COVID-19 and the Nursing Home Disaster

 

Nursing homes are supposed to be places of refuge for those who need long-term medical care and support. They are home to some of our most vulnerable, usually elderly people. Sadly, they have become death traps for many, especially in some states.

Avik Roy, writing in Forbes, says 2.1 million Americans, representing 0.62% of our population, reside in nursing homes and assisted living facilities. In a recent analysis, performed by Roy and Gregg Girvan for the Foundation for Research and Equal Opportunity, they studied the number of nursing home-related deaths due to the COVID-19 virus. They found 42% of all deaths due to the virus, in the 43 states reporting figures, occurred in nursing homes and assisted living facilities.

42% of all COVID-19 deaths happened in facilities that house 0.6% of the population!

These astounding numbers are probably too conservative. In New York, the number of nursing home deaths was certainly under-reported since they chose to exclude any deaths of nursing home residents that occurred after transport to a hospital. Outside of New York, more than half of all deaths from COVID-19 are of residents of long-term care facilities.

Here are some states with the highest percentages:

  • Ohio – 70%
  • Pennsylvania – 69%
  • Minnesota – 81%
  • New Hampshire – 70%
  • Washington – 61%

Tragically, the decisions of state government officials greatly impacted these figures. In the states of New York, New Jersey, and Michigan, nursing homes were ordered to accept infected patients in transfer from hospitals after discharge. This may have been designed to prevent overcrowding of ICUs, but at the expense of nursing home residents.

New York Governor Andrew Cuomo was outspoken in defending this practice. As recently as April 23, Cuomo declared that nursing homes “don’t have the right to object” to accepting elderly patients with active COVID-19 infections. “That is the rule and that is the regulation and they have to comply with that,” said Cuomo. Only on May 10 – after the deaths of 3,000 New York residents in nursing homes – did Cuomo stand down and partially rescind his order.

Florida Did Better

Florida Governor Ron DeSantis required all nursing home workers to be screened for COVID-19 symptoms before entering the facilities. On March 15, DeSantis signed an executive order banning nursing home visitations by friends or family, and also banned hospitals from discharging patients who were infected with the virus to long-term care facilities.

Florida also prioritized long-term care facilities for personal protective equipment (PPE). DeSantis said, “If I can send PPE to the nursing homes, and they can prevent an outbreak there, that’s going to do more to lower the burden on hospitals than me just sending them another 500,000 N95 masks.”

Roy says we should all learn from the Florida experience. He recommends the following:

  • Rescind all state orders to mandate nursing homes accept infected patients
  • Restrict visits to nursing homes by friends and family until further notice
  • Prioritize PPE for nursing homes at least as high as hospitals
  • Test all nursing home workers for active infection
  • Limit nursing home workers to one facility when possible
  • Force those 7 states not reporting nursing home deaths to begin reporting

 

The Silver Lining

The silver lining in this story is that the 99.4% of the U.S. population that doesn’t live in nursing homes is roughly half as likely to die of this corona virus than we previously thought. These latest figures show a strong correlation with advancing age, other medical co-morbidities, and nursing home residence. Those who do not fit into these categories are at considerably lower risk.

 

If you’re one of the 99.4% of Americans who do not live in a nursing home, you should feel better. If you, or your loved ones, do live in a nursing home, you should insist they comply with the above recommendations whenever possible.

 

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