Why COVID-19 Is So Dangerous for All Nursing Homes
By Robert A. Belflower, Ph.D.
Faculty Member, Emergency and Disaster Management, American Military University
One of the earliest reports of the coronavirus (COVID-19) pandemic in the United States was at the Life Care Center in Kirkland, Washington. The Life Care Center is a modern, well-equipped nursing care and rehabilitation center employing 180 staff members. Its parent organization operates 200 nursing homes in 28 states.
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Sadly, at least 37 Life Care Center residents died from COVID-19 complications. In fact, nursing homes have become the epicenter for deaths related to COVID-19.
As of May 15, 2020, nursing homes accounted for 31,900 COVID-19 deaths or a staggering 39 percent of the total fatalities in the United States. As of May 10, 2020, 19% of those dying from the virus in Hungary, 51% in France and 62% of those in in Canada were identified as nursing home residents.
What makes residents of these nursing homes so susceptible to the coronavirus? Some reasons include the medical care, the vulnerability of the residents and financial problems that impact the conditions in nursing homes.
Medical Care in Hospitals versus Nursing Homes
Hospitals admit patients requiring acute medical care. These patients typically have illnesses or injuries that threaten life, limb or eyesight. Without skilled medical care, the patients may not recover.
Most hospitals have a low patient-to-healthcare provider ratio. The medical care commonly comes from a Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Nursing Assistant (CNA).
Hospitals also have medical doctors on staff 24 hours per day and medical specialists on call day and night. People are typically admitted to hospitals to receive treatment, get better and go home – hopefully.
Conversely, nursing homes are designed to care primarily for the elderly, and the residents do not necessarily require medical care. Rather, most require assistance with daily living activities.
As people age, these activities become more and more challenging.
Nursing homes have a much higher ratio of staff to residents than do hospitals. Also, there are rarely any doctors or specialists employed at a nursing home. Consequently, very ill residents are typically transferred to a hospital that is better equipped and staffed to treat the illness.
Nursing Home Residents Are Commonly Elderly and Have Medical Conditions that Make Them Vulnerable to Infection
There are about 1.4 to 1.5 million nursing home residents in the United States. Approximately 39% of these residents are at least 85 years old, and most have multiple comorbidities.
Nursing home residents are extremely vulnerable to the coronavirus due to multiple comorbidities: 72% have hypertension, 38% have heart disease and 32% have diabetes. According to City Journal, this population faces disproportionately high mortality risks even under normal circumstances. In 2016, while nursing home residents made up just 0.4% of the U.S. population, they accounted for 19% of the total deaths.
Nursing Homes Also Suffer from Financial Problems that Impact Their Ability to Provide Quality Care
Further compounding nursing home woes is financial insolvency. Nursing homes receive much of their funding from Medicaid, which does not reimburse nursing home the actual cost of care.
The City Journal also notes that nursing homes typically have an operating margin of 0.6% to 3.8%; any disruption to the revenue stream has dire consequences. This lack of funding pressures nursing homes to reduce operating costs to the minimum, further reducing staffing levels and the quality of care. Approximately 550 nursing homes closed because of lack of funding between 2015 and 2019.
Government Misinformation Led to COVID-19 Infections in Nursing Homes
City Journal says that nursing home residents are very susceptible to infectious diseases. The residents are in close contact with each other and the staff all day long.
Many of the residents require assistance from staff members for personal hygiene. Combined with comorbidities that reduce the efficiency of the immune system, nursing home residents are very vulnerable to COVID-19.
Some state governors made this situation worse. Fearing that hospitals would be overwhelmed by COVID-19 patients requiring intensive care, state officials ordered nursing homes in New York, California, New Jersey, Pennsylvania, and Michigan to accept residents who tested positive for COVID-19 but who did not require critical care.
While much of the United States was being told to stay at home, shelter in place, practice social distancing and avoid contact with everyone who was not a close family member, people known to have COVID-19 were introduced into nursing homes. These COVID-19 residents sleep in the same rooms as nursing home residents, eat at the same tables, use the same restrooms, and have physical contact with other residents and the staff.
These government policies were the result of misinformation. For weeks after the COVID-19 outbreak in Wuhan, China, in December 2019, both China and the World Health Organization (WHO) contended that the disease was only transmitted to human from animals; there was no human-to-human transmission. This statement was later amended so that there was only minimal human-to-human transmission.
Government officials encouraged people to continue participating in everyday activities. The Speaker of the House encouraged people to attend celebrations in Chinatown, and New York City public health officials promoted large-scale public events in Manhattan. Even Dr. Fauci, a key member of President Trump’s coronavirus task force, stated that cruise ships were safe on March 9, 2020 and so were intimate relations with total strangers on April 15, 2020.
Prognosis for the Future of the COVID-19 Pandemic
The Centers for Disease Control and Prevention (CDC) recognized on May 14, 2020 that seniors are the most at-risk population during the COVID-19 pandemic. This population specifically includes people age 65 and older as well as residents of nursing homes and long-term care facilities.
Also at risk are people of any age with chronic lung disease, severe asthma, serious heart ailments, illnesses that cause their immune systems to be compromised, HIV or AIDS, severe obesity, diabetes, chronic kidney disease or liver disease. While young people are not immune to COVID-19, the average age of COVID-19 fatalities in the United States is 75. The children, teenagers and young adults who have died from COVID-19 in the United States tended to have another comorbidity that placed them in a high-risk group.
When the COVID-19 pandemic began, no one knew how deadly it was for senior citizens. Information from China and the WHO provided government officials with a false sense of security. Officials feared hospitals would be overwhelmed with COVID-19 patients requiring critical care.
Since these same officials did not recognize the seriousness of COVID-19 to seniors, residents with COVID-19 who did not require critical care were sent to nursing homes. But in hindsight, we now know this practice was a serious mistake. The nursing homes were not prepared to care for the population most at risk of dying from COVID-19.
About the Author
Robert A. Belflower, Ph.D., is an adjunct faculty member with American Military University. His background includes mentoring emergency and disaster managers and senior military leaders in decision making during high-stress situations. He holds a B.A. in social and behavioral sciences from Johns Hopkins University, an M.S. in systems management from the University of Southern California and a Ph.D. in public safety/emergency management.
Dr. Belflower served on active duty in the U.S. Army for six years before joining Northrop Grumman Corporation for a 32-year career as a program manager. Most recently, he has five years’ experience in higher education as an administrator and faculty member. Decision-making during stress is his research interest. He was a coach at the U.S. Army’s Leaders Training Program that trained brigade and battalion commanders and their staffs during an intense seven-day simulated combat environment.
He was the deputy exercise director for a series of emergency management and consequence management exercises conducted for large school districts, military installations, foreign nations and the U.S. Northern Command. His doctoral dissertation examined the decisions made by nursing home administrators during the approach of a hurricane.