No surprise COVID-19 hurting long-term care centers
The numbers are startling. Estimates have been made that 40% to 80% (or more) of U.S. COVID-19 deaths will have occurred in nursing homes and assisted living facilities.
We don’t really know the exact number attributed to these residential facilities because no one has been tracking them. On April 19, the Centers for Medicare and Medicaid Services announced the Trump administration would begin tracking outbreaks and deaths at longterm care facilities nationwide, but the data is still days away from being made public.
The delay in data collection is one of a number of bottlenecks in the effort to slow the virus’ deadly spread in nursing homes, hampering the ability to identify facilities with active cases and sending resources where they are needed.
Although Arizona facilities have been reporting the number of residents and staff testing positive and the number of attributed deaths, assistance to the facilities by both federal and state agencies has been almost nonexistent.
The media and general public have been quick to blame the long-term care facilities, yet from the beginning of the pandemic, it was clear COVID-19 affects the elderly far more severely, on average, than younger individuals. In spite of this knowledge, no one put the nursing homes at the top of the list for testing and Personal Protective Equipment (PPE). Facilities have been left to fend for themselves.
In addition to testing and PPE resources, facilities need to be reimbursed at appropriate levels. Most nursing homes and assisted living facilities receive the majority of their reimbursement through Medicaid and Medicare.
These rates translate to minimum wage or slightly higher for staff members performing important services such as housekeeping and other services, interfacing with residents on a daily basis. These staff members frequently work at multiple facilities in order to make ends meet.
Through contact tracing, it has been determined some of the staff who work at multiple facilities have been the carriers of the virus. Facilities are conducting temperature checks and personal contact questioning with staff prior to the beginning of each shift. Some of the staff have been asymptomatic, unaware they were infected. Others were less than truthful about their exposure to the virus which resulted in transmitting the virus from one facility to the next.
Staff indicted they were fearful telling the truth would result in a layoff and they needed the money to support their families. To eliminate this problem, facilities and subsequently staff, need to be reimbursed at higher levels.
The policy implications of the large number of nursing home-related COVID-19 fatalities are significant and suggest substantial flaws in the way we have managed the pandemic for vulnerable populations. Governor Ducey has ordered testing for all residents and caregivers of nursing homes and assisted living communities.
Increased testing may show where hotspots are, but it does nothing to address the underlying causes fueling the spread of COVID-19 in facilities. Facilities need assistance obtaining PPE, especially when prices have escalated 100%. For example, gowns that were 35 cents pre-COVID-19 are now $5 to $7, and that’s if they are available at all.
The first coronavirus outbreak in the U.S. began at a nursing home in Kirkland, Washington on February 28. We should have done a much better job at protecting the most vulnerable.
Our response to the COVID-19 crisis in our nursing homes and assisted living facilities has been wholly inadequate. We can and must do better.