The frail residents at these facilities are obviously especially susceptible to a lethal virus. But structural weaknesses endemic to America’s long-term-care system—underinvestment, understaffing, and the use of low-wage employees—have made a dangerous situation much more deadly, health-policy experts say. So has the government’s response to the virus: The initial epicenter of the pandemic in the United States was a nursing home outside Seattle, where at least 40 residents have died of COVID-19. Yet following that outbreak, health officials did not prioritize the residents and staff of such facilities in the rest of the country to receive lifesaving testing and equipment.
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“Nursing-home residents aren’t getting half of our resources or half of our attention, yet they account for roughly half the deaths,” David Grabowski, a health-care-policy professor at Harvard Medical School, told me. This, he said, reveals—or maybe reinforces—a devastating truism about American society: “We don’t value their lives as much as other people’s.”
Jim Wright, the medical director of a publicly funded nursing home in Virginia, was more blunt. “We’re literally killing elders now, through our lack of funding,” he told me. “It’s not metaphorical.”
Wright’s facility, Canterbury Rehabilitation and Healthcare Center in Richmond, had its first suspected case of the coronavirus on March 11, well before states and cities nationwide shut down. The sick resident, a man living on a floor with 50 other people, was immediately quarantined in a special wing of the facility. In the days that followed, 131 other residents would test positive for COVID-19.
“They were just dropping so fast; we felt helpless,” Nina Gwathney, a licensed practical nurse who has worked at Canterbury since 1982, told me. Overwhelmed employees soon began to quit in droves, causing a critical staffing shortage, and Gwathney spent her days running back and forth between rooms—taking temperatures, passing out Tylenol, fielding phone calls from worried family members. “We were getting overworked,” she said. “We were walking around the building just literally crying.”
By the first week of April, Canterbury was able to beef up staffing by recruiting through an outside agency. But the damage had already been done: More than a dozen residents in Gwathney’s unit were dead. From March 11 until the outbreak calmed down earlier this month, Canterbury lost 49 residents to the virus—a 37 percent mortality rate.
Adequate funding really matters in this crisis: It can’t prevent the virus from entering a facility, but it can determine the staff’s ability to respond, Wright told me. “If you’re looking for the perfect scenario for a virus to pass quickly through a population and kill a lot of them, look no further than a publicly funded nursing home.” Most of Canterbury’s residents, as is the case in many nursing homes, pay through Medicaid, which provides the facilities with limited reimbursement. That underfunding means that many residents live in cramped quarters, forced to share bedrooms and bathrooms, which can make limiting the spread of infection difficult. (In October, the Richmond facility was cited for violating infection-control protocols. The center came under new ownership earlier this year, and a survey conducted in February, before the COVID-19 outbreak hit, reportedly found no deficiencies.)