I love Rachel Maddow, and I especially love her reporting during this pandemic on the horrific toll COVID-19 is having in nursing homes nationwide.
As she has reported, nursing homes account for a significant portion of deaths from this disease, as much as 50 percent in some localities. The mortality rate among those infected in nursing homes is conservatively about 25%, well above the overall national mortality rate of about 11%.
Rachel is absolutely right that this disease is wiping out the elderly in care facilities at an alarming rate — Geriatric Genocide — and the federal government is doing little about it. States are trying to respond, but are a little overwhelmed themselves.
But despite her Peabody Award level reporting on the crisis in nursing homes and residential care facilities, Rachel is exhibiting a fundamental naivete and lack of knowledge of how nursing homes work that has her operating in fantasy-solution territory.
Her constant drumbeat has been more federal aid, more medical professionals, more testing, more isolation, but I’m not quite sure she understands the basics of the nursing home industry. And, I suspect, I doubt she’s actually spent much time dealing with the nursing home environment herself.
I, unfortunately, have had more experience dealing with nursing homes than I wish, and here are some facts I think Rachel needs to understand.
1) Most nursing homes in the U.S. are either part of for-profit chains or non-profit entities that expect the nursing homes to operate without subsidies. They have to make enough money to sustain themselves.
2) Most such nursing homes are operating on a shoestring. Pay is minimum-wage low, staffing is minimal, supplies are the cheapest available and are tightly rationed, and in most cases the facilities barely meet state regulations (and, frankly, the for-profits have managed to consistently water down those regulations).
3) Staffing in nursing homes is closer to home health workers than professional nurses. The typical employee’s job description involves more maid than nurse, helping the patient with personal hygiene and daily functions like showering and going to the bathroom, changing sheets, bringing meal trays and making sure the patient doesn’t fall. High on the list is making sure the nursing home doesn’t get sued. Very little nursing takes place except by the very limited medical personnel, most of whom are not staff but visitors. Turnover is high among the day-to-day staff. Just look at the classifieds in your local newspaper and see how many nursing homes are advertising for staff. This is not a put-down of nursing home workers. It’s a put-down of what we have allowed the nursing home industry to become.
I mention this especially because Rachel’s well-taken point is that nursing home staffers are getting the virus at an incredible rate. Her solution is for the government to step up and hire replacements. This shows her naivete. Most nursing homes can’t hire fast enough to maintain staffing levels in the best of times. Yes, getting the feds to pay is a good idea. But there simply aren’t the bodies available to meet the need, even in the worst of economic times, like now. And report after report confirms that staff in most nursing homes are not able or qualified to do the testing required to stop the virus’ spread.
4) Nursing homes are painfully slow to respond to anything, partly because of regulations, partly because of lack of staff, partly because management naturally resists change, partly because of “we’ve always done it this way,” and, unfortunately, partly because of profit motive – even in non-profits. So, many homes were in denial as COVID-19 spreads through their facility, many were paralyzed into inaction, many tried to ignore or hide the problem (the story of the nursing home with bodies stacked in a storeroom may be the most heartbreaking), many feared closure if they acknowledge the problem and some just exhibited callous disregard for patient safety in the face of lost revenue. In our area, the story that most shocked me is that the Rolls Royce nursing home, the one that almost every senior citizen desires to live out their life in, the most expensive, has the highest infection rate and the highest number of deaths in the state. If the best is the worst, imagine what’s happening in the worst.
4) Nursing homes are a huge drain on Social Security, Medicare, Medicaid, and state and federal resources, all things that Republicans would love to dispense with. Does anyone seriously believe the federal government under Trump and McConnell is going to lift a finger to stop this Geriatric Genocide? Naively, Rachel does.
Make no mistake, Rachel Maddow’s heart is in the right place. Her passion is sincere and her cause is just. But this is a case where she needs some boots-on-the-ground education. She needs to put on her mask and get out the studio and visit some nursing homes rather than just interview nursing home employees and advocates via Zoom.
Solving this nursing home coronavirus crisis is not going to be easy. Trying to do it from the safety of a TV studio is impossible. But I am supremely confident that if Rachel Maddow gets out in the field and does a Richard Engle-style investigation, the earthquake she causes in Washington will be felt nationwide.