Stemming the Fire in Dry Grass
COVID-19 has turned life in the nursing home world into a virtual nightmare. Where states and the nation are beginning to “flatten the curve,” circumstances in Nursing Homes are being described as “a fire in dry grass.” Despite measures to curtail the virus the numbers continue to explode. In just six weeks it has been reported that over 7,000 residents have been killed in these facilities. Individual homes with as many as 40 to 50 deaths are not uncommon. Some are even much higher. In the State of Pennsylvania about half of all the COVID-19 deaths in the state have been in nursing homes. In one facility in Kansas, over 100 residents and staff have been infected. And, these are just some of the examples of the devastation. As alarming as all these numbers are the actual tally is undoubtedly higher because there is no system for tracking or reporting what is happening.
In an early attempt to curb the spread of the virus, with little information and minimal opportunity to plan, the Federal Government and State Governors rapidly implemented changes in how nursing facilities operate. Significant regulations were waived, infection control enforcement measures were belatedly emphasized, and access to facilities by almost anyone not directly responsible for providing care has been restricted and/or denied altogether. Nevertheless, the infections and deaths have climbed essentially unabated.
Despite Nursing Homes being a primary epicenter for infections and deaths, very little support is being provided. In facilities where dozens have died they still cannot determine who else is sick. Comprehensive testing is simply nowhere to be found. Where requirements to assure proper staffing levels have now been removed, many workers are compelled to work while ill because they make ten dollars an hour and get no paid sick leave. The desperate need for PPE in nursing homes is only now beginning to get any attention at all. And, family members and Ombudsmen responsible for observing conditions in homes still have no access to facilities. These circumstances stand in contrast to the extreme measures that have been taken to attack the spread of the virus and collect data outside the nursing home environment. For nursing home residents and their families, the most vulnerable to this plight, the light at the end of the tunnel is in fact an oncoming train.
Where the measures taken to curtail the spread of the virus in nursing homes have so far failed, current conditions are causing other kinds of irreparable harm. Peoples’ rights are being trampled and the lives of residents are being turned upside down. Fragile people, many of whom are incapable of understanding what is happening, are being denied any opportunity to be with loved ones, are being involuntarily moved around from facility to facility, are being repeatedly herded around inside their homes, are being indefinitely secluded in a single room alone, are being served by an inadequate number of staff and are having to feed themselves without needed assistance. And this is happening to as many as a million nursing home residents and their families in over 15,000 nursing homes nationwide. The toll this is taking is immeasurable. And, those who have died, including those who never had the virus, are all dying alone.
Developing and implementing measures that successfully address the COVID-19 crisis in nursing homes is and will be a huge challenge. Planning what needs to be done in terms of operational regulations will take time and hopefully will involve the input of consumers and family members. Finding a balance between infection control and preserving quality of life is a must. It will not be easy. It will require a process that involves careful thought and planning. And, it must include collaboration and cooperation between groups that historically have not been allies.
While permanent solutions are being worked out there are steps that the Center for Medicare and Medicaid Services (CMS) and State Governors can and need to immediately take to improve the situation. First and foremost, family members and loved ones must be allowed to visit nursing homes in person. Under normal circumstances nothing is more important to a persons’ quality of life than personal contact with loved ones. During a time of crisis and disruption such supportive contact is not only essential, it can be life-saving
Under the new Federal Guidelines, long term care facilities are merely encouraged to develop “alternative methods” for residents to interact with family members. Efforts have gone out to provide I-Pads and to assist residents in doing FaceTime calls. Countless families are now trying to visit from outside the facility through windows. Without a doubt, such methods have been very inadequate if not impossible, particularly for residents who are physically and/or mentally unable.
Allowing family members to visit with residents can easily be accomplished by providing proper PPE, following standing infection control measures and, if necessary, establishing a proper location within each facility for visiting. Advanced scheduling would allow the volume of visits to be manageable. And, end of life visits should never be denied. There is no reason why such opportunity cannot be immediately created. All it will take is a full appreciation for the need and a willingness to act. Residents and family members deserve nothing less.
Another positive step that can immediately be taken is to allow Long Term Care Ombudsmen the access they need to simply do their jobs. The need for Ombudsman services has never been greater. Residents with and without the virus are being put at risk as never before and right now the Ombudsmen can’t even get in the building. We are at war with this virus and in nursing homes the Long-Term Care Ombudsmen are literally one set of “boots on the ground” for protecting residents and for observing what is happening on a daily basis. Ombudsmen can also provide families information about their loved ones that they cannot or are not getting. For numerous reasons the ability of Ombudsmen to access facilities would be of great value to residents, family members and public officials alike. When proper PPD and infection controls are available and protocols can easily be put in place, denying Long Term Care Ombudsmen access to facilities and residents makes virtually no sense whatsoever.
As we move through and past this crisis, we sincerely hope that the plight of nursing home residents and their families will begin to get the attention that is deserved. To date the decisions being made about how to respond have been inadequate and ineffective. Going forward there are many lessons to be learned and changes put in place to assure that residents are properly protected and their quality of life preserved. In the meantime, giving family members the opportunity to visit their loved ones and Long-Term Care Ombudsmen the ability to do their jobs will dramatically improve the situation.