“COVID caught us with our pants down.”– Nursing Home Administrator, Maricopa County, Arizona
The Center for Medicare Advocacy released a new report – Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic – which explores facilities’ responses to the coronavirus crisis and examines how residents’ deaths were not “inevitable”, as some have claimed. The report contends that COVID-19 exploited and exacerbated long-standing issues, such as staffing, infection control, and management problems, that existed for decades in the long-term care industry.
As our nation’s nursing homes continue to reel from the unprecedented toll that COVID-19 has taken, questions remain about how many deaths could have been avoided, and – crucially – what can be done to save lives moving forward to prevent a similar catastrophe in the future. Nationwide, 36% of COVID-related deaths have occurred in long-term care facilities (and in some states that figure jumps to over 60%). These statistics are even more shocking considering that less than 1% of the nation’s population live in these facilities.
“The wrath of COVID-19 in our nursing homes was felt, in large part, because we as a nation have not prioritized fixing these issues,” states Cinnamon St. John, the report’s author – who is also the Center’s Health and Aging Policy Fellow and Associate Director of NYU Rory Meyers’ Hartford Institute of Geriatric Nursing. “COVID-19 will very likely not be the last pandemic we experience in our lifetimes. If we don’t address these issues now, will see these mass casualties again. The good news is that we know more now. The lessons are clear. But we must act. The currency is lives – lives lost, or lives saved,” she added
- Analyzes and challenges the assertion that “Geography is Destiny” as the prevailing theory of nursing home transmission (concluding “a facility’s location does not equate to a facility’s fate”)
- Identifies lessons learned for nursing homes
- Provides specific policy recommendations for change
“While broad strokes are needed to make sweeping changes, smaller repairs are also required to fill the cracks in the nursing home industry’s foundation,” writes Ms. St. John.
The report also examines both the challenges and successes of nursing home administrators who have been combatting COVID-19 on a daily basis. “You can either panic during the pandemic or you can be prepared during the pandemic. It’s better to be prepared,” says Reverend Derrick DeWitt, Director and CFO of the Maryland Baptist Aged Home. His nursing home, with about a 90% Medicaid resident population, has remarkably remained COVID-free to this day.
DeWitt remembered, “I asked, ‘What is going to keep these people alive longer if it was in our hands?’ And the thing that was killing people was infection. If we can control infection, we could probably give these people a long life. So, I said, ‘Let’s turn the pyramid upside down and put infection control at the top.’ We developed protocols, practices, and procedures simply centered around infection control. And we didn’t know a pandemic was coming.” Other nursing home leaders weren’t so prepared. One administrator in LA County recounted: “It wasn’t until we had this epidemic where [ownership was] like, ‘Oh my God, maybe we should reassess our policies!”
According to Toby Edelman, Senior Policy Attorney at the Center, “The coronavirus pandemic brought into painful public view many longstanding problems in nursing homes – low staffing levels, poor infection control practices, non-enforcement of standards of care. Cinnamon’s paper documents that the effects of the pandemic on nursing home residents and staff did not have to be as bad as they have been. With better practices and leadership, more lives can be saved.”
The report’s inquiry spans across frameworks of category, scale, and scope – from the highest-level decisions made by those in top governmental posts, to the minute individual choices and circumstances of nursing home residents and staff themselves. The policy recommendations provided also cover this span. “It is up to us – those who have borne witness to the price of inaction – to insist on necessary change,” declares Ms. St. John. “The cost of not doing so will certainly be counted in lives. The choice is ours.”
About the Center for Medicare Advocacy
The Center for Medicare Advocacy is a national, non-profit law organization that works to advance access to comprehensive Medicare coverages, heath equity, and quality health care for older people and people with disabilities. The Center provides legal assistance, education, analysis, and advocacy with a focus on concerns of people with longer-term and chronic conditions. The organization’s systemic positions and actions are based on the experiences of the real people we hear from every day.