Do We Even Care About Nursing Homes?
Nursing homes are a disgrace to American society. They represent an antiquated way to care for vulnerable people, most of whom are in the sunset of their lives. Nursing home residents are at great risk from physical and emotional abuse, isolation, inadequate medical care and minimal mental healthcare. And as Covid-19 shows us every single day, nursing home residents are extremely vulnerable to death from a communicable disease. Too many nursing homes are dangerous and must be radically improved in order for them to be a viable alternative for our ageing and infirm loved ones. They just have too many critical problems, which, for so many, are heartbreaking.
Most people just don’t care about nursing homes. They know where the nursing homes are located in their cities and towns. But they just drive by the manicured lawns never wondering “What’s going on in there?” Nursing homes, and the loved ones in them, are not a “hot” issue that garners much attention, aside from Covid-19 issues of today. Conversely, issues such as LGBTQ rights, immigration policy, the #metoo movement and racial inequality generate much debate, action and passion; as well they should. But when it comes to the myriad of disgraceful problems with nursing homes, more often than not, we just hear “crickets.”
Nursing homes, as a way to care for some of our most vulnerable, is a crucial issue as our society gets older. How we treat our elderly and infirm tells us much about our American culture and society. Unfortunately, if you don’t have a loved one in a nursing home or never did, maybe it’s just not relevant to you. Talking about nursing homes can lead to uncomfortable conversations about getting older and ageing. It makes us think about our own eventual demise and that can be distressing.
But, if we did to children or immigrants what we allow to happen in nursing homes, it would be the lead story on the news, feature screaming headlines and endless talk-show debate. It would spread on social media faster than the latest Hollywood gossip. It would sicken us to our cores. But, it’s mostly the elderly who are impacted and I wonder, “Do enough of us really care?”
Today, approximately 40 percent of all Covid-19 deaths in America are from nursing homes. That’s about 90,000 out of 225,000 reported deaths as of October 26, 2020. People who have lived long and fulfilling lives are the most vulnerable to illness — especially a pandemic — and face incredible risk and terribly high chances of death. In an astonishing lack of foresight, the Federal government and many states decided it was somehow acceptable to place Covid-19 patients INTO nursing homes filled with vulnerable, mostly elderly residents. We have to ask “How many of those 90,000 deaths didn’t need to occur?”
A Free “Get Out of Jail” Card For the Nursing Home Industry. While nursing home residents died and families were being kept from visiting their loved ones, the $137 billion nursing home industry spent (and continues to spend!) millions of dollars to argue it needs immunity from civil law suits related to how it has and is handling Covid-19. So far, 21 states have succumbed to the pressure and provided legal immunity to healthcare providers, with at least 9 specifically mentioning nursing homes. (1) So, while tens of thousands are dying in nursing homes from Covid-19, the nursing home industry is doing its best to ensure nursing homes can’t be sued for…wait for it…how they deal with Covid-19 and poor infection control. What’s wrong with this picture?
Richard Mollott, executive director of the Long-Term Care Community Coalition, said it best in a TIME May 14, 2020 article on this push by nursing homes for immunity during Covid-19: “Underlying the request [for immunity] is essentially an admission that nursing homes are not capable of taking care of their residents. If they were doing a good job on a regular basis, if they were prepared to provide appropriate care, appropriate staffing, I don’t think that we would have seen how this has played out in nursing homes, how devastating it’s been.”(2)
From a Social Good to a Consumable Good. As bad as Covid-19 has been for nursing home residents, the problems with nursing homes didn’t start with the pandemic. Nursing homes are — in general — a terrible way to care for the elderly and infirm. Yet, it wasn’t always this way. As Lydia Ogden and Kathleen Adams note in their Oxford Press article Poorhouse to Warehouse: Institutional Long-Term Care in the United States (3), “From an economic perspective, nursing home care shifted from being a social good to a consumable good, like other health care.” Consumerism means money and if you got it, great. If not, your options are limited. And with these changes came increased Federal involvement in oversight of nursing homes. Raise your hand if you think that’s somehow a good thing!
Now, get your virtual “nursing home bingo card” out and “mark your spaces” every time you read or hear about nursing homes that are alleged to have had incidents of:
— Physical and mental abuse of nursing home residents
— Sexual abuse of nursing home residents
— Negligence when it comes to basic care (i.e., poor patient care)
— Discrimination against Medicaid-paying potential residents
— Inadequate levels of staffing
— Unsafe facilities including overcrowded rooms
— Inadequate infection control and prevention
— Extremely low wages for care-giving employees
— High employee turn-over and job dissatisfaction
— Unqualified staff
A simple Google search of the phrase “nursing home abuse” gets you 216 million results in .54 seconds. Read some of the news articles, they will make you shudder. And these are just the allegations that are uncovered and then reported. Common sense tells us those 216 million Google search results may only be the “tip of the iceberg.”
Aside from abuse — which is truly evil and should be enough to shock us into action — nursing homes suffer from systemic problems that make them a “house of cards” when it comes to adequately and compassionately caring for people. The biggest systemic problems — and there are many — include:
— Inadequate Medicaid monies which represent the majority of nursing home federal funding, with the state-Federal program paying out the lowest rates of any private or public health insurer (4) (This is a complex financial problem and the financing mechanism needs reform and a total revamp in order to fairly and honestly pay for nursing home care for our most vulnerable.)
— Lack of transparency among those nursing homes who complain about Medicaid funding (i.e., reimbursements) yet have financial structures that allow them to make millions of dollars in profits. (Nothing against making big profits, but those profits should enable great care, not just more greed.)
— Infection controls that just do not work. Even before the pandemic, 82% of all nursing homes had infection prevention and control deficiencies cited in one or more years from 2013–2017, according to the U.S. Government Accountability Office. And 48% had such deficiencies in multiple years. (5) (The disproportionate number of Covid-19 deaths among nursing home residents proves infection control is abysmal in nursing homes.)
— Discrimination against potential residents who will pay through Medicaid instead of private monies. (This is illegal, but it is common in this billion-dollar industry.)
— Understaffing and inadequate pay for employed care-givers. (If we pay care-givers “peanuts” and don’t hire enough of them, how can we expect them to have the passion to provide the best care for our most vulnerable?)
— Loneliness and depression plagues the mental health of too many nursing home residents. (6) (Nursing home responses to mental illness are inadequate and too many residents are treated like products in a warehouse instead of being treated as suffering human beings.)
Disgusting. I find the disgrace of nursing homes disgusting. As a society, we have allowed our elderly and infirm to be commoditized by small and large corporations set up to make money from caring for our most vulnerable. This is an inherent conflict of interest as the raising of the quality of care is diametrically opposed by the accumulation of profit and wealth. As far as I can tell, greed didn’t make things better for the millions who suffered in nursing homes before Covid-19. And greed has not made things better for the 90,000 who have died in nursing homes from Covid-19. And greed will not make things better for the millions who will soon face the prospects of living and eventually dying in a nursing home.
If we don’t radically change and fix the nursing home experience, we will just further degrade ourselves as a society and culture. In the words of my high school humanities teacher, we will continue enabling “man’s inhumanity to man.”
IT’S NOT RIGHT. DO WE EVEN CARE?
[I am PASSIONATE about making radical changes to the nursing home experience and helping others avoid the heartbreaking experiences my parents had. If you have a loved one in a nursing home or are currently considering your options, I would love to hear from you to better understand your experience. Please contact me at AlintuckNHA@gmail.com or on Twitter @martinalintuck or via LinkedIn.]