Categorized | Family Care, Features

Pandemic Reveals Need For Nursing Facility Overhaul

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On May Day, I received a confidential call from a person who works in a Massachusetts nursing facility. Many of the elders and staff are COVID positive — including herself.

By Al Norman

On May Day, I received a confidential call from a person who works in a Massachusetts nursing facility. Many of the elders and staff are COVID positive — including herself.

Fifteen of her clients have died from COVID. “I’ve known them all,” she said. “Every room here is COVID positive.” She cares for 30 patients at once, a task she described as nearly impossible. “As for social distancing — it’s not always possible.” Some rooms hold as many as four residents. “Sometimes people’s heads are only two feet apart.”

COVID 19 has not only made tens of thousands of people deathly ill, it has highlighted the sickness in our long term care system. The traditional nursing facility model — which dates back to Medicare and Medicaid in 1965 — has not changed much. The largest job classification inside most skilled nursing facilities is a certified nurse assistant (CNA), an entry-level job with mostly custodial care duties like bowel and bladder care, bathing, dressing, feeding and walking.

The wages are chronically low.

According to national data collected in early May, a total of 6,139 U.S. long term care (LTC) facilities reported 128,098 confirmed COVID cases, and 24,974 deaths. Based on 37 state reports, the average number of COVID cases in LTC facilities as a share of total COVID cases was 15 percent. New Hampshire reported 27 percent of its COVID cases were in long-term care facilities.

Massachusetts and Maine reported 20 percent, Rhode Island 16 percent, Connecticut 18 percent. (Vermont failed to report.) Of 33 reporting states, Massachusetts had the third highest LTC facility COVID deaths (2,653) behind New York (5,215) and New Jersey (4,556).

Social Security, ageist, nursingCalifornia, which has an elderly population nearly five times that of Massachusetts, had only 946 LTC facility deaths — about one-third (35 percent) of the LTC facility deaths in Massachusetts. Florida, with nearly four times the elderly population of Massachusetts, had only 423 deaths in LTC facilities — only 16 percent of the LTC facility deaths in the Commonwealth.

According to NPR, COVID fatalities in LTC facilities “are at least a third of the deaths in 26 states and more than half in 14 of those.” In Massachusetts, by May 11, the cumulative COVID death count in nursing facilities had climbed to 3,071 — which was 60 percent of the 5,108 total COVID deaths in the state.  4,859 of the COVID deaths in the Baystate were age 60 and over, or 95 percent of all COVID deaths. Being an elder and living in a nursing facility is double jeopardy during this pandemic. “They’re death pits,” said a former lieutenant governor of New York. “These nursing homes are already overwhelmed. They’re crowded and they’re understaffed. One COVID-positive patient in a nursing home produces carnage.”

In Ontario, Canada, over 1,200 long term care residents have died, with 180 confirmed outbreaks in these facilities. The province adopted an emergency order allowing the government to take control of long-term care facilities struggling to deal with a COVID-19 outbreak. The province can appoint a manager to help nursing facilities to deal with a high number of cases among residents or staff, an ongoing outbreak, a high number of deaths, staffing and infection prevention and control measures. “We will be better prepared to immediately swing into action if a home is struggling to contain this deadly virus,” Premier Doug Ford said.

Nursing facilities have been reluctant to make death data public. As one facility owner said: “We weren’t discussing exact numbers because they can sound frightening and things were changing moment by moment, so none of those numbers were real at any given time.”

But the numbers were real, and each death was a tragedy for family and friends. Federal, state, and local officials all have been complicit in keeping “death data” suppressed. State COVID data in Massachusetts still reports only death ranges in individual facilities, like “over 30,” which are anything but transparent.

The American Health Care Association, a nursing facility lobby group, realized they had a health crisis and public relations disaster on their hands. They wrote to federal officials pleading for specific help:

✔️Expanded Testing capacity for ALL Residents and Caregivers of Nursing Homes and Assisted Living Communities – Regardless of Symptoms

✔️Expedited Shipments of Personal Protective Equipment (PPE)

✔️$10 Billion in Emergency Relief Funding to Pay for Staffing, Testing and PPE Equipment

But the 20th century nursing facility model cannot survive another pandemic. We urgently need to:

✔️Raise the wages and skillset of the CNA workforce

✔️Double the RN and CNA staff available to patients

✔️Offer patients a private room and not allow more than two occupants per room

✔️Implement comprehensive infectious disease protocols and periodic 3rd party inspections/reporting

✔️Make nursing facility referral the last resort, and care in the least strictive setting the first resort

We have lost tens of thousands of lives due to our flat-footed response to COVID 19.  We must reinvent a new paradigm for care to replace the outdated nursing facility model before the next pandemic arrives.

Al Norman worked in the eldercare field in Massachusetts for nearly 4 decades. He can be reached at




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