Coronavirus Pandemic Exposes Cracks In Nursing Home System Nursing homes have accounted for nearly half of COVID-19 deaths in some states. Why have they been so vulnerable to the virus, and what could improve that in the future?
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Coronavirus Pandemic Exposes Cracks In Nursing Home System

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Coronavirus Pandemic Exposes Cracks In Nursing Home System

Coronavirus Pandemic Exposes Cracks In Nursing Home System

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STEVE INSKEEP, HOST:

We report now on a brutal reality of the pandemic - vast numbers of deaths from coronavirus have come in nursing homes. In some states, they account for almost half of COVID-19 deaths. On one level, this seems obvious because those facilities house seniors who rank among the most vulnerable. But why have nursing homes found it so hard to protect residents? NPR's Ina Jaffe covers aging and is on the line. Ina, good morning.

INA JAFFE, BYLINE: Good morning.

INSKEEP: How bad is the situation?

JAFFE: Well, it's pretty dire. According to some estimates, as many as a third of the people who have died across the country are either residents or staff in nursing homes. I've been talking to people who study nursing homes or who work in them. One of them is 31-year-old Christopher Brown (ph). He's a certified nursing assistant at a facility in Chicago where 133 residents have been infected and 23 have died. And he says that the COVID-19 crisis didn't create the problems in nursing homes. It exposed the problems that were already there.

CHRISTOPHER BROWN: We were always underpaid. We were always short of PPE. We were always short of towels, soap, linens, diapers. They don't have what's needed.

JAFFE: And one of the particular problems in this nursing home was a failure to have a plan to control infection. And every nursing home's supposed to have one.

INSKEEP: Every nursing home was supposed to have one even previous to this, even before this pandemic. Why are those plans so important?

JAFFE: Well, it gets at the most fundamental protections that a nursing home can provide. It keeps residents from getting the flu and pneumonia and all kinds of other bugs. But failure to have a plan for controlling infection is the most commonly cited deficiency in nursing homes nationwide. Even before the pandemic, almost 388,000 nursing home residents died of infections every year. And even after the pandemic, government inspections found that more than a third of the facilities still had trouble following proper handwashing procedures, and a quarter didn't use protective gear correctly.

INSKEEP: How would the nursing homes get away with that when so many people are dying?

JAFFE: Well, you know, for nursing homes, there's not much of a price to pay for these lapses. The fines are usually small. It can just be the cost of doing business, and sometimes all the nursing homes have to do is give the government a written plan to show how they'll fix the problem. Critics of nursing homes say it's also a matter of staffing. There aren't enough people to do all the work and do it safely. There are no federal minimums for staff, and many states don't have them either. And since most nursing homes are for-profit businesses, the simplest way to cut costs is to keep the staff small.

INSKEEP: When you talk to experts, what do you hear about what nursing homes should be doing?

JAFFE: Well, the thing I hear most often is that if you want to control infection, nursing homes should be smaller, and everyone should have a private room and bath. But that would affect the bottom line. Currently, many facilities have two or three or even four residents sharing a room and bathroom. Other suggestions ranged from how to make the inspection process more effective to changes in design and architecture to organizing facilities in a way that would respect the dignity of residents. And on npr.org, we're devoting some space to expand on those ideas.

INSKEEP: Why would people not be pressing facilities to do more or to do better?

JAFFE: Well, first, I should say that there are nursing homes that do do a good job. I've been in some. But, you know, until we suddenly need one of these facilities for a family member, we never think about them. They're not something we picture ourselves - a place we picture ourselves living someday. I spoke to Dr. Louise Aronson. She's a geriatrician and the author of "Elderhood," which was just named a Pulitzer Prize finalist. And she thinks that these conditions show that we don't value older lives.

LOUISE ARONSON: As a society, we claim to have family values, and yet we outsource care of key members of our families, the people who gave birth to us and raised us and our parents and our grandparents, and then we pay people a paltry wage to do work that is so hard we don't want to do it ourselves.

JAFFE: You know, that said, not everyone has a choice about moving a loved one to a nursing home. There may be, you know, someone with two or more jobs. They may be older themselves and physically unable to meet their loved one's needs. So these facilities are providing a profoundly important service. Advocates are hoping that with all the attention on nursing homes now, maybe they'll finally get the scrutiny and support they deserve.

INSKEEP: Ina, thanks for the thoughtful coverage.

JAFFE: You're welcome.

INSKEEP: NPR's Ina Jaffe.

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