Prepare Nursing Homes for the Next Coronavirus Wave

By Betsy McCaughey, Ph.D.
May 20, 2020

Nursing-home residents make up less than 1% of the U.S. population, but in many states they account for half of all Covid-19 deaths. In some states it’s higher, such as Minnesota (81%), New Hampshire (77%) and Pennsylvania (71%), according to data from the Kaiser Family Foundation. Shutting down the economy and ordering the public to stay at home didn’t prevent these deaths. These people were already staying home.

Public-health officials are warning that Covid-19 could surge again in the winter. The single most effective way to save lives would be to improve infection control in nursing homes and prepare to rush supplies of masks, gloves and other personal protective equipment to these facilities. Overlooking nursing homes was the biggest lost opportunity in the battle against Covid-19.

When the pandemic hit, the White House marshaled federal agencies, the military and private industry to rush ventilators to hospitals in hot zones like New York and erect field hospitals to handle patient overflow. It was an impressive accomplishment. Yet nursing homes were ignored, despite early warnings they would be the deadliest places. Nursing-home residents accounted for roughly half of deaths in Italy and Spain as of early April.

The carnage at the Life Care Center in Kirkland, Wash., was another red flag. The first patient tested positive on Feb. 28. More than 40 people died, including several staff members. Employees were untrained in infection control and the use of personal protective equipment. Infected patients weren’t given masks, even when they were transferred to a hospital. Hand sanitizer, masks and gowns were in short supply, according to a federal investigation. Kirkland turned out to be a preview of what would happen across the country.

Even in normal times, nursing homes are cauldrons of infection. Each year some 380,000 residents die from infection, according to the Centers for Disease Control and Prevention. Not all deaths are preventable; the elderly are vulnerable to infectious diseases. But lax standards are a major problem. Patients with superbugs are seldom separated from other residents, and caregivers go from one bed to the next without using disposable gowns and gloves, spreading bacteria and viruses. A quarter of nursing-home residents contract dangerous drug-resistant bacteria, according to Columbia University School of Nursing research.

It was predictable that nursing homes would become the riskiest place during a pandemic. Yet state and federal officials treated them as an afterthought. The CDC and the Centers for Medicare and Medicaid Services didn’t begin tracking nursing-home deaths until the end of April.

Worse, several states refused to disclose which nursing homes were affected, making it impossible for families to choose a safer location for their loved ones. New York held out until May 5, finally releasing the information in response to a public-records request.

New York made its deadliest mistake on March 25. As hospitals became inundated, the state mandated that nursing homes accept all patients being discharged from a hospital regardless of whether they had Covid-19. The basic principle of infection control is identify and isolate. The New York edict did the opposite, dispersing the infection to any facility with an empty bed. Patient advocates warned of the dangerous consequences. On May 11 the state reversed the edict.

New York excludes from its nursing-home death toll residents who were hospitalized before dying. But data from 37 states with more complete reporting suggest that nationally 51% to 53% of Covid-19 deaths are nursing-home residents, according to health-care analysts Phil Kerpen, Greg Girvan and Avik Roy.

In New Jersey, where 52% of deaths have been nursing-home residents, Gov. Phil Murphy said that when the “postmortem” is done on this pandemic, nursing homes will be “at or near the top of the list.” States shouldn’t wait. They should be working with nursing-home operators now to designate which facilities will handle Covid patients if the virus surges next fall, and how to supply these facilities and train their staffs.

Most important, all nursing homes need rigorous infection control. The past 90 days have shown how lax standards turn deadly when a pandemic targets the elderly.

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths, a former lieutenant governor of New York, and author of “Next Pandemic,” forthcoming from Encounter Books.

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