The question remains how to limit transmitta, if we can. Decent ventilation in spaces where many people gather. Good hygiene -- put a washcloth doused with alcohol and Clorox in your purse... in fact put to (different colors)-- one to wipe down surfaces -- and wash daily. Hands away from face. Wear a hat with netting over the face. Wear gloves... cotton, wash em. We have relatively clean air compared to China so our lungs may be healthier. Get enough sleep, eat properly, keep up exercise but NOT at the gym.. most of us will be fine. Why are we panicking?
One study indicated that more than 50% of nursing home residents are vitamin-D deficient which is very important for the immune system. Nursing home residents who spend a lot of time indoors and/or live in sunlight-poor locations (such as the Seattle area) should be given vitamin-D supplements to improve their immunity. I'm not saying vitamin-D cures the corona virus. But it is a well known fact that vitamin-D is extremely important for the immune system, which weakens with age.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/
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I can't speak for nursing homes on the national scale, but can speak very well of nursing homes throughout New York. They are a shameful part of our society which few want to even recognize. They are, as a whole, dirty, run down and staffed by pretty much incompetent staff and led by profit driven administrators.
As paramedics, one of the first things we do early on in our careers is when in an elevator in a nursing home, we look at each other and say, 'if I ever end up in one of these, you know what you need to do if I'm unable to'. I understand they are probably a necessity for those unable or unwilling to be cared for by family and that may have no one, but there must be a better approach.
Most lay day in and day out vegetating literally, often abused physically or neglectfully by underpaid and poorly supervised staff.
We all need to be better informed in end of life care, advanced directives and better care for our loved ones.
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RN's, LPN's, aides. MD's, PT/OT, dieticians, speech therapists. Housekeeping, food service, laundry, medical equipment. Comfortable and safe housing, social services, spiritual care, psychotherapy, age appropriate activities and transportation to medical visits. Medications, wound care, oxygen and IV support. All this, 24 hours a day, 365 days a year, and medicare pays $432 a day per person FOR ALL THIS.
Please tell me how it can be done better, how staffing problems can be solved and every elderly person can be given the quality of care they need, when our government values the care of SNF residents at $432 a day. Staff work at these care facilities not for the wages (atrocious) or the caché (zilch) but because they have a heart for the elderly. If you can do better, then step up.
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@Caregiver M.D. Your point is well taken but understated. Most residents of nursing homes are covered by Medicaid, not Medicare. Medicaid rates are about one third the level of Medicare rates and are woefully inadequate to support all of the requirements for high quality nursing home care.
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I am a registered nurse. I've worked in hospitals and nursing homes in Connecticut. In the hospitals, I've received hands-on training to don and doff PPE, however, in the nursing homes this was not the case. Also, in these hospitals designated equipment was used for patients whose conditions warrant isolation. In the nursing homes the same equipment, i.e. blood pressure cuffs, thermometers, mechanical lifts are used for all patients. These items not disinfected in between residents as I had learned in the hospitals. The infection control personnel at the nursing homes lacked the training I had received in the hospitals. They were not amenable to my insistence that this was not proper practice.
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This concerns the ability to monitor the health and wellness of those under care. if you are a family member or custodian of someone in quarantine or in a managed care facility, you may want to consider establishing a monitoring service. Something as simple as a home monitoring or “baby cam” device can work wonders. If a facility pushes back, which happens, fight them on it.
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@Daniel Kauffman Not allowed. They consider it a privacy issue to try to monitor your relative.
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@Daniel Kauffman Huge privacy issue! This is usually why we do rounds as aides, it's like monitoring protocol. It is a huge thing to wash hands after leaving any residents room under our care.
@Daniel Kauffman
Here's a novel idea. Bring your elderly parent in the nursing home to your home! Why is this person there anyway? For whose convenience? It's a miserable life.
There are a few people who are so sick that they would present challenges in a home situation: memory loss, physical loss of strength (major), but many people would be just fine at home.... even if they were in bed most of the day.
Put the bed in the living room or other if there is not extra bedroom. Yes, it's all been done.... and you/we can do it.
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The pay is low. The supervision is lacking. The lowest level employees are often immigrant women who don’t have the culture to speak up to their white bosses in the chain of command. These are run as ‘for-profit’ which means the biggest cost variable is payroll. Wage rate x number hours of labor. The residents don’t have the compunction to revolt because they are frail. It is really up to caring family members to band together with other families’ members of the residents to fight for their collective rights.
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The situation with the most vulnerable and their caregivers is tragic.
The President reassures the world that many patients are “recovering while going to work”.
When world leaders see the President lie again and again about an epidemic, how they they trust him with the health of their nations, their children...or themselves?
Along with all the rest, isn’t this what Putin wants?
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The issue is not nursing homes specifically:
A primary issue is people living in densely packed conditions, the same conditions that created plagues thousands of years ago.
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Interesting article. However, the ACA actually measures readmissions from long-term care to hospitals, so it should discourage sending ill patients to the nursing homes. I think your comments in this area should be reviewed.
@rob I perform admissions at a nursing home, often the people are unstable arriving from a top hospital in the country in a major city to our nursing home. I have to turn these indviduals around and send them back. In theory, you are right, however in practice we have a culture of quicker discharges from hospitals with sicker patients that persists. Unitl the priority is people and quality care, and not money, I believe this trend will continue.
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I don't have any suggestion for a solution, but I hope something can be done. Because of the chronic understaffing in so many of these facilities family has to stay involved in a daily basis to keep patients healthy and cared for - who knows what decrease in ability and cognition and health will have occurred in the surviving patients.
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Thirty years ago as a new doctor I was tasked to be our clinic's nursing home rounder. One of the older docs smirked and said something like, "You're it, bud, have fun!"
I told him the nursing homes were a mess, and he shrugged his shoulders and said nursing home patients got second-class care and that was way it always was and always will be.
He was right.
I quit that job not long after.
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@Suburban Cowboy Not the medical staffs fault. As long as we continue to allow insurance companies and corporations to provide our "healthcare" this is what we will get.
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@vbering Yes, few people make our elderly a priority unless they or their loved ones are affected.
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Too bad you did not decide to make a difference then.
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It is probably far above my pay grade to do anything about this or future pandemics, but ensuring a robust care system to respond is ALL our responsibility. It is times like this when we see how for-profit healthcare including assisted living fails us. That we have allowed the AL and skilled nursing industry to prevent even the kind of reasonable regulation necessary for basic patient safety in the name of ever bigger profits speaks volumes. Until state health authorities, the public and large payers with no profit motive (Medicare) require caregivers to provide sufficient staffing along with other scope of care rules, our loved ones and eventually we ourselves will be more vulnerable than we should be. In short, let’s train staff to wash hands properly, but let’s also make sure they have time to do it, too.
PS. My heart goes out to the staffers of LifeCare Kirkland who have no doubt run themselves ragged trying to care for patients with complex care needs in the face of an unknown, deadly illness, who have to follow what seems like dumb rules in who is tested (we haven’t had enough tests even of the sort-of variety) and who being few in number, have to try to deal with fear-gripped family and public blaming for what is ultimately a much larger, systemic failure. They aren’t paid enough.
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@WhatshernameOne
Well, we can do something. Wait for it.
2
The most serious problem at this time is that there is a severe shortage of testing kits. Without the ability to test those at risk and those with symptoms of the virus appropriate quarantine protocols will not be taken.
I strongly believe that Trump has sent out the order to stand down on preparing and distributing test kits because it keeps down the statistics of those infected.
I call upon the media to begin investigating why so few testing kits? We Americans deserve answers. Lives are at stake.
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Don’t ask don’t tell, as far as testing. Even this very first step in uncovering the unknown unknowns of the coronavirus - widespread testing - is being politicized into the usual rhetoric, “how great we are, how grateful to our dear president”.
Test kits could cost hundreds, perhaps thousands of dollars. And Alex Azar has already stated that HHS cannot control the patient cost of any expected vaccine (translation: expect aggressive gouging from the pharma companies). Not to mention the cost of hospitalization.
Obamacare has been largely dismantled by Trump and many red states decided not to expand Medicare. Therefore expect great reluctance on the part of lower and middle class people to self-report and check themselves into care facilities. Instead they’ll just hope to recover on their own. Who wouldn’t wish to avoid the crippling bills? Needless to say this would only exacerbate the problem.
Deafening silence from Trump’s team on how patients are supposed to pay for testing and subsequent coronavirus treatment.
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@KJS
Even more frightening is that Florida REFUSES to test unless the patient has been to a "hot spot." Its stated reason is that it would "overwhelm the testing centers." With the elderly population in this State, this decision could be catastrophic.
Would a backlog not be better than a straight-out refusal to test? Are we more worried about tourism dollars than the health and safety of our population? It's negligent and borderline criminal.
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@domplein2 If Trump can command loyalty then let him command that the pharmaceutical companies put monies from their billions in profits into a fund that will provide free testing and healthcare for those who are victims of the virus.
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I have watched this deterioration of nursing homes for many years. The profit motive for investor owned homes is a real estate gold mine to them and a death threat to patients and staff. Health care workers do not have such lobbyists. It is interesting that the owners of Life Care Center did not respond to questions by Matt Richtel. And obviously missing is reporting from nurses, nurses aides, rehabilitation therapists and other employees is not reported at this time. Don' t they have a voice in this as they dodge the virus bullets? Or do they have voices that are not listened to because these corporate entities can choose not to hear because of the money talking so loudly in their portfolios. Well that is, until they or their loved ones get infected. But maybe their wealth protects them. Time to read the next article in the Times about how the rich do in times of pandemics.
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@limbic love when you work in healthcare most places have you sign an agreement not to speak publically about the organization. I have been working in healthcare for 12 years. These organizations pretty much own you. The nurses in California who have the union are lucky, they have higher standards in that state.
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The nursing homes are one of the problems. Homeless populations will be in the headlines in a few weeks, and it won't be pretty. The control over them is almost non existent.
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@Ernest Montague and the homeless population here in Seattle is huge. We have more tents than the Oregon coast
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@Ernest Montague
Not necessarily -- they live out of doors.. great ventilation, they tend to self isolate, so so long as they have access to clean decent food and water.... they are at less of a risk than someone who goes to his gym daily.
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Would like to know how many other patients have died from the flu since January at Lifecare Kirkland, or what the average flu deaths are at nursing homes in general. Some context would be helpful.
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@SXM It depends on the strain of the flu. Some years the flu is more deadly than others. I have been at the same nursing home as a nurse for 7 years. Some years no one gets it and some years several people get it and a few people unfortunately die. It varies.
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That won’t really take away from the fact that they passed from the COVID-19, albeit those places were already under scrutiny.
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I have several close relatives who have worked in nursing homes.
They all left the profession primarily from exhaustion from understaffing. They were CNAs, social workers and LVNs.
Most of the staff are CNA workers paid minimum wages and are overworked. Cynical doesn’t come close to describing them.
Regulations and oversight are not strong. Greedy owners cut corners because they can.
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Inspections of nursing homes has been lacking at State and Federal level. Reason of course is that the for profit nursing homes have lobbyists and make large donations to the elected officials. Even when inspections show serious or repeated violations, they often succeed in having penalties mitigated . Nursing home workers are often minimum wage workers while the administrators are well paid. As more and more people reach advanced age and need nursing home care, it will be important that ti.ely and honest inspections are made to make sure residents receive the quality of care they deserve and pay for. Medicare and Medicsid pay for many and they must do better job of I specting and enforcing rules
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@Rolfneu -
Inspections of PALTC and SNF's by state and federal investigators is relentless. They are scheduled and unscheduled, sometimes as often as weekly, with citations made for things like nonrecyclable paper being in recycle bins and refrigerators in storage with unmonitored temperatures. The amount of documentation that staff have to do to meet state and federal regulations is incredible. There have to be care plans that detail every minute of a resident's day for safety, comfort and optimization of medical care. Evaluations are documented every shift for resident's psychological health, medication reactions and administration, notes written to qualify every interaction, however brief, with each patient. Aides are so busy documenting the size, frequency, consistency and continence of bowel movements that they barely have time to help residents in the bathroom. Inspecting and enforcing the rules is necessary, but the thousands of regulatory criteria are what is interfering with the actual care of the patient.
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Not just nursing homes. There are many elderly and disabled living in independent senior communities and assisted living communities. We need to be vigilant about helping those who are most vulnerable.
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@RP I live in a geriatric-skewed retirement-popular city 50+ miles from San Antonio, a city victimized by the incompetence of the federal agencies evacuating cruise ship /Wuhan virus-exposed populations. I care for my partner of 42 years with multiple chronic conditions - the primary risk factor is his age (over 80, with 15% mortality rate according to Chinese demographics). I’ve asked local authorities to be prepared because I do not trust the federal response. We’re very vulnerable in this geriatric-skewed town - vulnerable to the federal incompetence and presidential dissembling as well as vulnerable to this novel virus. We have a large institutionally housed geriatric population with varying levels of quality of care. We’re sitting ducks.
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@RP Agreed! and not just elderly. Homeless, immigrants, migrant workers, Native persons, those in rural and innercity areas, children, the poor, blind....anyone vulnerable to healthcare disparities should be the top priority for care of a first world country, not Jeff Basos/billionaires and the like!
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