On their best days nursing homes start out behind the eight ball. Underfunded and understaffed, they care for the most physically needy and vulnerable among us. Generally, they are paid about 70% of the cost of care by their biggest customer, Medicaid.
Try to imagine any business whose biggest customer tells them this is what I will pay you, take it or leave it. Actually, there is no leave it because the nursing home agrees to take it in order to be paid anything at all. Most will be in a negative cash position in the next few months.
The most critical care personnel (certified nursing assistants, dietary aides, housekeepers and laundry personnel) are mostly working women, many of them single moms who work more than one job. Usually paid at the state’s minimum wage, they work their eight-hour shift and drive to another nursing home to do another eight hours.
Nursing home staff provide the most intimate of care services for their patients from bathing and teeth brushing to bathroom care and cleanup. More than 50% of residents in nursing homes and assisted living have some form of dementia or cognitive impairment, including Alzheimer’s, which can make them uncooperative and even combative toward this care. This is high-touch, not high-tech care. Most nursing home patients live in two-bedded rooms where the beds are 3 feet apart with a thin curtain that can be pulled for privacy.
And now comes the coronavirus or COVID-19, a potentially fatal germ that can be spread by asymptomatic carriers for up to 14 days. Fourteen days of unsuspecting nursing assistants providing hands-on care including feeding and the aforementioned teeth brushing. If symptoms occur and testing takes place, three to seven days can pass before results are returned.
Nursing homes create the perfect storm for the spread of viruses. Lots of patients in close proximity to each other being cared for by staff who are required to be up close and personal to do their jobs. Reporting for duty each day is no longer an act of love and compassion; it is an act of courage. Nursing home staff are staying away from their own families and putting their lives on the line to care for frail, confused, vulnerable elders. Nursing centers have been last on the list to receive needed protective supplies, testing and support.
Their reward is to be vilified in the media and punished by the Centers for Medicare & Medicaid Services, the nursing home regulatory agency. While hospital workers are lauded as heroes, nursing home workers are hardly mentioned except as a footnote to the rising body count. In Washington State, CMS fined Life Care Center of Kirkland $600,000. What is this intended to accomplish? Is it any wonder that staff are stressed and some in leadership positions are contemplating leaving the field?
This disdain toward our nursing homes and their residents is without a doubt the most blatant display of ageism this country has ever witnessed. Our elders deserve better.
Our nursing home and long-term care staff need personal protective equipment (PPE) and testing now! Our regulators must work with us on both the state and federal levels to ensure that nursing homes are provided with clear concise guidance and a collaborative work environment. Our employees are truly on the front line of this battle and they deserve our recognition and our praise.
Bill McGinley is president and CEO of the American College of Health Care Administrators.
