By Thomas Baird, LCSW
Today, in the midst of a pandemic, it is common to feel anger toward senior care facilities. Each day, we find new articles about the staggering number of COVID-19 related deaths in these long term care environments. In such an emotionally charged public discourse, we all must commit ourselves to education and advocacy, so that we can better understand the complex senior care industry and properly empower and support those that protect our beloved residents.
There is no doubt that a tragedy is taking place within the walls of our senior care communities. Two weeks ago, national news outlets shared the story of a skilled nursing facility in Riverside, CA, which was forced to move 83 residents due to dramatic staff shortage. In the weeks since, the L.A. Times has continued to report on nursing homes and residential care facilities that have been infiltrated by COVID-19, pairing the angry voices of grieving families with gaudy totals of virus-related deaths. The portrayal of these tragedies will undoubtedly infer to some readers that incompetent workers and reckless management are to blame. This is unfortunate. The faulted, stumbling elder care industry now fights the virus with less equipment, less staff, and less public support, while still serving the needs of our nation’s most vulnerable.
Countless articles about COVID-19 are referring to all facilities as nursing homes, but these titles are misleading. In truth, these articles are referring to multiple long term care environments, some of which fall under different licensing entities, offering different levels of care. This only leads to more confusion regarding what these providers are able to treat, control, and prevent. Many of these places are not required to have nurses present at all times. Other facilities cater strictly to residents with dementia (an impairment that makes isolation efforts very difficult). All of these places share our country’s lack of access to proper protective equipment and testing. No matter the level of care being provided, these places are being grouped together as a focal point for our derision and blame. Their workers need to be spared that blame.
They may be publicly praised as essential, but these healthcare workers are thinking about leaving their posts. Many have already left. Negative sentiment toward the industry grows each day, and the headlines have not been ignored by senior care workers and their families. Negative posts fill their social media feeds, and their loved ones privately beg them to leave their jobs. Some caregivers internally consider sleeping in a spare room at their facility, where the virus is already rampant, rather than risk spreading the virus to elderly in their own home. Caregivers and custodians show up each day, furtively suppressing the urge to abandon a low-paying job in favor of protecting their own families. They fight that impulse in order to keep residents safe and support their colleagues, despite the increasing likelihood that they themselves will eventually contract the virus that has already engulfed a contingent of their workforce. They remain entrenched despite the fact that many of their parents and grandparents, also vulnerable, will be taking care of their children while they continue to work. They do all this with little hope of hazard pay.
As a society, we must examine the deeply rooted issues that have left so many workers, residents, and families vulnerable. This is not a reprieve of the senior care industry, or a criticism of good journalism. This is a reminder to keep our system accountable without pouring our grief into vengeance, and damaging more lives. The public must be aware of the impact this pandemic is having on our vulnerable seniors. I only ask that we respond to these articles appropriately, and that the stories be reported with accountability, void of the grief-fueled inference that staff are largely to blame for a pandemic for which the country never prepared.
It is not like each of these facilities has been skirting state regulations or ignoring newly implemented guidelines. In most cases, they have been staffing their care environment in accordance with regulations and have done their best to provide personal protective equipment (PPE) for their workforce. External factors have led to extreme shortages in both staff and PPE, and this has been seen throughout the U.S.
It has been well reported that healthcare facilities are suffering from a nationwide shortage in protective equipment. A Time Magazine report examined multiple surveys at U.S. hospitals, discussing the plight of medical facilities struggling to protect and equip their front-line. The surveys revealed desperation among staff working directly with patients, and presented numerous reports of PPE being improvised. A nationwide survey conducted and reviewed by McKnight’s Senior Living, an industry news and analysis site, suggested that long term care facilities had been particularly hard-hit by shortages in PPE due to the outbreak. In the McKnight's survey, over 75% of long term care facilities reported shortages in PPE, and 59% reported having to improvise with homemade or reused PPE. In fact, this unprecedented crisis has resulted in regulating bodies and city health departments encouraging the reuse of PPE due to vast shortages.
When reading articles regarding COVID-19 case totals in facilities, we should keep in mind that these totals consist of both patients and staff. A recently released KFF study showed a “disproportionate effect on people who reside or work in long-term care facilities.” The data was comprised of only 23 reporting states (many entities are not self-reporting), yet revealed over 10,000 deaths in LTC facilities across those reporting states, including staff and patients.The data also frighteningly revealed in 6 states that long-term-care facilities account for over half of the state’s reported COVID-19 related deaths. The researchers suggest these numbers could indicate a high rate of testing in these regulated facilities and a low rate of testing for the general public. In other words, we will likely continue to see grossly disproportionate case totals and death totals in these communities because a) there are not enough tests in the public to collect data, and b) this is an extremely vulnerable population living in very close quarters to one another. These numbers will continue to pour out, and public concern over these care environments will grow. As scrutiny and concern grow, encourage friends and loved ones to educate themselves on these care environments, and better understand the data (The NIH National Library of Medicine features KFF as a health data source).
Our health system has been in shambles for decades, and its faults are laid bare under the weight of this outbreak. Elder care has become less accessible to the working class over the past fifteen years, due to both cost and increased behavioral acuity of potential residents. An excellent article from last year’s Health Affairs Journal details the growth of the senior housing industry and projects accessibility over the next ten years. The projections paint a bleak picture, and the authors call for policy intervention.
There are numerous flaws in this industry, and I beg that they be discussed. I only ask that we simultaneously advocate for all of the staff that work inside these facilities. This includes on-site managers, administrators, and administrative support staff that are regularly exposing themselves (and their families) to significant health risk in order to serve their residents and families. The leadership teams at these communities are notorious for working long hours and being on-call throughout nights and weekends. It should be noted that healthcare professionals in LTC settings are also traditionally paid less than hospital workers, although this should not be used to pit one brave group against another. It is merely an acknowledgement of another oft-hidden corner of healthcare that also deserves our support.
It is unknown whether these workers are more susceptible to contracting COVID-19 in the confined quarters of senior care environments, but these numbers will eventually be available. I personally know individuals who choose each day to work for an extremely low wage in a long-term care environment saturated by COVID-19 exposure, with no hope for hazard pay. Some are making the minimum, but choose to stay. If they leave, we should never vilify them. If they stay, we should praise them. Morale matters, and it will unfortunately be the reason why a caregiver stays or leaves, at this point, because significant factors like safety and compensation will not change for the better in the coming months. If this angers you, direct your voice toward the health system that leaves elder care environments so vulnerable.
In these next few months, though, I urge you to advocate for these workers. With their help, residents are able to walk, eat, sit up, and maintain hygiene. In my experience, residents are also able to volunteer at non-profit organizations, attend parties, wash cars, sing karaoke, fix broken appliances, take improvisational comedy classes, and teach courses. These individuals could not achieve this level of well-being without vital assistance from staff. Every one of these staff members deserve increased wages, better health benefits, safety provisions, and tangible support (more staff). This has been the case for years, but is hopefully now clear to the public. For right now, our support must come in the form of advocacy for their rights, sensitivity to their situation, and praise of their willingness to show up and get sick for our seniors. The individuals that work inside these buildings are as immune to our criticism as they are to this virus, and we must spare them of the vitriol. Public outcry will only bring a positive outcome if it is redirected toward defending these homes and affirming their purpose.
Thomas Baird is a Licensed Clinical Social Worker specializing in Dementia Care. He has worked with seniors since 2011. He holds Masters Degrees from Rutgers University School of Social Work and Princeton Theological Seminary. His friends have been social distancing with him since high school, mostly because of his awesomeness but also because he talks about baseball too much.
Thomas Baird LCSW
Maggie Dawson MSW