Lucian Leape was losing patience. Brookhaven, the senior-living facility where he is a resident, had imposed strict social-distancing rules in March to prevent the spread of the coronavirus, but as recently as last week, according to Leape, some residents were still driving off campus and congregating in small groups. One met with family members who had delivered food. Another got in a car accident.
Brookhaven is an upscale community in Lexington, Massachusetts, where most of the buildings take their names from local colleges and prep schools. (Exeter shares a courtyard with Harvard on one side and Amherst on the other.) So many of its residents once taught at Harvard, MIT, or Tufts that it has been described as a “geriatric university.” Compared to many nursing homes and assisted-living facilities, it has fared relatively well during the pandemic so far. But last week, two more residents tested positive for COVID-19, bringing the total case count to four, half of whom are known to have ventured off campus. Leape, a former public-health professor at Harvard, convened a group of residents who are former physicians and health experts. On Thursday, they made an announcement.
“For the sake of our community, we are taking a drastic step,” Leape wrote in an email obtained by The Atlantic. “With this notice, we are asking everyone to confidentially report … the name of any resident whose behavior appears to be a threat to our safety.” The group would then consult the reported resident to judge whether their behavior posed a threat and, if it did, urge them to stop. If the resident refused, the group would publish their name to the Brookhaven listserv so that other residents would know to avoid them.
The email was, in effect, asking residents to tattle on each other for failing to socially distance. (Brookhaven administrators did not respond to multiple requests for comment.)
It is a particularly surreal episode in an already surreal time: A policy that just a few months ago would have seemed like a dystopian surveillance tactic could now seem, quite plausibly, like a necessary public-safety intervention. Whatever the risks and implications, Leape, for his part, thinks there comes a point when matters of life and death transcend privacy considerations. “We’ve been dealing with this problem for more than a month, and we just finally said, ‘You know, lives are at stake,’” he told me. “The individual has a right to put their own life in jeopardy if they wish. We don’t think they have a right to put our lives in jeopardy.”
The Brookhaven residents’ policy is not without precedent. In February, at the height of China’s outbreak, local officials in the city of Shijiazhuang offered payments of up to $290 to anyone who narced on people violating travel restrictions. In the United States, Sedgwick County, Kansas, set up a hotline and an online form for reporting businesses and residents that defy stay-at-home orders. The mayor of St. Louis urged residents to tell authorities about any people or businesses disobeying restrictions on social gatherings. And New York Mayor Bill de Blasio has exhorted his constituents to snap photos of social-distancing violations and text them to the city. “This is not snitching,” he said. “This is saving lives.”
None of the half-dozen interest-group and industry-association representatives I spoke with for this article had heard of senior-living facilities employing such tactics. But it is in some sense unsurprising that these communities—where elderly residents living in close quarters have already made trade-offs between safety and independence—should be the crucible for some of the nation’s most aggressive enforcement of social distancing. The first reported COVID-19 outbreak on American soil occurred at a nursing home. Since then, the pandemic has killed more than 40,000 people in the U.S., about a fifth of them linked to senior-living facilities. Last week, at a nursing home in small-town New Jersey, police found 17 bodies stacked in a morgue made for four.
That’s not to say that facilities haven’t taken precautions. Many have forbidden visitors, canceled communal dining, and screened staff for symptoms upon entry. They have encouraged residents to stay in their rooms when they can and wear masks when they cannot. Facilities are doing their best, industry leaders told me, but their efforts have been hamstrung by shortages of funding, testing, and, above all, personal protective equipment. According to Jeff Horton, the executive director of the North Carolina Senior Living Association, staff members have in some cases stopped showing up after rumor gets around that someone has the virus. In others, they have decided that their meager pay is not worth the risk of working. A Southern California nursing home was evacuated earlier this month after employees didn’t come in two days in a row.
Brookhaven, unlike many of its competitors, has no shortage of personal protective equipment. Nor has it had trouble with staff absences or scarce funding, Leape told me. Over the past month, it has ramped up social-distancing measures to the point that staff members hardly have contact with residents, except when delivering food and groceries to their rooms. And still, people have gotten sick.
While most residents have conscientiously followed the guidelines, Leape said, a few have not—even after their neighbors tried to persuade them. Since announcing the policy on Thursday, he told me, the group has not received any reports of misbehavior. What he has received, to his surprise, are thank-you notes from residents.
When I asked industry leaders and experts what they made of the policy, it got a decidedly cooler reception. Janine Finck-Boyle, a former nursing-home administrator and the vice president of regulatory affairs for the senior-living-industry association LeadingAge, said she would never have approved it. The way to change behavior is communication, she told me, “not posting a resident’s name up like a scarlet letter.” If efforts to persuade a resident failed, she would enlist the help of their family or close friends. (When I asked Leape about this approach, he said it was a good idea and that he would consider it if the group receives any reports.)
If persuasion fails, facilities should consider notifying their local public-health agency, said David Gifford, the chief medical officer at the National Center for Assisted Living, one of the nation’s largest nursing-home- and assisted-living-industry group. As a last resort, Gifford said, a facility can in certain cases discharge and transfer residents who pose a serious threat to their neighbors.
Public-health experts I spoke with voiced two main concerns with the Brookhaven residents’ policy. First, there’s the difficulty of balancing the safety of the community with the freedom of its members. “I always worry when we use citizen informers to try to enact sanctions for public-health violations,” said Lawrence Gostin, a professor of global-health law at Georgetown University (and a recent contributor to The Atlantic). “I think that’s the kind of intrusive surveillance and Big Brother eavesdropping that are really contrary to American values.”
Second, there’s the perhaps even more pressing question of whether such a policy even keeps people safe. Lindsay Wiley, a law professor at American University who has studied the use of shaming tactics in the context of various public-health issues, said their long-term damage can outweigh their short-term benefits. “In general there’s a concern that that shaming approach erodes public trust and widespread cooperation,” she told me. “People will comply out of a sense of fear of getting caught or fear of social approbation or judgment, but you may be sacrificing long-term cooperation by doing that.” With no end to the pandemic in sight, she added, that is not a sacrifice we can afford right now.
Leape understands these risks. Under more normal circumstances, he told me, he would never have considered asking residents to report each other. But nothing about this moment is normal.
“Different political opinions, different ideas of policy—fine, fine,” he told me. “But we’re not talking about that. We’re talking about threats to life. And that changes the whole equation as far as I’m concerned.”
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