Utah’s Nursing Homes are Hurting from the Coronavirus Pandemic
By Dr. Joe Jarvis
Currently in the United States, 1.3 million elderly people live permanently in about 15,000 nursing homes. These facilities are vulnerable to disease outbreaks during the best of times. Most nursing homes have little privacy and many group gatherings, such as for meals and activities. When a new microbe enters the facility, there’s no place to hide. These structural problems are made worse by poor hygiene practices that are shamefully common. A recent set of nursing home inspections found that 36% of long-term care facilities did not follow proper hand washing guidelines, and 25% failed to properly use personal protective equipment. Even worse, 63% of US nursing homes have been cited for one or more infection control problems during the past two regular inspection periods, such as staff coming to work while experiencing symptoms like cough, fever, or difficulty breathing.
While serving as Nevada’s State Health Officer, I personally saw how one active case of tuberculosis in a nursing home quickly infected every staff member and most of the facility’s residents. And now our nursing homes have COVID-19 to contend with. How are they doing?
Not well. At least 7,000 Americans have died of COVID-19 in nursing homes so far, including several in Utah. Our elderly assisted-living residents have suffered an outsized burden during this pandemic—more than 15% of American deaths have occurred in nursing homes. Not only do diseases spread rapidly in nursing homes, but their residents are especially vulnerable to the worst outcomes of COVID-19 because of their age and frequent pre-existing chronic conditions. What is to be done?
The CDC has made recommendations for improving infection control in nursing homes during the pandemic. Included among these recommendations are several measures such as routine identification of staff members with potential infection followed by quarantine for those who are likely suffering COVID-19, restriction of visitors except in end-of-life situations, and the cancellation of all group activities, including communal dining. Several states have decided to organize skilled nursing facilities which will be entirely dedicated to caring for COVID-19 patients for the duration of the pandemic. In those states, all patients requiring long-term care who test positive for the novel coronavirus will be referred to a dedicated COVID-19 skilled nursing facility, sparing their as-yet-uninfected neighbors from exposure risk.
To my knowledge, Utah does not yet have such a facility. A Garbett/Jarvis gubernatorial administration would have already designated at least one of them, and we would have arranged for a higher level of hygienic practice in all nursing homes.
The problem is complicated by the fact that nursing homes are under financial duress during the pandemic. They are denied a usual source of income because patients needing elective surgery are not being treated at present and therefore will not require post-operative rehabilitation, which they often receive at skilled nursing facilities. In addition, the personal protective equipment required to reduce contagion within skilled nursing facilities with COVID-19 risk is expensive, as are the extra staffing hours needed to maintain higher levels of facility hygiene.
Rather than simply accepting what the Washington political establishment wants to pay hospitals for COVID-19 care as adequate, Gov. Garbett would be actively pushing Utah’s congressional delegation to fund long-term care as well. A separate Congressional appropriation should be made for our nation’s 15,000 nursing homes, lest they close and our seniors be left with nowhere to go.
The challenges in nursing homes are personal for me. My mother currently resides in a senior living center with the full spectrum of care options available, which was vital for her and for my father, before he passed away. About one month ago, as the coronavirus epidemic began to accelerate in the city where she lives, the owner of the senior living center imposed limited access rules upon the whole complex. My mother is now essentially confined to her apartment. Communal eating in the dining hall has been discontinued, as have been all of her various usual activities, from book club to exercise in the gym. Visitors are not allowed, so she is alone all day long. She can leave the facility if her family members make arrangements, but then she places herself at the risk for coronavirus exposure. I have a friend whose grandparents are even worse off—they are completely confined to their one-room quarters at an assisted living center. They can receive no visitors. Their entire view of the world is limited to the small window of their room.
Utah’s elderly residents are at great risk, both from the coronavirus and from the measures we must take to contain it. They deserve our care and concern. One thing we can all do, without being Governor of a state, is to remember our family members and friends who are in situations like these. Whoever you are, whenever you’re reading this, I challenge you to make today “Call Your Grandparents Day.” Set a reminder in your phone to do it more than once a week. Most of us are stuck at home, but some of us are even more stuck than others. Let’s remember them and do what’s in our power to make life worth living for our oldest citizens.