Nursing homes and other long-term care facilities account for a major share of COVID-19 deaths, a tragedy that appears to be attributable to the vulnerability of the population, poor conditions at facilities, and a series of policy failures.
Data from the health departments of six states with the highest number of coronavirus deaths shows that a large percentage occurred in long-term care facilities. In Connecticut, Illinois, Massachusetts, New Jersey, New York, and Pennsylvania, the percentage of coronavirus deaths occurring in nursing homes and other facilities is 37%, 32%, 57%, 32%, 13%, and 57%, respectively.
Altogether, more than 14,000 residents and employees at such facilities have died from COVID-19, which amounts to nearly one-quarter of total deaths from the virus, according to data from the New York Times.
Nursing homes and other long-term care facilities are highly susceptible to the coronavirus because residents often have weakened immune systems, and close interaction is required between the residents and staff members.
Policy failures, too, though, have contributed to the disaster, particularly the low prioritization of nursing homes for personal protective equipment and testing, lax enforcement of regulations, and states forcing nursing home to accept COVID-19 patients from hospitals.
Long-term care facilities, which also include skilled nursing facilities and assisted living facilities, house a high-risk population. “Nursing home residents are more frail than the general population with multiple comorbidities,” said John McHugh, a professor at the Mailman School of Public Health at Columbia University. Residents often have weakened immune systems that put them at higher risk of death due to the coronavirus.
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These facilities generally house residents in a relatively confined space with common areas where multiple people gather. “Unless meals are served in residents’ rooms, many long-term facilities have common eating areas,” said Misha Eliasziw, a professor at the Department of Public Health and Community Medicine at Tufts University. “Residents should be discouraged from congregating.”
The American Health Care Association, a trade association of long-term and post-acute care providers, said in a statement to the Washington Examiner that “facilities are following government orders to limit visitors and restrict group activities, such as communal dining.”
The AHCA raised another possible cause of the high death rate, namely interaction between staff and residents at these facilities. The groups said that facilities “are trying to target (preventative measures) when staff have direct contact with residents. This is challenging to do in nursing homes and assisted living, where residents need assistance with basic daily activities such as eating, dressing, and bathing. ”
Government policy also shares in the blame. President Trump banned visitors to these facilities in March, but that was not sufficient.
When the federal government ramped up its response to the pandemic, it prioritized hospital employees to receive personal protective equipment such as surgical masks and gloves. Staff at nursing homes and other facilities were overlooked. That may have worsened the spread of the coronavirus at such facilities.
Furthermore, the general policy of testing only those who are front-line workers and those showing symptoms of COVID-19 may have also contributed. “The answer is testing, testing, testing — almost on a daily basis,” said Eliasziw. “Currently, testing is being rolled out for first responders. Very little testing, from what I’ve read, is being provided for facility residents. It will certainly be given to staff, but not residents.”
This is a problem because many carriers of the virus are asymptomatic. “Asymptomatic transmission means the virus can spread fairly quickly through a nursing home,” said McHugh.
Richard Mollot, executive director of the Long Term Care Community Coalition, points the finger at lax enforcement of government standards for the high death rate. “Many facilities have inadequate infection control and prevention protocols,” he said.
The Centers for Disease Control and Prevention report that between 1 and 3 million infections occur in nursing homes annually, and the Center for Medicare and Medicaid Services reports that these facilities are most commonly cited for inadequate infection control. “In my experience, it is most commonly related to staff not properly washing their hands or changing gloves,” said Mollot. Those protocols are also key to preventing the spread of the coronavirus.
Colorado nursing homes with coronavirus outbreaks had, on average, twice as many citations for deficiencies of care than did ones with no outbreaks, the Colorado Springs Gazette found.
But in its statement to the Washington Examiner, the ACHA emphasized that “outbreaks are not the result of inattentiveness or a shortcoming in nursing homes. It’s the combination of the behavior of this virus and the unique threat it presents to the people we care for.”
The group’s president, Mark Parkinson, said the problem lies in a broken regulatory system. “The survey system used to evaluate nursing homes measures too many things,” he said. “When you survey too many things, then nothing becomes important, instead of focusing just on things that matter. If the survey system focused just on infection control, I don’t think we’d be where we are today.” He also said the regulatory process was too punitive and not sufficiently collaborative between regulators and facilities.
Mollot replied that state regulators are lax because many have been co-opted by the nursing home industry.
Another policy failure was state regulations forcing these facilities to readmit residents who were hospitalized for the coronavirus. The New York Times reported Friday that California, New Jersey, and New York were among the states with this requirement. Eliasziw noted that while knowledge of the coronavirus is limited, it is possible that “a recovered patient who has antibodies can infect others. Some speculate — and there are some case reports from China — that individuals can get reinfected — i.e., they’re not immune from further infection.” The ACHA released a statement Tuesday urging states not to adopt policies forcing long-term care facilities to readmit coronavirus patients.
A New York Post investigation found that the New York Department of Public Health denied a request from Cobble Hill Health Center to send coronavirus patients to the makeshift hospital at the Javits Convention Center or the U.S. Naval hospital ship Comfort. Fifty-five residents at Cobble Hill have died from the coronavirus.
However, the states that have gone in the opposite direction have still seen very high death rates. Instead of sending nursing home residents with the coronavirus back to these facilities, Connecticut and Massachusetts sent them to special facilities set up just for coronavirus patients. Yet, 37% of the deaths from the coronavirus in Connecticut have occurred among long-term care residents. The corresponding rate is 57% in Massachusetts.
