To paraphrase the late, great writer and activist Maya Angelou, nursing homes and other long-term care facilities are showing the public in the middle of this pandemic just truly what they are.
It is hard to believe, still, the shabby way they are treating the aged, sick, and injured. Just consider this sampling of recent news reports:
“Care” facilities — including centers dealing with veterans — have been too willing to subject residents to risky medical experimentation to fight the novel coronavirus, including what appear to be inappropriate treatments with a much-promoted anti-malarial drug. This echoes a situation involving nursing home residents in Galveston, Texas, and their facility’s dosing them with hydroxychlorquine without their loved ones’ knowledge and iffy circumstances about their individual capacity to consent to receiving the drug. As the Washington Post reported of a Philadelphia area veterans’ facility (shown in federal photo above):
“For more than two weeks in April, a drug regimen that included hydroxychloroquine was routinely dispensed at the struggling center, often for patients who had not been tested for Covid-19 and for those who suffered from medical conditions known to raise the risk of dangerous side effects … Though precise estimates vary, the state Department of Military and Veterans Affairs said about 30 residents received the drug. Several nursing home staff members placed the number higher.”
When the going got tough, a facility important for a poor and largely African American part of the nation’s capital simply shut down, doing so in a sketchy and maximally inconvenient way for families and loved ones. As the Washington Post reported:
“The nursing home at United Medical Center in Southeast Washington, which temporarily relocated its patients because of the coronavirus pandemic, now plans to close permanently — a move that advocates for the elderly say was mishandled and may violate the law. The 120-bed, publicly financed facility was housed on two floors of the city’s only public hospital, which is slated to close in 2023. In May, the nursing home told patients and their families that the residents were being relocated to other facilities to prevent them from catching the coronavirus. According to news reports and a union leader, at least eight patients and eight nurses at the nursing home had caught the virus when the hospital temporarily closed the nursing home wing. It wasn’t until the end of June that the board of the Not-for-Profit Hospital Corp., which runs the hospital in the city’s poorest ward, voted to keep the nursing home closed for good.”
The Los Angeles City Attorney, sadly echoing advocates for the elderly nationwide, has accused nursing homes in his community of “dumping” residents and seeking higher-reimbursing replacements, throwing on the streets or into flophouses some of the most vulnerable individuals to be found. Here is what the Los Angeles Times reported of this unacceptable course:
“Without notifying his family first, an 88-year old man with dementia was transferred from the [the Lakeview Terrace skilled nursing facility in Westlake] to a boarding house in Van Nuys, only to be found wandering the streets profoundly confused a day later, according to a lawsuit filed in Superior Court in Los Angeles … by City Atty. Mike Feuer. Another resident with HIV who was dumped on the street instead of being provided the hospice care he needed wound up cowering in a friend’s backyard, hoping that would keep him safe from the pandemic, according to the complaint. The ‘sustained’ and ‘intentional’ misconduct by Lakeview Terrace administrators comes at a time when nursing homes have an incentive to dump long-term residents, for whom they are paid little, to make room for COVID-19 patients, for whom they are paid much more …”
As concern spikes about surging Covid-19 infections, hospitalizations, and deaths in the southern and western parts of the United States, experts are shaking their heads in disgust that facilities for old, ill, and injured learned zero lessons from catastrophes elsewhere.
The coronavirus is spreading fast in the new hot spots, notably in nursing homes and other long-term care facilities, and health care workers and residents short of testing, desperate for personal protective equipment, and unable to detect and isolate those with the disease. Here is what the Atlantic magazine reported:
“Few places represent the awful consequences of this neglect more than nursing homes. Of the country’s nearly 130,000 coronavirus deaths, more than 40% have been residents or employees of nursing homes and long-term care facilities. One in five facilities have reported at least one death. In just one New Jersey nursing home, at least 53 residents died after the sick were housed with the healthy and staffers had little more than rudimentary face shields for protection. Like so many other effects of the pandemic, the U.S.’s nursing-home COVID-19 crisis is hitting communities of color especially hard … And yet, state, and federal officials seem to be doing little to protect the elderly from further devastation. Coronavirus cases are now surging in Sun Belt states. In recent weeks, deaths in nursing homes have continued to climb in Florida, Georgia, Texas, South Carolina, and California …”
Meantime, in New York, recriminations keep raging over a state policy that let hospitals push patients, purportedly recovered from Covid-19, into nursing homes — a move that helped cause a rapid spread of illness and disease among vulnerable and isolated residents of these facilities, families and safety advocates say. Gov. Cuomo’s administration has rejected this assertion, and, in a new study, officials blame the coronavirus’ spread, instead, on families and friends of residents who visited before the facilities were locked down and tens of thousands of health care workers at the care homes.
Nursing homes, the New York Times reported, insist that the differing views support their case — that they did the best they could in dire circumstances and that they are deserving of a shield given to them by the state from legal liability from claims by residents or their loved ones.
This all is not good. 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 and their loved ones by abuse and neglect in nursing homes and other long-term care facilities. These institutions already were problematic before the coronavirus pandemic, with, for example, glaring staffing issues — the centers rely on poorly paid, overworked, and ill trained aides, experts have testified to Congress.
The facilities, nationally, have recorded tens of thousands of diagnosed coronavirus infections and more than 50,000 deaths — meaning they account for roughly 40% of the U.S. Covid-19 death toll, according to recent media accountings. Both Maryland (two thirds of all deaths) and Virginia (62%) estimate even higher percentages.
As the pandemic rages, it is deeply disturbing to hear of unceasing neglect, abuse, and even criminal level conduct inflicted on the aged, ill, and injured in nursing homes and other long-term care facilities. These are human beings, not nonconsensual drug test subjects, nor inanimate objects to be kicked out and to the curb in the pursuit of profits. It is hard to imagine how facility owners and operators now have failed to heed the danger warnings that began in the earliest days of the U.S. outbreak in Washington state, where media reported extensively on a nursing home’s raft of infections among residents, staff, and extending to first responders. How could anyone in the industry ignore how Covid-19 ripped through facilities in New York, New Jersey, and elsewhere in the Northeast?
Truly damning testimony about how the disease might better be and have been handled has come from an unexpected source: The Rev. Derrick DeWitt, director of the 100-year-old Maryland Baptist Aged Home. Even as other care facilities across the country and in Maryland have been savaged by the sickness, the Baptist Aged home has recorded zero infections.
Why and how did this occur in a small, church supported facility in an “underprivileged and underserved area of Baltimore City?” It is worth hearing the pastor out, at length, as DeWitt told PBS television news:
“I just listened to the news around the world and how this [coronavirus] was affecting other countries. And then, when I heard — when I heard the president say, we only had 15 cases, and he thought that, by the end of the week, it would be zero … I knew that it was time that we take action … we have kind of gotten used to the fact that, if help is going to come, it’s probably going to come too late, so we need to be prepared to take care of ourselves …
“The first thing we did, probably very end of February, 1st of March, we locked down the facility. We allowed no visitors in or out. We knew that, if the disease was going to get into the nursing home, it was going to come from the outside. And probably it was going to be an employee that brought it in. So, we have a very rigorous screening process when they come to work. And it’s almost an hour-to-hour detail on what you did the 12 hours or 14 hours that you weren’t at work. Who did you see? Who were you with? We take their temperatures. Everybody’s wearing masks, gown, gloves when they have any contact with residents.
“We had a full-time quality assurance infection control nurse for years who set up a lot of measures that would help us in time of catastrophe or pandemic or even an epidemic. I took a lot of criticism for having a full-time person in a 30-bed facility, which most facilities even three times as large don’t have a full-time infection control person. But, then, being a faith-based facility, a lot of people said, hey, you’re overreacting. I thought you were a man of God and you had faith in God. And I just simply replied that, to be forewarned is to be forearmed. And I have faith in God, but I still wear my seat belt when I get in the car.”
Amen. We have lots of work to do to get nursing homes and other long-term care facilities in a far better place — not only in dealing with Covid-19 but with their residents and the common sense and humanity of their owners and operators.
