According to Paraprofessional Health Institute data, there were 581,000 nursing assistants working in nursing homes in 2018. Their median wage was just $13.38 an hour. Ninety-two percent were women, and the workforce is predominantly comprised of people of color — 37% are Black. Perhaps these demographics make it easier for some policymakers to marginalize these essential workers.
They may also explain the federal response to the crisis COVID-19 has created in our nursing homes. While hospitals receive most of the attention, and funding, nursing homes — at the very epicenter of the pandemic — have been treated as an afterthought. It was not until May that the Federal Emergency Management Agency (FEMA) announced it would send personal protective equipment (PPE) supplies to the nation’s nursing homes. And what has it sent?
Instead of fluid-impermeable, disposable isolation gowns, nursing homes received bright blue, unlabeled rectangular bags. At least one provider I know feared these were body bags. It was not an irrational fear — the bags, made of garbage bag material, had no holes through which functioning arms or hands could protrude. When I wore them for reporters, they were enormous on me, and I’m 6’3” tall and weigh 220 pounds.
Perhaps because these “gowns” wouldn’t allow the use of hands anyway, or perhaps in anticipation of the child labor prohibitions under Fair Labor Standards Act of 1938 being overturned, nursing homes also received extra small, child-sized gloves, a remarkable size I was not even aware was made.
Nursing homes were sent “surgical masks” with strange plastic ear loops (“Dumbo masks,” some called them) that lack the elasticity to fit on faces. They were shipped permeable fabric masks from underwear maker Hanes that are very much like underwear and, according to their own labeling, useless in a medical setting. One article reported that FEMA is looking to Hanes to produce as many as 10 million of these masks, as part of $781.2 million in contracts.
That dedicated caregivers would be expected to effectively wear garbage bag gowns and repurposed underwear on their faces — or any other useless PPE — is symbolic of a crisis in which nursing home staff and residents have been treated as garbage. If the nursing home staff soldiering on through this wrenching tragedy needed any further confirmation that some regard them as worthless, they now have it.
Nursing homes are heavily regulated by the federal government, so where is a federal testing regimen to safeguard residents? Should not nursing home staff have access to the same onsite, rapid-result testing that the White House has? The president’s press secretary says President Trump is tested “multiple times a day.” The testing that detected the virus in Kim Guilfoyle, girlfriend of the president’s eldest son, should surely be the standard for protecting our nation’s most elderly and infirm citizens, including a dwindling number of World War II veterans.
Belatedly, the federal government has announced it will send unreliable antigen test kits to nursing homes, though with no real sense of urgency — reportedly by October perhaps. Though these cheap tests provide rapid results, they are rapidly inaccurate. The vendor for one claims it “is capable of achieving 84% sensitivity” – which means a 16% false negative rate. I don’t know any provider who would want to play those life-threatening odds.
On June 30, before the U.S. Senate took a two-week recess, Sen. Maggie Hassan (D-NH) correctly noted that “[m]onths into this pandemic, there is still no robust Federal strategy to support the residents and employees of nursing homes. That is inexcusable.” And the federal funding given nursing homes has been but a small fraction of the allocations for hospitals and other providers.
The heartbreaking tragedy that has befallen long-term care from COVID-19 is one in which nursing home caregivers and those they care for are clearly expendable.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.