- Experts say nursing facilities aren’t well equipped to handle a pandemic such as COVID-19.
- They recommend that family members with loved ones in a nursing home communicate with as many employees there as possible.
- They also recommend having regular FaceTime sessions with loved ones as well as bringing them reading material.
More than 10,000 people in nursing homes have now died from COVID-19 in the United States.
As those deaths continue to rise, medical professionals in these facilities are struggling to take care of a population who is most easily victimized by the pandemic.
“When you look at the mortality rate from COVID-19, according to the CDC (Centers for Disease Control and Prevention), about 85 percent of the deaths have been in people 65 years or older,” said Emma, a nursing home physical therapist on the East Coast. “So there is an obvious trend.”
“You have the most at-risk population for COVID-19 mortality and symptoms in the hospital and in the nursing homes because these are where there is the highest senior population and highest population of people with multiple illnesses or diagnoses,” said Emma, who asked that her last name not be used in this story. “You are going to potentially see more fatalities in these facilities, and I think a majority of these fatalities are because of the frailty many patients already had, which then placed them at higher risk for mortality, and not necessarily poor preparation or care.”
The situation in nursing homes is so dire, the CDC
Facilities are now required to report cases directly to the CDC as well as to other patients and their families.
“Our country, unlike others, is segregated by age,” Steven M. Levin, a Chicago attorney specializing in nursing home advocacy, told Healthline. “Only 13 percent of older people live with extended family members, Instead, they live in their own communities. Now we’re seeing that, once an infection hits, it can quickly turn into a catastrophe.”
Nursing homes in the spotlight
An analysis by the New York Times found that the 10 deadliest COVID-19 clusters in the United States occurred in nursing homes, including 43 deaths at the Life Care Center in Kirkland, Washington, in February.
That facility was fined $611,000 for its response.
That isn’t necessarily the right way to address the problem, according to Josh Luke, PhD, who teaches at the University of Southern California’s Sol Price School of Public Policy and was an administrator at Carriage House Nursing Center in Fullerton, California, from 2003 to 2004.
“The federal government has to take a long look at nursing homes,” Luke, who also served as the chief executive officer for Memorial Hospital in Gardena, California, told Healthline. “They’re trying to figure out what’s going on and you’re saddling them with fines?”
Luke said laws regulating a certain amount of staff per patient are already too low in nursing homes, many of which won’t be taking new patients while the current lockdown lasts.
He said nursing homes are well aware they’re going to be targeted in lawsuits when this is over.
“Nursing homes are going to have to partner with health plans. They have to increase nursing ratios. They already operate on the thinnest of margins,” Luke said. “It could take a year to fill 50 beds in a facility. The staff gets sick, they get scared, and they don’t show up.”
Not well equipped
Advanced age and underlying health issues of patients work against nursing facilities.
In addition, most aren’t equipped with the expertise and equipment to deal with a deadly outbreak.
“Facilities are not required to have an on-site physician,” Gail Trauco, RN, a registered nurse, author, and patient advocate, told Healthline. “Most facilities have a medical director that may oversee a number of facilities and is available via telephone. Long-term care facilities are dependent on 911 and patient transport to local hospitals for simple issues.”
“Long-term care facilities were not prepared for a pandemic,” Trauco added. “PPE (personal protective equipment) is limited to masks, gloves, and gowns. Isolation rooms are virtually nonexistent. Why would you have an isolation room when there is profit to be made in all occupied rooms and beds?”
Emma said facilities are doing what they can with what they have.
“It’s important to understand the United States medical system before assuming that nursing homes aren’t caring enough for everyone’s loved ones,” she told Healthline. “The hospitals are the most prepared for a crisis like COVID-19 because they are used to the sickest patients and they have a whole array of physicians, specialists, and special equipment. They have intensive care units and they have monitoring systems.
“In comparison, a nursing home is for generally stable medical conditions that just need further support and supervision,” she added. “I think the COVID-19 crisis has pointed out a weakness in this model, and I think we all learned an important lesson.”
What families can do
It can be difficult to transition someone into a long-term care facility.
Levin said communication with workers at the facility is key. Ask questions, especially with regard to staffing ratios.
“It’s horrible to think that your loved one is in a facility where they might become infected at any time and there’s just nothing you can do about it,” Levin said.
Once a family member is in a nursing facility, Levin says to “communicate, communicate, communicate.”
“Call up the facility. Talk to the director. Talk to the director of nursing,” he advised. “If possible, talk to the nurses delivering care to your loved one. See what you can do with electronic communication to talk to your loved one directly.”
Physical visits are restricted during the pandemic, so Luke suggests asking if there’s a way to see someone through a window or other form of barrier.
He also said families should explore bringing older relatives into their home if they can care for them, or seek in-home or outpatient therapy if they can afford it.
Emma said that can be difficult if that person can’t get out of bed or has trouble eating.
“You should know that many facilities may not be admitting new patients right now due to the risk of exposure for their current patients,” she said. “If a facility is willing to admit your family member, my No. 1 recommendation is to request a private room.”
Emma said, if possible, give family members reading material as well as simple exercise equipment. You should also make sure they’re able to walk safely.
“From my experience right now, the social isolation and boredom is what’s really challenging,” she said. “I encourage families to call or perform FaceTime at least once a day. That way you can keep your relative mentally stimulated, comforted, and you can also check in on the call. Try to get creative. Instead of just a phone call or FaceTime session, try to do an exercise routine, play a game, or make fun plans for when this crisis is over.”
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