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Manhattan Project for Nursing Homes

Published on May 5th, 2020

Karl Pillemer, PhD, is the Hazel E. Reed Professor of Human Development at Cornell University and the Director of the Cornell Institute for Translational Research on Aging and Mark S. Lachs, MD, MPH, is the Psaty Distinguished Professor of Medicine at Weill Cornell Medicine and President of the American Federation for Aging Research.  They wrote an article for The Hill abiout implementing a “Manhattan Project” to improve long term care in America. 

What if a targeted set of actions taken in January would have cut COVID-19 deaths by 40 percent or more and reduced hospitalizations by a similar amount? And what if this possibility still exists?

No, we are not talking about a vaccine, a drug treatment, or a new surveillance and testing system. We are talking about stopping the coronavirus from entering nursing homes and assisted living facilities. 

Nursing home and assisted living residents make up less than 1 percent of the U.S. adult population. However, they constitute at least 40 percent of COVID-19 deaths in many states.

Statistics reported by Colorado, Rhode Island, New Hampshire show that two-thirds or more of all deaths in those states are among long-term care residents. In a study of five European countries, between 42 and 57 percent of deaths related to COVID-19 have so far occurred in nursing homes.

It doesn’t take an epidemiologist to reach the following conclusion: providing extraordinary resources to protect people in nursing homes and assisted living, who are both at very high risk and easily located, could reduce COVID-19 deaths dramatically, perhaps by as much as 60 percent in states and around the world. This simple fact, however, has been tragically ignored. To date, most calls for action, plans, and protocols focus on personal distancing, increasing critical care capacity, and antibody testing and enhanced surveillance measures.

Yet these proposed measures will have minimal effect on long-term care residents. Few people ever enter nursing homes and assisted living facilities unless they are staff and family members. These broad public health initiatives will bypass the single largest source of serious COVID-19 cases.

We must dramatically shift gears before it is too late. A “Manhattan Project” mentality is already being deployed for the development of a vaccine and pharmacological treatments. We need to unleash a similar, all-out effort to determine how, where, and under what circumstances vulnerable older people in congregate settings can be protected effectively.

First, controlling the spread of COVID-19 among the most vulnerable will greatly relieve hospital systems. Given their level of impairment, nursing home residents are likely to be sent to the hospital. Many need long-term ventilator use. After recovery, they are difficult to relocate and as a result may occupy hospital beds needed by others. Much of our resources are now focused “downstream,” that is, on increasing critical care capacity in many communities. A focus “upstream” can prevent hospitalization of the long-term care population in the first place.

Second, when we can identify, assess, and develop prevention and safety plans for nursing homes and assisted living, illness and death rates will decline steeply.  We would then have greater confidence to allow lower-risk individuals to return to their lives.

What can be done right away? Long-term care providers cannot do it by themselves. It will be necessary to greatly exceed current funding for nursing homes and assisted living to achieve real protection for their residents and care workers. We can accomplish an enormous amount with just a fraction of the trillions of dollars now allocated to remediate the economic effects of the virus.

A national task force should be convened immediately, focused on ramping up existing efforts and generating innovative solutions. Personal protective equipment must be made available universally to long-term care staff.  Specialized care sites, away from uninfected residents, must be created for those under treatment or recuperating from COVID-19. Creative approaches to keeping staff free from infections should be initiated and evaluated. Substantial financial incentives should be provided to staff to self-isolate for rotating periods of time. Testing resources must be immediately and extensively deployed to nursing homes and assisted living facilities

These options may have seemed implausible three months ago. However, given both the enormous human and financial costs of doing nothing, a major investment in protecting the most vulnerable older adults is not only justified, but absolutely essential.

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