There are really two pandemics currently wreaking havoc across the US. Both involve the same COVID-19 virus, but while they are both terrifying and dangerous, they differ in the type of damage they are causing.
One epidemic is a general contagion afflicting everyone. Even as the number of people it kills still remains relatively low compared to some of our worst flu outbreaks, COVID-19’s contagiousness, its ability to kill, the continued lack of any reliable treatment, plus a lack of testing kits and even masks, has forced nearly every state in the country to shut down most businesses and public activities and to urge or even in some cases, require, people to maintain social separation in their homes and when outside. These state and federal lockdowns are resulting in an unprecedented jump in unemployment and a precipitous decline in economic activity that together are threatening to plunge the country into a deep economic depression.
Meanwhile, the other epidemic is causing what amounts to a massacre of the nation’s institutionalized elderly in nursing homes. While not a cause of economic collapse, this sad and brutal second epidemic is proving heart-rending as quarantines imposed by states and overwhelmed nursing homes themselves prevent younger relatives from even visiting or comforting the parents and grandparents they are losing.
These two epidemics combined have so far officially infected more than a million Americans (though some studies suggest that the number of untested cases of people who got mild symptoms or are asymptomatic carriers could be as much as four times that amount). As of Monday, they have also killed over 57,000, with 1,000 or more Americans dying daily. Of that number, more than 10,000 have been elderly people who have died as patients in nursing homes. That too is a number that is also probably far too low, since elderly people typically have other ailments that can be listed as the cause of death, from heart failure to kidney failure to pneumonia to stroke. Nursing homes, notorious for their bad record keeping and inadequate care, are at the same time in control of drawing up the death certificates and have an incentive to keep their coronavirus death toll down.
Some states are reporting that half their coronavirus deaths are of people in nursing homes (my home state of Pennsylvania says it’s an astonishing 61% of state coronavirus deaths!) Nationwide the percentage of deaths that are in nursing homes is 20%.
How much worse things are at many other less well-funded nursing homes in New Jersey and across the country can hardly be imagined (a number have even higher mortality rates), but after someone blew the whistle to report that one nursing home was hiding the bodies of 17 dead patients in a refrigerated semi-trailer behind the building, the state began demanding accurate reports and announced last week that 40% of the state’s then 4225 deaths had been of patients in its nursing home facilities.
While there are good nursing homes that take their role seriously and do their best to provide care to a population that has many difficult care issues and medical vulnerabilities, as an industry nursing homes have a long sordid history of neglecting patients, shorting staffing and pay for skilled caregivers, and of intensely and successfully lobbying both state and federal elected officials to cut them slack on regulation.
According to FollowTheMoney.org, nursing homes and long-term-care facility companies, both for-profit and not-for-profit, donated a total of $105 million to state-level candidates alone between 2001 and 2016. That’s $7 million a year. The annual amount contributed each year nearly doubled over that 15-year period. More than half the money came from 38 big contributors, nearly all of them large for-profit nursing home chains (70 percent of this multi-billion-dollar industry are for-profit companies, most of them part of large corporate chains). At the federal level, during the 2016 presidential election year, the nursing home industry invested a lot more in buying influence: $1.7 billion was handed out to presidential and congressional campaigns of both parties, making the industry the 16th largest contributor among health care campaign funders.
Part of the problem is that 70 percent of nursing homes in the country are for-profit operations, most of them owned by large corporate chains where the goal is not patient care, but generating profit for shareholders, owners and managers. This is generally accomplished by minimizing (and overworking remaining) care staff. Not surprisingly, one academic report found that there was a direct inverse correlation between the staff-to-patient ratio and profits, writing, “The profit incentive has been shown to be directly related to low staffing. For-profit nursing homes and for-profit chains operate with lower staffing and more quality deficiencies (violations) compared with nonprofit facilities. 62–64 Facilities with the highest profit margins have been found to have the poorest quality.”
It should be pointed out that even in such a cut-throat setting, as with other caring professions like teaching or child care, nurses, nurses aids and other nursing home support staff, regardless of low pay, tough hours and often a lack of paid sick leave, can usually be counted on to do their best to provide skilled and caring assistance to the patients they serve. But these patient care professionals can only do so much when staffing is too thin — and when the coronavirus also invades a facility, staffing can become thin indeed.
The impact of all the campaign cash thrown at politicians by the industry is clear to see. The Obama administration, unable to pass significant regulatory measures in Congress to reduce abuses in the nursing home and long-term care industry, instead resorted to a bunch of regulations established by executive order. All, or nearly all, of those regs were cancelled by President Trump after he took office. Not content with that presidential gift, the industry is currently pushing for more. The New York Times reports that in response to industry calls, President Trump is considering, believe it or not, actions to “relax regulations governing America’s nursing homes, including rules meant to curb deadly infections among elderly residents.” This just as it is becoming clear that lax regulation during this pandemic is deadly.
While attorneys general in 17 states have decried the plan to reduce such regulations by executive order, the Trump-appointed administrator of the federal government’s Centers for Medicare and Medicaid Services (CMS), Seema Verma, eerily echoing Trump’s explanation for wanting an early end to state lockdowns, said, “We have to make sure that our regulations are not so burdensome that they hurt the industry.”
“In ordinary times, nursing homes have a bad infection control record, so the fact that they are having major problems with the coronavirus is sadly predictable,” says Eric Carlson, directing attorney with the Justice in Aging in Washington, DC. He says his organization has been pushing for measures in state legislatures to improve regulation. Agreeing that it’s a bit late in the game to try and fix problems in the middle of this deadly pandemic, he says, “Well even though the horse has left the barn, you can’t just let it run wild. You have to try and drag it back into the barn!”
Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, agrees that the nursing home industry was something of a disaster waiting to happen just prior to the pandemic. “Their infection control has been bad historically, with 4,000 patients dying per year of infections they should not have gotten,” she says. “That laid the foundation for what we’re now seeing.”
She adds that transparency is a big problem too, noting that many states still don’t even know how many patients are dying in nursing homes from the coronavirus. (With a continuing shortage of testing kits, thanks to the Trump administration foot dragging and incompetence, so do many nursing homes themselves!)
As the bodies pile up in refrigerator trucks parked behind nursing homes across the nation, that may change, as hopefully will Congress’s current scandalous support for further deregulation of the industry.
Meanwhile, after this experience many families may start to rethink the growing practice of putting their elderly parents into such institutions. The record suggests that it’s a dangerous move to make and that other options, like hiring in-home care, could be a better in all but the direst of cases. Every state now has some program or multiple programs that allow Medicaid to fund care for an elder person in the home, but in many of the states the limitations in type of care and in income limits can be severe. These programs, resisted by nursing home lobbies which want the revenue bodies, need to be expanded.
Dave Lindorff, 2019 winner of an ‘Izzy’ Award for ‘Outstanding Independent Journalism” from the Park Center for Independent Media in Ithaca, is founding editor of ThisCantBeHappening.net and author of four books, including ‘Marketplace Medicine: The Rise of the For-Profit Hospital Chains’ (Bantam, 1992) This article is published under a joint agreement between Tarbell.org and ThisCantBeHappening!