In his 1964 State of the Union Address, President Lyndon B. Johnson declared that “[e]very American community will benefit from the construction or modernization of schools and libraries and hospitals and nursing homes” – perhaps the last time nursing homes had so prominent a place in a statement of the nation’s ambitions.
We could use that commitment today. For we have seen the nursing home care sector suffer decades of governmental neglect that, inexorably, contributed to the tragedy inflicted by COVID-19.
That neglect has not just manifested itself in the failure of governmental Medicaid reimbursement to keep facilities modern for the many residents for whom the government is the payor. This failure alone led to outmoded facilities being especially susceptible to respiratory virus spread due to shared rooms and cramped communal spaces.
Nor has that neglect been limited to suppressing the economic mobility of nursing home staff through Medicaid parsimony that squeezes the compensation of a workforce that is overwhelmingly comprised of women.
No, the culmination of that neglect was a willful disregard for the well-being of nursing home residents and staff during a pandemic especially lethal in a congregate care setting.
In New Jersey and New York, nursing homes were compelled to take COVID-positive hospital discharges. While New York Gov. Andrew Cuomo has at least faced bipartisan condemnation over this, including a critical report from a fellow Democrat – the attorney general – New Jersey’s Senate president reneged on a pledge to form a bipartisan committee to examine how his fellow Democrat, Gov. Phil Murphy, handled nursing home care.
Confronted at one press conference about nursing home deaths, even as he sought to protect golfers from COVID-19 through restrictions, Murphy simply blamed providers, stating, “The uneven performance of this industry is jaw-dropping, and that’s as charitable as I can get.”
Yet it was an order from Murphy’s own administration that stated: “Post-acute care facilities are prohibited from requiring a hospitalized patient/resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.” Nor was “a confirmed diagnosis of COVID-19” grounds to deny admission.
Is it too much to expect contrition, if not accountability?
In Pennsylvania, the state’s Democratic auditor general reported that the state-run nursing home for veterans, which suffered terrible losses due to the virus, was run negligently. An independent investigative report commissioned by Gov. Tom Wolf confirmed those findings and acknowledged “misjudgments and lost opportunities in controlling and limiting the spread of the virus.”
Here at least blame over government actions was assigned, as opposed to a well-massaged, farcical report Cuomo’s administration had issued – reportedly “rewritten several times by senior advisers to Mr. Cuomo” – that deflected all blame for nursing home deaths.
Similarly, Massachusetts Republican Gov. Charlie Baker, according to an intensive Boston Globe investigation, pretended not to know Bennett Walsh, the superintendent of the state-run Holyoke Soldiers’ Home, after it was ravaged by COVID-19, though Walsh was, according to the Globe, “a politically connected hire by Baker that went disastrously wrong.”
No one can dispute that nursing home providers should be accountable for neglect. Yet, every time a provider gets into trouble, contrast the collective blame imputed to more than 15,000 nursing homes to the impunity with which politicians can mistreat their state’s most vulnerable wards. And with what repercussions?
Last month, a Sienna College poll found 50% of New Yorkers felt Gov. Cuomo did at least a “fair” job of “[m]aking public all data about COVID-related deaths of nursing home patients” – when, in fact, all reporting shows his administration assiduously concealed that information. And as is, sadly, true of everything these days, respondents perceived the answer through a partisan lens: Only 33% of Democrats felt Cuomo had done a “poor” job, with 41% thinking it was no less than “good.”
In the end, it is perhaps here as it is elsewhere. Until April 15, 2020, British policy was to discharge COVID-positive hospital patients into care homes. As one manager of two care homes in England was quoted stating in the Telegraph: “The elderly were dispensable.”
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.