The COVID-19 outbreak has brought the world to a standstill. Countries are in lockdown, major sporting events have been postponed, and the stock market appears increasingly turbulent. Every continent other than Antarctica has reported a coronavirus case, and all age groups, even infants, have become infected.
But one segment of the population is especially vulnerable to COVID-19 — the elderly.
In China, about 15 percent of coronavirus patients over 80 have died. In Italy, a country with one of the world’s oldest populations, the virus has hit especially hard. Early analysis has found that the average age of deceased patients is 81.
Many countries today, particularly in the western world, have an ageing population. It is common, especially in these countries, for families to put their elderly, often frail, relatives into nursing homes.
Even before the coronavirus outbreak, healthcare for the elderly in the US was facing increasing problems. But the rapid spread of COVID-19 through the country has posed an unparalleled threat to the industry and those who depend on it.
Life inside nursing homes
The first reports of the virus hitting US nursing homes came in early March. A 70-year-old resident died, and more than 50 others displayed symptoms at Life Care Center of Kirkland in Washington state.
In the following days, at the same facility, there were more cases and more deaths. By March 17, 35 coronavirus deaths had links to the nursing home.
But the outbreak was not limited to Washington state. The virus spread to nursing homes all across the country, emerging at facilities from Illinois to Oregon to Wyoming.
Throughout the world, the elderly have been dying at a higher rate than the rest of the population, serving to illustrate their particular vulnerability during the coronavirus pandemic.
In response to the widespread nursing home outbreaks, the federal government and various health care associations have released guidelines to try to protect elderly residents. The government recommends that the nation’s 15,600 nursing homes close off to visitors, cancel group activities and communal dining, and increase the number of health screenings.
In a statement after the guidelines became public, the American Health Care Association (AHCA) said in a statement: “We must do everything we can to prevent the further spread into our buildings."
“It may be very hard for families and friends who cannot visit their loved ones at this time. But we know there is a risk that people who appear healthy will enter nursing homes and assisted living communities and still infect residents."Following the advice, many homes have locked their doors to all outsiders, including family members and volunteers. Communal activities, like bingo or games nights, are gone. Once a place where the elderly received care and attention in their final years, often from organized gatherings, nursing homes have become “islands of isolation,” locked down out of fear that they’ll become the next place devastated by an outbreak.
A nurse The Millennial Source spoke to, who asked to be identified only as Raven, works in a handful of facilities across the Dayton, Ohio area. “You don’t know who’s going to still be there the next day,” she said. “Though I suppose that’s normal for nursing home environments, the fear is worse now.”
A nursing home chaplain writing in Vox detailed other unprecedented procedures that have now become commonplace.
The facility where the chaplain works checks the temperature of all visitors. Anyone who has traveled out of the country in the past two weeks is not allowed to enter.
Although the measures are drastic, some health care experts say they are necessary. “The mortality rate is shocking," said Mark Parkinson, president and chief executive of the American Health Care Association. According to The New York Times, Parkinson also believes the US could see a higher mortality rate for people over 80 than China, where 15 percent of those over 80 died.
But staff and family members are not just worried about the virus. As thousands of homes shut down and prohibit visitors, countless elderly residents face a period of isolation and loneliness, cut off from interactions that are as vital to their wellbeing as their prescriptions.
“I’m concerned that the loneliness and helplessness will kill her quicker than the virus," Melissa West told The New York Times. Her 95-year-old mother-in-law lives in a nursing home in Seattle. “I just think of her being there by herself. Just sitting in her wheelchair all day. Being trapped and waiting."
And as nursing homes scramble to protect their elderly residents, staff members are also at risk.
Almost fifty employees at Life Care Center of Kirkland have so far tested positive for coronavirus. At the same time, 65 additional employees at the nursing home are displaying symptoms of illness. They have quarantined themselves, uncertain whether they have the virus because there aren’t enough test kits for them.
Virus exposes underlying issues
For some, including Dr. David Gifford, chief medical officer of the American Health Care Association, the coronavirus outbreak has exposed the “systematic problems that have been around for a while" in nursing homes across America.
One such problem is severe staffing shortages. According to David Grabowski, a Harvard Medical School professor, 75 percent of US nursing homes don’t meet federal suggested staffing levels.
Another issue is that employee turnover is high, and homes find it difficult to keep staff, leading to a lack of experienced workers to deal with the outbreak.
Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine, said that low wages force many employees to work in multiple nursing homes.
Rather than protecting residents, this “relatively common practice" has a catastrophic effect.
A recent CDC investigation found that nursing home staff in a Washington state nursing home spread coronavirus to other facilities, resulting in more than half of the coronavirus-linked deaths in the state.
As the outbreak spread, David Gifford said that staff members could help prevent the spread of the virus in nursing homes by staying out of work if they are sick. But that might prove difficult for many employees.
According to NPR, less than half of nursing home workers receive paid time off, which includes both vacation and sick leave. And due to chronic staff shortages, if there are significant numbers of employees absent, nursing homes might struggle to care for residents.
There is also concern that many facilities are ill-prepared for a crisis on this scale.
According to ABC News, health inspectors have found that roughly 75% of US nursing homes don’t have adequate disease control procedures. Despite lapses in disease control being the most frequent health violation, the Trump administration deemed it unnecessary for nursing homes to employ infection prevention specialists.
In similar moves, supported by the nursing home industry, the Trump administration proposed the rollback of regulations on long-term care facilities and the reduction of fines for violations.
The same CDC report that discovered that Life Care Center of Kirkland workers had spread the virus to other facilities also discovered other harmful practices in nursing homes across the country.
It’s been shown that employees have worked while showing symptoms of the coronavirus, and many did not take the necessary disease control precautions. In addition, several facilities lacked adequate supplies of personal protective equipment and other items such as alcohol-based hand sanitizers.
Nursing homes are aware of many of the problems noted in the report, and many have recently warned of an imminent shortage of masks and gowns.
Summing up the challenge of combating the spread of COVID-19 in the nation’s nursing homes, Wasserman said, “You’re taking a lethal virus, and if it gets into the nursing home setting, where the staff are not trained to address it, this is what you get. The majority of nursing homes in this country are not prepared."