What’s Behind the Nursing Home Horror

After decades of mistreatment, older Americans are bearing the worst of the pandemic.

By Charles C. Camosy
Dr. Camosy teaches bioethics and moral theology at Fordham University.

Emergency medical technicians transporting a patient from a nursing home to an emergency room bed at St. Joseph's Hospital in Yonkers, N.Y., on April 20th.Credit...John Minchillo/Associated Press

We knew it from the beginning. A nursing home in Washington State was the center of the first known coronavirus outbreak in the United States. We knew that institutions caring for the elderly and disabled in close quarters would be particularly vulnerable during the pandemic.

But we did not act. Personal protective equipment, special training and extra staff went almost exclusively to our critical care facilities. Nursing homes got virtually nothing. Well, that’s not entirely true. In New York and other places we gave them patients, and even nurses, infected with the virus.

The result has been a raging wildfire of infection and death. We don’t have full reporting of anywhere close to all the deaths at this point, but the best estimates right now are that about half of those who have died from Covid-19 have been nursing home residents. In some places, it’s much more: Connecticut reported that nearly 90 percent of its Covid-related deaths between April 22 and April 29 occurred in nursing homes.

We tend to see this as a public health failure, but it is also a moral failure. That fact hit me recently, after I went on Fox News’s “Tucker Carlson Tonight” to talk about the plight of nursing homes.

Even before the pandemic, these were places where what I call “throwaway culture” was thriving. The staff aren’t paid a living wage, often have poor training and are hopelessly overworked. The residents face elder abuse, and large percentages of them are desperately lonely. A good number get no visitors at all, which pushes rates of dementia among residents to unbelievable levels.

I suggested to Mr. Carlson’s audience that it was no surprise that throwaway culture kicked into hyperdrive in nursing homes during our current moment. I was excited to be able to make my case to a national audience; afterward, I was exhausted. All I wanted to do was help my wife get our 2-year-old to bed and go to sleep myself.

But that’s when the messages started coming in. Email. Facebook messenger. LinkedIn. Twitter. One after the other after the other. And they were horrifying.

It is one thing for a professor of bioethics to cite abstract numbers and trends and offer a theoretical explanation for them. It is another thing to get message after message detailing the human toll of what you had just discussed.

One of the most moving — and frightening — was from a nursing home staffer. She said she was given inadequate P.P.E. and training, and had likely been exposed to the virus. Her communications with management were ignored. Staff members at her facility were not being tested. She decided to quit her job rather than risk infecting her residents. “I don’t know if you can help me,” she said. “I feel that what you said is true; the elderly need a voice by someone that cares.”

Another correspondent, who had worked in health care administration, said that she was “not surprised in the least that the hospitals were trying to discharge their Covid-19 infected patients” back to long-term-care facilities because, in her experience, this has “been happening for quite some time.” It got worse: Agreeing with me about the radical understaffing of nursing homes, she said that it is “increasingly common is to discharge high cost and difficult patients to homeless shelters … Yep, you heard me right … HOMELESS SHELTERS.”

Not every story was coronavirus-specific. One man told me the story of the fatal neglect of his father — after which the nursing home falsified his father’s records and hid behind state laws that nursing home lobbyists had written.

A former director of nursing at a long-term-care facility said that given her terrible professional experiences, she had refused to put her 78-year-old husband, who was suffering from dementia, anywhere outside her own home. Another clearly frightened woman explained that she had just had a horrible experience with her mother in a nursing home; she even gave me, a complete stranger, her phone number, in the desperate hope that I could raise the alarm about how bad things were.

We need to listen to people like this and act on what they are saying. The pandemic doesn’t have many silver linings, but as the number of nursing-home deaths piles up, the news media is being forced to cover a world many of us would prefer to ignore.

It is understandable that we would. Part of the price we pay for living in a death-denying, consumerist, throwaway culture is that we must push these kinds of grim realities to unseen places that afford us plausible deniability. The pandemic forces us to look. If we want to understand the current phase of the coronavirus pandemic, we can no longer look away.

After receiving this waterfall of messages, I expected to fall into despair. But while I do have my bad days, I also have hope. Times like this have produced major cultural changes in our past. If we do take a hard look, we may change more than just the way we treat older Americans. We may, along the way, find a way to push against throwaway culture in all its forms.

Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us? To honor the moral and social equality of every human being, regardless of their mental or physical status?

Why not? Many of us are staying home and practicing physical distancing, not primarily for ourselves but for the benefit of our elders and others who find themselves at risk. Let us build on that good and decent impulse by challenging a throwaway culture that, right up until this very moment, has marginalized these populations and made the nursing-home crisis a tragic inevitability.

Charles C. Camosy (@ccamosy) is an associate professor of theological and social ethics at Fordham University. His most recent book is “Resisting Throwaway Culture.”

Full Article & Source:
What’s Behind the Nursing Home Horror

NYC nursing homes forcing residents into homeless shelters

Editor’s note: This article is the second in a three-part series examining how and why New York’s nursing homes too often fail to keep their residents safe. Read the first part here.

Robert Negron, 60, has been shuttled between more nursing homes than he can remember – at least six and perhaps as many as 20 – before landing in his current bed at Beth Abraham Health Services in the Bronx. The instability has been wearing on Negron, a Crohn’s disease patient who uses a wheelchair and needs regular attention for an unhealed wound on his foot and chronic skin ulcers – but it’s still better than being in a homeless shelter, he would say.

“In the shelters it's dirty, it’s nasty. You could not get enough medical attention and lose a limb,” Negron said, explaining how the unsanitary conditions at the men’s shelters on Ward’s Island, over the 10 years he occasionally stayed there,put him at risk. Although he visited a clinic for care and did the best he could to change his own bandages, “There were times when my foot was really bad,” he said. A New York City Human Resources Administration spokesman said that since Negron’s stay, “substantial improvements” have been made at that shelter.

Yet nursing homes, Negron said, have forced him into city homeless shelters three times. While there, the only thing that concerned him more than the lack of medical care were the people around him.

“They victimize you,” Negron said. “The criminals and the undesirables, they prey on the homeless disabled.” Once, he said, another man assaulted him in the shelter when he refused to hold drugs for him.

Negron’s case is an extreme one, advocates for the disabled say, but he is not alone. His experience is illustrative of a long-standing practice of nursing homes placing residents into New York City’s Department of Homeless Services shelter system. These vulnerable New Yorkers often have chronic medical conditions that have improved little, advocates say, but are moved to shelters that are poorly equipped for ailing individualsand are rife with violence.

Long-term care advocates are alarmed by a sudden spike in the number of older adults who report being forced out after having received nursing home care for many months or years. Although the city keeps no official statistics on transfers from nursing homes to shelters, advocates say there is evidence that the figures are rising.

In March, Gov. Andrew Cuomo called the city’s homeless shelter system “deplorable” and “dangerous,” citing recent news reports that show high numbers of assaults. The city has taken steps to try to address these issues, most recently opting to retrain shelter security staff in order to manage the violence.

“We are in the throes of a homelessness crisis in New York City … and we are watching people being poured into the shelters from nursing facilities,” said Susan Dooha, executive director of Center for Independence of the Disabled, New York. These often frail individuals, she said, “cannot be cared for in the shelters,” where there is no skilled nursing care and part-time clinics offer what is often the only medical aid available.

Nursing homes are required by state law to ensure all transfers are made to a safe place. For that reason, Dooha said she “cannot fathom” how nursing homes could send their residents to the city’s homeless shelters. Beyond that, Dooha said, federal protections were also being trampled.

When reached for comment, an HRA spokesman said “no one” should have been transferred from a nursing home to a shelter “if the needed medical treatment is not available at that shelter.”  (Continue Reading)

Full Article & Source:
NYC nursing homes forcing residents into homeless shelters