inequities that exist across state lines that penalize the poorer urban and rural areas.
If there is one thing we have learned from the pandemic it is that our healthcare system, especially the way we care for the elderly, is totally broken and we can no longer leave it up to the politicians to fix. Change will only happen if the people want it to happen. Those who are young and middle aged may think it is not their problem to worry about, until it is, when their own elderly parents, relatives or friends suddenly end up in a nursing home or when they themselves, in not too many years, could end up there as well. We owe it to our elderly citizens who built and defended this country, who spent long hard years working and contributing to the economy and the society, to ensure that when they need ,safe, high quality, affordable nursing home care it will be available.