A tragedy is unfolding in the world’s nursing homes that’s only partly being accounted for in official data.
Common infections in nursing homes: a review of current issues and challenges
Over 1.5 million people live in 16,000 nursing homes in the USA and experience an average of 2 million infections a year. Infections have been associated with high rates of morbidity and mortality, rehospitalization, extended hospital stay and substantial healthcare expenses. Emerging infections and antibiotic-resistant organisms in an institutional environment where there is substantial antimicrobial overuse and the population is older, frailer and sicker, create unique challenges for infection control. This review discusses the common infections, challenges, and a framework for a practical infection prevention program. Now COVID-19 is killing American in nursing homes at record numbers per day!!
For more information go to https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/SNFsCOVID_19.aspx and see California nursing homes with COVID-19 staff and patients.
In one day last week, France’s official death toll from Covid-19 rose by a staggering 1,355. The cause was not just the severity and speed of a coronavirus disease that has infected more than 1 million people and killed 50,000 around the world, but also the brutality of fresh data. The new tally included 884 deaths in nursing homes that had gone uncounted since the start of the crisis.
While that should stoke concerns over the quality of the statistics the general public and policy makers are poring over every day — and on the likely under-counting of deaths — it should also alert us to an unfolding tragedy happening on the pandemic’s front lines. It’s not just hospitals that need help, but all institutions that care for the frail and infirm.
The numbers trickling in point to a sizable number of virus victims who are dying away from hospitals. The latest count shows that nursing homes account for about one in four Covid-19 deaths in France, or 2,189 out of 8,078 total. In one part of the Grand-Est region, total reported deaths (from all causes) rose by 73% in one week last month.
There are similar stories all over the world, though differences in reporting methodology make it hard to build a full picture. In New York City, one in four Covid-19 deaths is in a nursing home. The Life Care Center in Washington state at one point accounted for more than half of the national U.S. death toll, according to media reports. As of last week, approximately a third of Spanish Covid-19 deaths came from nursing homes. In Italy, one study estimated that of nursing home residents in the Lombardy region who died since Feb. 1, half either had the virus or its symptoms.
It’s clear that these centers are painfully vulnerable to the new coronavirus because of the age and underlying health conditions of their residents. A multi-country analysis of virus-related deaths shows the over-60s, over-70s and over-80s are most at risk. In France, the average age in homes is 85, while in the U.S., more than two-thirds of residents are over 75.
However there are many aggravating factors in care homes that merit urgent attention, even in countries with sizable public health-care sectors and state-run homes. There’s a reported lack of medical equipment such as masks or gowns, which makes it harder to stop infection transmission between young workers and the people they care for. There’s also not enough staff, reflecting years of health-care spending stagnation even as populations have aged. And in this pandemic, the broader strain on hospital resources and intensive-care beds means nursing homes are sometimes left to their own devices to care for the elderly who’ve been infected.
This should be top of mind for policy makers, who are now confronted with horrific stories that are every family’s worst nightmare. When the army in Spain mobilized to disinfect nursing homes last month, it found some patients lying in squalor and others left on their death beds. In the U.S., the Life Care Home now faces more than $600,000 in fines over its handling of the outbreak, which regulators say put people in danger. It’s not just the unforgiving nature of the virus that’s being brought to light, but the quality of care the elderly receive.
There’s a resource crunch here that goes beyond Covid-19. When nursing-home workers in France went on strike in 2018, they brought to light how their pay, training and equipment haven’t matched the increasing age and complex health issues of the people they care for. In the U.S., personal-care workers are paid a median rate of $11.57 per hour. “You’re going off to war and you’re in a battlefield where supplies are limited, the help is slow to get to you, and there’s a lot of casualties,” according to a nursing director in Washington.
The use of lockdowns in many countries to limit the spread of the virus — often due to a lack of testing resources — has also turned the concept of the care home on its head. Not only are they vectors of infection, but they’ve become prisons too, with many residents confined to their rooms and carers reduced to the role of enforcers. Families the world over are being cut off from their elderly relatives, sick or well. Heart-wrenching loneliness, the deepest fear of nursing home residents, is now prescribed as preventive medicine. We are reminded daily of what doctor and author Atul Gawande described in his book “Being Mortal” as the choice facing us as we age: “Yielding all control over our lives” to be kept safe in a home, or “going down with the volcano” to live freely, yet at greater risk.
The ultimate cognitive dissonance of Covid-19 is that it forces us to behave inhumanely to save lives. Three months without seeing your family can also kill, as one care-home specialist in France put it. Adding to the suffering, those who die do so without their families present, and some countries have banned funerals altogether. This cuts deep: Burial rites are at the core of humanity. 2020 is the year of dying, and living, alone.
A lot of this pain will eventually pass. Once lockdowns are lifted, and the virus is gone, families will reunite and find the best way to remember those they lost. But the resource strain facing workers in nursing care will still be there. They need extra support, not just in the current battle against Covid-19, but in the wider struggle of curative and palliative care. This isn’t just about a temporary epidemic, or mortality rates, but about what makes us human.