The first outbreak of COVID-19 in the United States was in a nursing home in the Seattle area, where 37 residents and staff died. It was an almost unthinkable tragedy – the type that shakes the conscience of a nation and requires immediate action, so that it doesn't happen again.
Instead, the following weeks produced even more stories and even more horrible death tales: 47 in a nursing home in Minneapolis, 52 in a facility outside Pittsburgh, 70 in a New Jersey home where, notoriously, body bags integers were piled up in a detention room. The aggregate numbers are equally arresting. At least 16,000 nursing home residents and workers in the United States have died, which equates to about 1 in 4 of all COVID-19 deaths, according to the latest USA Today count. The real number could be even higher due to inconsistent tests, autopsies and reports. The heavy toll of the pandemic on nursing homes is not surprising. Residents are elderly, have significant physical or mental limitations, suffer from severe chronic conditions or a combination of the three. This makes them particularly susceptible to the serious and potentially lethal effects of the new coronavirus. Residents also require at least some assistance with the functions of daily life, including food, bathroom and toilet, and are typically found in relatively close spaces. Infectious diseases spread easily in those environments, all of which makes it easy to think that nothing could have been done to reduce the level of suffering and that now nothing can be done. Both of these assumptions are wrong. The biggest problems in nursing homes include three clearly identifiable shortcomings: insufficient evidence, insufficient protective equipment and insufficient workers. Repairing these would not end the nursing home's COVID-19 deaths. But it would almost certainly reduce them and, along the way, would make an experience more and more miserable for residents and workers much more tolerable. A handful of states are already taking this action. Among these, Maryland stands out, where nursing homes accounted for about half of all state deaths and in which the administration of Larry Hogan, the republican governor, responded with a series of initiatives to help facilities as much as possible. as soon as possible, but states can only do so much on their own. What nursing homes really need is more federal intervention along with more federal money. And they need these things immediately. Problem # 1: Tests A shortage of tests has put the national COVID-19 response at risk from the start, and nursing homes have been among the places where the shortage has had the most harmful effects. The facilities typically only tested and isolated those patients who were symptomatic – which was a big deal, said Morgan Katz, an infectious disease specialist at Johns Hopkins University's School of Medicine, because so many patients carried the disease and they also spread as they showed no symptoms. Katz led Hopkins' efforts, in coordination with the state of Maryland, to identify and address outbreaks in long-term care facilities. At first, he said, he found that about half of the residents and workers with positive results had no symptoms at the time of the test. "It was really amazing," said Katz. "At that time, viruses were spreading and no one had any idea. … We are not capturing this image by testing only symptomatic residents."
Chip Somodevilla via Getty Images About half of Maryland's COVID-19 deaths occurred in nursing homes. Governor Larry Hogan (R) responded by promising to test all nursing home residents across the state and to deploy "bridge teams" of health workers who can provide temporary help for structures with overwhelmed staff. states have moved to test nursing home residents and staff more aggressively. Marland, for example, now plans to test all nursing home residents and it won't be just once, Deputy Health Secretary Fran Phillips told HuffPost. . The state is developing a return visit schedule to catch new cases and prevent them from turning into outbreaks, and Phillips said he expects this to mean repeating tests every few weeks. "I can't give you a frequency now, but we want to keep track of this," said Phillips. One reason Maryland can make the guarantee is that it appears to be holding trial supplies. Officials acquired 500,000 of the kits directly from South Korea and Hogan claimed to have National Guard troops protecting them in a secret location, but many states lack that ability, which means they can't make the same promise and likely they will not be able to do so until the federal government supplies additional test supplies. "Our profession has sounded the alarm for weeks and weeks," said Mark Parkinson, president of the American Health Care Association, a trade group representing long-term care facilities statement prepared at the start of this week. "If we are not given top priority, this situation will worsen with the loss of the most vulnerable in our society." Problem # 2: GearPersonal or PPE protection devices are another all too familiar challenge. Pearl Gooden, a certified nursing assistant in a Florida nursing home, told HuffPost this week that she and her colleagues still only receive one mask per day – a standard surgical mask, not one of the more protective N95 versions – and just a dress, too. (HuffPost has agreed not to identify the name of the nursing home, because the workers who spoke have been paid by the employer.) "You are going from one room to another, with the same things" , he said, without changes between the beginning of his shift at 7:00 am and end, at 3:15 pm "A surgical mask was not to be worn for a full day, to be worn in a patient's room and then a & # 39 ; other, again and again. " His story is by no means atypical, David Grabowski, a professor of health policy at Harvard, said in an interview. Although the facilities may meet official guidelines for adequate protection, Grabowski said, it is misleading because the federal government has tightened those guidelines to allow for reuse, as new tools were so difficult to obtain. We are not capturing this image only by testing symptomatic residents. Katz, Johns Hopkins School of Medicine "They don't have N95 masks – they have lower level masks – and therefore it appears they have, unquoted quotations, adequate PPE, but it doesn't depend on high quality infection control standards," Grabowski said . And although nursing home operators tried to find the tools, it wasn't easy, Grabowski said, because hospitals grabbed the limited supply. "It's a really desperate situation," said Grabowski. , the Trump administration has announced that it is shipping protective devices to over 15,400 nursing homes across the country. This will help, but it's only a week of supply. And it is not for other types of structures, such as assisted living communities, that have reported their lack of IPR. "It is now all too clear that states cannot handle a pandemic of this magnitude unless they have basic supplies to protect residents and staff," senior vice president of the Henry J. Kaiser Family Foundation, HuffPost, told Truffa. .Problem n. 3: shortages of workers Although testing and supply situations improve substantially, it is likely that nursing homes are still struggling with insufficient staff. previously they found that facilities with fewer workers were more likely to have problems with infections, in part because the best way to prevent the spread of the disease is by careful, complete adherence to safety measures – especially washing hands – and the hurrying staff among patients have less time for these practices. The COVID-19 crisis has only increased pressure on staff. In order to slow the spread of the disease, nursing homes have now reduced or eliminated group activities. Instead of eating together in the dining rooms or being together in the common areas for music and physical activity, the residents largely stay in their rooms, where they get everything from meals to physical and verbal therapy. As a result, workers spend much more time in and out of rooms, if not to provide food or provide therapy, then only to check on residents. This is especially true of CNAs such as Pearl Gooden in Florida, which are the backbone of the nursing home's workforce. We had a real problem before COVID hit. These people have very hard work with very low wages. Richard Frank, Harvard Medical School At the same time, nursing homes are facing an unusually high number of absences, because workers who are exposed to COVID-19 – like many others – end up on their own – insulating or, if they get sick, end up in quarantine. There are also some who stay at home because, given the risks of working without protective equipment, they fear that they will get sick and bring the virus to their families' homes. To make matters worse, nursing homes cannot rely on visitors to waste time – say, helping with food or simply providing company – because COVID-19 security protocols require the exclusion of visitors except in extreme circumstances, such as visitors to a resident who is about to die. "They have no family members to come and talk to them," explained Margaret Boyce, CNA of a New Jersey nursing home. In particular, she described a resident who told her that she looked at her watch every day to wait for her arrival, and how her heart broke that she can no longer stay long. "They're just there and they want to talk to you, they want to tell you," This is what I did when I was young "and give you good stories," said Boyce. "And I love listening to them, but now you don't have time to do it because now you have to hurry." Gooden, who says she prefers the title of "carer" to CNA because she is proud of that role, said she doesn't have much time to console residents who "cry or seem worried." "I can't do any of this," he said, "because I have to run, I do what" we have to do it, leave them and move on to the next one. The basic problem: money The safest solution to staff shortages would be to hire more workers. But nursing homes had problems filling places even before the pandemic, in part because of the wages they were offering. Medical wages for nursing assistants today are $ 14.25 an hour, according to the United States Labor Statistics Office. But this is for all nursing assistants, and payment in nursing homes tends to be lower, with fewer benefits, experts say. "We had a real problem before it hit COVID," said Richard Frank, a Harvard health economist, in an interview. "These people do very hard jobs with very low wages." Many facilities rely heavily on part-time staff who work on multiple sites in a week or even a day, in part because part-time workers often cannot benefit from benefits such as health insurance or sick leave. Such provisions are particularly problematic in a pandemic because workers are more likely to transport the disease from one nursing home to another.
Eduardo Munoz Alvarez via Getty Images Medical workers load a deceased body into an ambulance outside a New Jersey nursing home. Work groups such as the Service Employees International Union (to which both Boyce and Gooden belong) have long asked for higher wages and better benefits, especially when it comes to paid sick leave. So they have national defense organizations. Industry officials say they can't pay more. Unions and supporters claim that the industry is very profitable, especially for some private equity firms that have structures with stories of quality and safety issues. In the future, many advocates hope, the federal government will require nursing home operators to spend more money on patient care, just as the federal government now requires health insurance companies to do. But this is a long-term reform project. It will no longer bring workers to the facilities at this time. Furthermore, it is unclear how much owners can do to increase wages at this particular time given the financial pressures they face due to the pandemic. As in hospitals, which have lost revenue due to a sharp decline in elective money-making procedures, nursing homes have lost on a large source of income: patients who will remain briefly while recovering from procedures or treatments. The payment for those patients comes from Medicare, which pays more than Medicaid, the main long-term care funder. With those Medicare dollars declining, says Grabowski, smaller, independently managed nursing homes in particular may have a hard time finding the extra money it would take to attract staff. An idea for state action: "bridge teams" State governments are starting to act on their own. Many are already using "strike teams" that send epidemics to nursing homes to help test multiple residents, assess equipment needs and make all necessary arrangements (such as moving residents to different parts of facilities) to isolate the sick. Typically these strike teams include a combination of infectious disease specialists, nurses and National Guard troops, but Maryland, which has operated these strike teams since early April, announced this week that it has also started. to deploy "bridge teams" they can provide, temporary staff for nursing homes that don't have enough workers. The elders think that we have just decided that their lives do not deserve to be saved – it is not and can never be true. Debbie Dingell (D-Mich.) Each of Maryland's new teams will include at least one more registered nurse between five and seven CNAs, according to Phillips, the deputy secretary of health, with the goal of providing assistance to a maximum than 100 residents in one time. One of the reasons why the teams, he said, was the recognition that more tests would likely have produced more positive aspects among existing staff, creating even more absences. "We didn't want the last resort which would be the nursing home to transfer these hospitalized patients simply because they didn't have adequate home care," explained Phillips. "The patients themselves are stable … they don't need to be hospitalized. And these are people who don't travel very well – it's very disruptive to put them in an ambulance." The Maryland initiative also has its limitations. As of now, bridge teams will only be available for four days at a time because, as the name suggests, they should be a temporary solution as nursing homes hire more workers alone. This cannot happen without offering workers much more money, which many nursing homes do not have right now and the states, bound by balanced budget agreements, cannot provide for themselves. Ideas for Federal Action: Risk Compensation and a "Nursing Body" The federal government, on the other hand, can borrow at will. And there is already a proposal under discussion that could immediately help nursing homes. This proposal is for risk remuneration. As part of the "Heroes Fund" initiative proposed by the Democratic Senate a few weeks ago, wages for nursing home workers could almost double and new recruits could get bonuses of up to $ 15,000. Senator Mitt Romney (R-Utah) made a similar, though less generous, proposal this week, and the money alone may not be enough to attract workers, simply because nursing home work is so difficult and dangerous in the Current environment. Experienced health workers who are on leave or being laid off, as many have been in the past few weeks, may feel better if they remain unemployed, at least for the time being.
A member of the PRESS ASSOCIATE of the Georgia National Guard cleans and sanitizes a room in the nursing home. Some states are using troops to help with infection control and staff shortages, but it may be possible to target an additional pool of work: college students and recent graduates and health education programs. Based on a proposal now developed by a couple of economists, Frank of Harvard and Jonathan Gruber of the Massachusetts Institute of Technology, the federal government would offer free training for nursing jobs and then match those completing the training with openings. They provisionally call it a "care body". Training won't take long. CNAs also usually only need 75 hours of education, and federal regulators, in response to the crisis, are allowing nursing homes to hire temporary workers who complete shorter online courses. For many graduating students, the possibility of having an initial career experience, together with risk-based remuneration, could be interesting: "Students have a particular sense because at the moment, unlike other workers, students they don't get unemployment insurance, "said Gruber. “They are graduating without any job prospects, but not even with government support. … and therefore it is a good group to target, especially students who have been trained in the care professions. "The proposal is very much in its embryonic stages and could, for example, include an offer of debt forgiveness for students and recent graduates who carry out large school tuition loans. According to the proposal, the program would also be open to over 7,000 workers in the Peace Corps which the government brought home and fired last month. It's a matter of political will. Any serious initiative to strengthen nursing home staff will require a lot of new government spending. Democrats never put a price on the Heroes. Fund, but it would likely run into tens of billions of dollars, and former Republican leaders in Congress like Kentucky Senate majority leader Mitch McConnell are saying the government is taking too much debt, but tens of billions of dollars aren't a lot of money in the context of a rescue spending effort that is now, cumulatively, well in the billions of billions, especially when much of that expenditure went to large corporations. In addition, any new spending on nursing homes is probably money that should have already been spent, if residents of nursing homes and other long-term care facilities were receiving the care they always needed. "The elders think we have just decided that their life is not worth saving – this is not and can never be true," Representative Debbie Dingell (D-Mich.) Told HuffPost on Saturday, who introduced legislation to help nursing homes in March. "We have to make sure every person in a nursing home is aware of their own lives, we care and there is a reason to live." A HuffPost guide to Coronavirus