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.
Read: The people ignoring social distancing
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.”