By Carolyn Rosenblatt, Forbes, April 24 2020
COVID-19 is particularly dangerous to many of our nation’s most vulnerable: those living in nursing homes. In some places, a state’s death rate from the disease is about 40-50% of all deaths from this pandemic. According to the Washington Post, the World Health Organization reported that almost half of the deaths from COVID-19 in Europe were in nursing homes. Our nation needs an immediate action plan to stop the disease from spiking further in America’s nursing homes.
California has been successful to date in a relative flattening of the curve of the disease in the state, with early stay-at-home orders. But it has not been successful in avoiding the spiking of deaths from COVID-19 in nursing homes there. California’s nursing home advocacy organization, the nonprofit California Advocates for Nursing Home Reform (CANHR) recently outlined how to stop the spread with strategic steps in its Emergency Action Plan.
There are 13 steps in the plan, all of which make sense. If we prioritize attention to these facilities rather than focusing exclusively on how overwhelmed our acute hospitals are, our country can do much more to save lives of our vulnerable elders. Nursing homes are even more underprepared and more overwhelmed than hospitals when it comes to dealing with medical care. For example, one of the Action Plan steps involves the use of “strike teams” to step in when an outbreak is identified:
“Deploy strike teams to intervene at facilities when residents are endangered At the earliest sign of facility crisis related to COVID-19, send strike teams composed of state and local health departments, local health systems, the National Guard, ombudsman programs and CMS region 9 to provide emergency leadership, medical treatment, care, testing, supplies and equipment to save the lives of residents in overburdened facilities.”CANHR Emergency Action Plan
My own experience early in life involved working at nursing homes as an aide and later as an R.N. I recall that no M.D. was on staff anywhere every day in any of those homes. The physician’s role was to visit residents routinely or write orders for specific patient care as requested by nursing staff. They came and went. Their role was not to teach staff how to prevent the spread of infection. Licensed Vocational Nurses (sometimes called Practical Nurses), who have less education than Registered Nurses were frequently in charge of an entire facility. I met some who were Directors of Nursing, never having worked in a nursing home prior to getting that job. I worked in one facility with many Medicaid beds in which I was the only R.N. on the night shift for 90 residents. Some rooms had 3 residents in them. A shortage of skilled nurses with comprehensive education in infection control is only one of the problems in nursing homes.
Imagine the task of trying to prevent the spread of a highly contagious disease under such circumstances! From that perspective, one can easily see how a lack of leadership in emergency preparedness, lack of training, short staffing, lack of personal protective equipment, lack of testing for coronavirus, and residents nearly always in proximity in shared rooms and bathrooms facilitates rapid disease spread.
At AgingParents.com, we tell anxious adult children with any aging parent or other loved one to temporarily remove the elder from the nursing home or assisted living, if at all possible, under current circumstances. This matches one of the steps in the CANHR Emergency Action Plan:
“Enable residents to go home temporarily if they are able to do so Give residents who wish to return home temporarily the means to do so by expediting assistance to provide home caregivers, making testing readily available, and giving residents the right to return to their nursing homes once the crisis recedes or if their stays at home become unsafe or unmanageable.”CANHR Emergency Action Plan
Not everyone can take an elder home. Many in these homes need 24/7 care. I urge all states to consider CANHR’s Plan as a model for all nursing homes. Our country needs to find the political will, the funding, and the equipment to enact similar plans across the U.S. as rapidly as possible. The very lives of our aging parents and other loved ones there depend upon it. We must be their voices.