Infection control is a long-standing, well-documented problem in nursing homes and similar facilities. They are chronically understaffed, even though they generate significant profits for some private-equity firms. Government oversight has always been lax ― although, notably, the Trump administration has for the last few years been taking steps to weaken it even more. More than 60% of nursing homes had at least one citation for lapses in infection control since 2017, Kaiser Health News reporter Jordan Rau found after reviewing federal inspection records.
36 residents of the Seattle-area nursing home had died because of the coronavirus. Twenty-one current residents had tested positive for COVID-19, the disease caused by the virus that first showed up in China late last year. The facility was already short-staffed and this emergency has made it worse. At one point last week, administrators said they had just three full-time workers to care for the facility, which has more than 100 beds.
“I just feel ill that my mom could be dying alone,” a relative of one resident told The New York Times. “It’s pure panic and I can do nothing. I have no control.”
The recent guidelines for nursing homes are safety practices that nursing homes are required to follow in the normal course of providing care and treatment. One additional atypical one is the restrictions on visitors and a new “emphasis” on infection control. Experts say the single biggest infection hazard in long-term care facilities is also the most obvious one and, in theory, simplest to fix: lack of adequate hand-washing. Citations for poor hand-washing are more common in facilities with fewer staff, researchers have found, and it’s not difficult to imagine why. The more that care workers are rushing to handle their high-needs patients, the less likely they are to wash their hands thoroughly or, in some cases, to wash them at all.
Long-term care is yet another example of the U.S. failing some of its most vulnerable citizens, and the issue is only now starting to get the attention it deserves in American politics. In recent years, the emphasis for long-term care has been to have the elderly stay at home whenever possible. But people end up in long-term care facilities because hiring enough qualified home aides would be too expensive, and in many cases they or family members must shop around for the cheapest options because those are all they can afford.
“Many more than 1% of infection control deficiencies reflect serious failures of care,” Toby Edelman, senior attorney at the Center for Medicare Advocacy, told HuffPost. “Problems in infection control cause, literally, millions of infections in nursing homes and other care settings each year, with hundreds of thousands hospitalized and many deaths. To call these problems ‘no harm’ is just not true.”
“The biggest problem in nursing homes is not enough staff, not enough people to get done what needs to be done,” Edelman said. “And there’s certainly not enough professional nurses. … They can be really decent, caring, doing the best they can, but with so much to do. It’s not their fault.”
A 2016 report from the Government Accountability Office found that, on the whole, independent and nonprofit facilities ran at lower margins but also had higher ratios of caregivers to patients. Other studies have linked private equity specifically to “lower-quality care, declines in patient health outcomes and weaker performance on inspections,” as a recent review by Eleanor Laise of MarketWatch noted.
If owners weren’t so determined to extract so much money for themselves and their investors, advocates say, they could hire more staffers, pay more salaries and offer better benefits ― including not just health insurance but paid sick leave.
“They’re always saying the same thing: There isn’t enough money and there’s too much regulation,” Edelman said. “But this is a profitable industry.”
And to make sure these long-term care providers are actually spending money on their residents, many senior groups have called for creating a “medical-loss ratio” for providers ― that is, a minimum standard for how much revenue must go to patients, rather than administration or profits ― and penalizing those who violate it.
The safety of residents, and the safety of the people who care for them, depends so heavily on what happens outside the facilities ― specifically, on whether the rest of society can slow the pandemic’s spread.
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