THINKING ABOUT HEALTH
The headlines have been grim. Seventeen bodies piled up in the morgue at a New Jersey nursing home. Fifty-five residents dead in Brooklyn, N.Y. In one week, 104 residents dead in a facility in western Pennsylvania and 102 dead at a home in San Antonio. In Detroit 26 percent of nursing home residents and staff test positive for the coronavirus.
Residents in nursing homes had been at risk long before I began reporting on them in the 1990s, and care facilities have continued to be the subject of press inquiry all across the country. Staffing shortages, poor care, and downright abuse had been the stuff of media exposes for years long before anyone had heard of the coronavirus.
The usual response? Nursing homes that got in trouble promised to clean up their act, engaging in what came to be called yo-yo compliance with state and federal regulations.
Nursing facilities with numerous deficiencies in care-giving would promise to make recommended changes and improve conditions. But promises were just that. Often, they did not result in permanent or meaningful change. A facility would get in trouble again.
The nursing home story today is different: 100 dead residents at one facility in one week when even 55 or 25 would be highly unusual. Casualties during the coronavirus pandemic raise serious questions about infection control, testing protocols, protective equipment for staff, and the number of personnel to care for residents who are vulnerable to begin with.
Most visitors have been prohibited since the pandemic began, making it more important than ever that the public has access to information about complaints, infection rates, and staffing at their local nursing facilities.
The public needs someone or some agency to be their eyes and ears to help them learn what’s happening on the inside.
Carol Marbin Miller, the deputy investigations editor for the Miami Herald, told me many Florida families wanted to move their relatives who were in Florida facilities when the pandemic hit and residents started dying in large numbers. She said the paper had begun hearing from families wondering how facilities that housed their relatives were adapting, people who needed information to decide whether to leave a family member in what could be a troubled nursing home.
She added that some readers told her they were able to care for their relatives at home for a short time if need be, but they were in the dark about conditions in the nursing facilities where their relatives were living.
Other families, looking for new nursing home placement for relatives coming from a hospital, asked the same question: “Where should I send mom?”
Florida, like a lot of other states, had refused to release numbers of nursing home residents who died from the virus, and it has been something of a national struggle for families and the media to get this information. Marbin Miller’s newspaper, along with other media outlets, threatened legal action, and eventually the state agreed to release the death counts.
At the end of the first week of May, the state reported 665 people had died in the state’s nursing homes and assisted living facilities, an increase of 242 from the previous week. Fourteen facilities reported more than 10 deaths.
A few weeks ago, the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare and the country’s nursing homes, issued “guidance” requiring the country’s nursing facilities to be more transparent. Beginning May 17, nursing homes will have to report their COVID-19 cases to the federal Centers for Disease Control and Prevention (CDC) and to families and residents already in nursing facilities. Presumably this information will be on the CDC and Centers for Medicare and Medicaid websites and in the states, too.
Earlier this spring, Kaiser Health News offered a glimpse of what nursing home inspectors found when they visited facilities across the country. Infection control was a problem before the days of the coronavirus.
In the past three years, 61 percent of about 9,400 nursing facilities sampled were cited for one or more infection control deficiencies. Sixty-three percent of about 9,700 were cited for infection control deficiencies on their last two standard government surveys.
Even nursing homes with five-star ratings from the government, presumably a designation of high quality, have had problems. It turns out 40 percent of those facilities were cited for infection control lapses.
Results like these suggest families with relatives already in nursing facilities or those about to place a relative in one should look long and hard at the new data available.
“A society’s quality and durability can best be measured by the respect and care given to its elderly citizens,” British historian Arnold Toynbee once warned. Do we measure up?
Have you experienced any problems with nursing homes? Write to Trudy at [email@example.com]firstname.lastname@example.org.
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