Covid-19 and nursing homes: an american tragedy

CMS’ VERMA: Nursing homes were always high priority. Originally, states weren’t necessarily getting PPE out to the nursing homes, which is why we changed that strategy. FEMA [the Federal

Emergency Management Agency] started directly sending supplies to the nursing homes, and I think that made an incredible difference. NURSING ADVOCATE PORTER: FEMA? We had one nursing home in

Oklahoma that received condoms from FEMA as PPE. Condoms! AARP'S RYAN: It was stunning to see that at the start of the pandemic, there was quick action to dismiss college students from

campuses, to close down basketball games because these were congregate settings. Yet nursing home residents were ignored. No one suggested moving them to safer settings. As I see it, the

problem was ageism. THE LOCKDOWN _On March 13, the day President Trump declared a national emergency, CMS issued guidance for infection control and prevention of COVID-19 in America’s

nursing homes. This included recommendations to restrict nearly all visitors — loved ones as well as most ombudsmen and nursing home inspectors._ CMS’ VERMA: The lockdown was a heartbreaking

decision. Many of us have friends and families in nursing homes. But we approached this issue to think about safety, and also about the quality of life for these residents. BILL MEDINA_

(son of Pedro Medina Gonzalez, 81, a resident of the Symphony of Orchard Valley assisted living facility in Aurora, Illinois):_ I heard about the shutdown from the news. I swung by the

nursing home to see my dad like I did every day, but was told I wasn’t allowed to come in. SHERRY PERRY _(CNA at a facility in Lebanon, Tennessee):_ They locked the doors, and it was on us

to figure things out. Thirty-four years on the job and I was now flying blind. These residents touch us. We roll them, toilet them, take care of them. You can’t really social distance in a

nursing home. ALISON LOLLEY _(Lolley moved her 81-year-old mom, Cheryl Fink Lolley, into The Oaks, a nursing home in Monroe, Louisiana, on the last day of 2019. This is from her statement to

the House Select Subcommittee on the Coronavirus Crisis): _Mama was in a wheelchair, but her mind was as sharp as a tack. My heart just sank when they restricted visitation. We were to

visit from outside the facility, behind an air-conditioning unit in a wet, mushy area, while trying to see her clearly through a window screen, all the while trying to compose ourselves and

exhibit stability for Mama. “At this time, we have a single confirmed case of COVID-19 in one of our centers. We are working diligently to minimize potential spread, but are also preparing

should any more of our facilities experience the coronavirus.” — Richard Feifer, M.D., chief medical officer for Genesis HealthCare, America’s largest nursing home conglomerate, in a March

17 call with investors TOBY EDELMAN _(attorney with the Center for Medicare Advocacy):_ The situation in nursing homes became horrible. Overnight we lost transparency and accountability.

After CMS waived the 75-hour training requirement for nurse aides, many states allowed staff to provide care after just an eight-hour online training program. Workers are sick, they’re

dying, taking care of their own families. New staff are needed because residents need care. But eight hours? ALIX HANDY_ (her mother, Lona Erwin, 86, died of complications from the virus on

March 18, just 3½ hours after Handy learned COVID-19 had entered the Family of Caring nursing home in Montclair, New Jersey):_ The hardest part was, my mother died alone. I don’t blame the

nursing home for her death. I do blame them for how they handled the communication. If they had admitted to me that they had COVID in the facility that morning, I would have insisted I see

her. I don’t know what her last 24 hours were like, and that really bothers me. PHYLLIS SCANTLAND_ (her husband, Bill, 84, has Lewy body dementia and lived in Golden Living Center in

Mishawaka, Indiana): _I did the window visit, and that was a disaster because all he was trying to do was get to me. I wrote “I love you” on a piece of paper, and he said, “Don’t do that to

me!” He tried getting out of his chair to get to the door. And then he just cried. MARCH–APRIL THE MAP EXPLODES _By March 27 — just four weeks after the first case showed up in Washington

state — more than 400 long-term care facilities were reporting COVID-19 cases. A Maryland facility reported two confirmed cases on March 27, then 64 confirmed cases the next day. Within

days, 77 of its 95 residents had tested positive for the virus._ WILLIAM LACORTE, M.D._ (medical director for several New Orleans–area nursing homes):_ The systems were overwhelmed. Our

nursing home patients would go to the ER and hospitals would say, “Don’t admit. Send them back to the nursing home.” I went nuts. “You’re sending Typhoid Mary back to infect other people?”

For every patient they sent back, we probably saw 10 more residents, staff or family members get infected. “DOUBLE-TIME PAY RATE and $2,500 sign on bonus. All shifts available.” — online job

posting at Canterbury Rehabilitation & Healthcare Center in Richmond, Virginia, where at least 46 residents had died of the virus by mid-April LAURIE FACCIAROSSA BREWER _(New Jersey’s

long-term care ombudsman):_ The calls from concerned families shifted from “I’m told my mother has a fever, but nobody’s calling me back” to “I was told she was stable and 90 minutes later I

got a call that she was dead.” _NEW YORK TIMES_ REPORTER IVORY: By early April, we had identified more than 36,000 cases and more than 7,000 deaths in nursing homes. BERNICE STAFFORD-TURNER

 _(her brother, Fred Stafford, 66, a resident of Canterbury in Virginia, tested positive for COVID-19 but was asymptomatic):_ One of my biggest concerns is: OK, Fred tested positive. What is

the facility doing? What is the plan? How many people have to die from this facility for them to realize you need to do something different? ANDOVER TOWNSHIP, NEW JERSEY, POLICE CHIEF ERIC

C. DANIELSON _(quoted April 15 after a tip turned up 17 bodies in a makeshift morgue at Andover Subacute and Rehabilitation Center):_ “The staff was overwhelmed by the number of bodies that

were becoming deceased.” PHIL MURPHY (D)_ (governor of New Jersey, on April 16):_ “New Jerseyans living in our long-term care facilities deserve to be cared for with respect, compassion and

dignity. We can and must do better.” Dear Family Member: Today, we have been notified that an employee has tested positive for COVID-19. Please join us in praying for a speedy recovery. —

letter to Alison Lolley from director of operations at The Oaks, dated April 13, received April 17 ALISON LOLLEY: I began to see vacillating practices by the staff and facility, and Mama

began to look disheveled. She would gently complain that “things didn’t seem right,” and on more than one occasion, she shared that she “was not fed a meal all day.” I texted the director of

operations and was told the RN had been slammed with nonstop calls and that they were doing their best to return calls as quickly as possible. I began asking questions. Unsolicited, the

director told me that while she could not guarantee anything, she felt confident that they were “past it.” BETSY MCCAUGHEY_ (former lieutenant governor of New York who founded the Committee

to Reduce Infection Deaths, quoted April 17 ):_ “One COVID-positive patient in a nursing home produces carnage.… They’re death pits.” JUDITH REGAN_ (publishing executive quoted that week

about her 91-year-old father, Leo Regan, a resident at the Long Island State Veterans Home at Stony Brook University, where 32 residents had died):_ “The residents and staff are being led to

slaughter. He is on the _Titanic,_ but there are no lifeboats.” FAITH HEIMBRODT_ (her mother, Carol Orlando, 79, was a resident of the Geneva Nursing and Rehabilitation Center in Geneva,

Illinois, a 91-bed facility with at least 145 reported COVID cases and 30 deaths among residents and workers):_ I last saw my mother in person on April 23. She wasn’t well, but they assured

me she didn’t have COVID. She died on April 25. I called to request an autopsy and they called back and said, “We can’t touch her body. There’s a positive COVID-19 tag on her bag,” though

she hadn’t been tested at the home. Her body tested positive five days later. ALISON LOLLEY: Our family watched Mama deteriorate. She complained of lack of care, and “manhandling” from

people in her room that she didn’t recognize. During one visit to her window, I found Mama unclothed, unkempt and confused. I reported these issues and received boilerplate explanations or

promises to handle it “immediately.” BILL SWEENEY_ (AARP’s senior vice president for government affairs): _Over 6,000 people reached out to AARP across the country with absolutely

devastating stories about what happened to their loved ones. Seeing a family member emaciated. Finding them lying naked. This isn’t simply coronavirus-related. This is shining a light on a

broken nursing home care system that’s lacked adequate attention for years. ALISON LOLLEY: Mama was transferred to the hospital on April 23 and admitted to the COVID unit. She died there on

April 29 at 5:05 p.m. Mama died alone, and my family will forever be scarred by this tragedy.