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COVID Has Exploited the Cracks in Nursing Homes’ Care Models

A recent New York Times article delved into a topic we’ve been covering for years: Most nursing homes are ill-equipped to care for their patients. In the best of times, their negligence is mostly reflected in fines from inspectors or complaints and lawsuits from injured patients and their families. In the worst of times—like this past year—their focus on profits above patients has resulted in the mass spread of the coronavirus and over 100,000 deaths.

Staff and caregivers are aware they can’t provide the help their patients need. Especially in the first half of 2020, when personal protective equipment (PPE) was hard to come by, nurses knew they could easily become vectors of disease. However, even N95 masks, goggles, face shields, and gowns haven’t helped contain the spread. In fact, by the end of December, nursing home patients were dying at 3 times the rate they were in July.

This tragedy has hit many families hard, and the worst part is, so many deaths could have been prevented if only we’d been prepared. Our nation must do more to protect the residents of assisted living centers and nursing homes.

Poor Working Conditions Make Viral Spread More Likely

While doctors rake in enough money to comfortably support a family (and then some), the same is not true for nursing home caregivers. Often paid $12 or $13 an hour, these workers—typically women—may have to attend multiple jobs to make ends meet. During a normal year, this is an unfair burden. During a pandemic, it may have resulted in an increase of viral transmission, as caregivers moved between nursing homes, assisted living facilities, and home assistance each day.

Some caregivers quit their jobs, frustrated by the lack of support and hazard pay and scared of contracting the virus themselves. Their positions were filled by contractors or, in worse cases, “temporary nursing assistants” allowed to step in due to COVID-era government policy. With little training, these individuals cannot provide the same sort of care as a certified nursing assistant.

Understaffing Results in Care Gaps

Along with underpaying caregivers, most nursing homes simply don’t employ enough of them. Nursing home patients have become, on average, sicker and older as healthier elders have been able to maintain their independence with new options for care and assistance. This means today’s patients need more attention. Caregivers, saddled with too many patients, do not have time to attend to them all fully.

Over the course of the pandemic, homes with a higher ratio of staff per patient have seen fewer positive tests and deaths. Understaffing can result in residents going days or weeks without a shower, or even without having their teeth brushed. With nursing homes locked down to visitors, they may receive little human contact, which is a health burden in itself. Stories of caregivers rushing between patients without having time to change out PPE—thus reducing its effectiveness in preventing viral spread—are just one example of how staffing problems can lead to an increase in infection.

Decreased Regulations Allow Bad Conditions to Persist

Nursing homes are overseen by both federal and state governments, but regulations cannot be successful unless they provide guidelines that match patient needs and penalties for those who break them. However, under President Trump, the federal government decreased its fines for nursing homes that violated standards. When the pandemic started, it dealt another blow by ending regular inspections.Without effective oversight, how can anyone trust their loved one is being kept safe?

Especially because many nursing home residents are covered by Medicare, our government must take a stronger hand in ensuring tax dollars are going to facilities that provide adequate resources for patient care rather than lining executives’ pockets. Over $300 million in pandemic aid went to nursing homes previously alleged of violating labor rules or committing Medicare fraud. “Not good enough” is hardly a strong enough admonition for this system.

The lack of financial oversight and transparency is not a new issue, either. As nursing homes have passed from private hands into corporate systems and become for-profit facilities, the amount of money going into the industry has increased, but few benefits have made their way to the patients. The industry must be redirected to prioritize patients over investors.

What Can Be Done?

Aside from taking individual action by filing a nursing home abuse case against a negligent facility, the New York Times piece suggests reforms the Biden administration could make. They include:

  • Requiring Medicare and Medicaid funding only be used for care-related costs
  • Expand nursing home regulations to cover assisted living facilities, which may also receive government funding
  • Increase staffing by regulating a certain amount of care hours per patient per day (preferably at least 4 hours)
  • Give the agencies that oversee nursing homes sufficient resources and authority to inspect facilities and hold them accountable for safety violations
  • Pay certified nursing agents a wage of at least $20/hour

With nursing homes lobbying for immunity to lawsuits for COVID-19 claims, we would also humbly suggest the incoming administration think of the many families who deserve recompense for the ways their loved ones were treated. A pandemic is no excuse for ignoring simple infection control standards or staffing to only minimum levels.

Aging and death come for us all, and even those who are healthy now may find themselves in a nursing home at some point in the future. We should all do our part to raise awareness and push for change now. Someday, we or our loved ones may be reaping the benefits of this work.

Brown & Barron, LLC is proud to advocate for nursing home residents in Baltimore and beyond. Call (410) 698-1717 at any time for a free consultation.

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