Beginning with the outbreak of COVID-19 at a nursing home in Kirkland, Washington, policymakers were on notice as to the contagiousness, and lethality, of the virus in a congregate care setting with residents who are medically fragile.
The nursing home resident population is very elderly, with 41.6 percent of all residents 85-or-older according to the most recent federal data. New Hampshire is one of 10 states where more than 10 percent of nursing home residents are 95-or-older. Prior to the pandemic, I traveled around to my state’s nursing homes to interview centenarians.
One of the disturbing findings in Washington was reported in the New England Journal of Medicine: “More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission.” The stealthy nature of COVID-19 made it immune to the infection control procedures of nursing homes that had been so successful in the past against contagions such as the respiratory flu or the norovirus.
What was known about COVID-19 makes it inexcusable that some policymakers, including the governors of New Jersey and New York, insisted on bringing it into nursing homes, by forcing facilities to take COVID-positive hospital discharges, even as a state like Louisiana barred facilities from admitting hospital discharges positive with COVID-19.
Health experts warned against the consequences, beginning with a March 26 article in the Wall Street Journal. But it was clear nursing homes were to be sacrificed to free up hospital capacity.
While New York Gov. Andrew Cuomo in April described the nursing home setting as a “feeding frenzy for this virus,” that did not cause him to change his administration’s policy of continuing to feed the virus new victims. It was only in May that Cuomo finally rescinded the policy, a point at which the worst was past for New York’s hospitals — but unimaginable horrors had occurred in the state’s nursing homes.
It was reported by the Wall Street Journal on May 14 that “[d]espite the homes’ elderly, frail populations, the state long put its major focus on the safety, staffing and supplies of hospitals, according to researchers, consumer groups and nursing-home executives.”
And, typically, Cuomo did not apologize for the tragedy his administration had created.
Instead, as the New York Post editorialized, Cuomo “ordered an investigation that’s plainly supposed to pin all the blame on nursing and adult-care facilities: It’s led by state Attorney General Tish James, who got her job with Cuomo’s crucial assistance — and it’s only looking at what homes did wrong.”
In March, the Medicare Payment Advisory Commission’s annual report to Congress had found that the nursing home sector operated at a loss in 2018 for the first time since 2000. Now Cuomo, who has actively worked to cut nursing home funding, is ordering nursing homes to pay for a twice-weekly testing regime — an unfunded mandate with new costs that reportedly might be as high as $60 million a week for the beleaguered sector.
Cuomo may yet succeed in decimating the safety net for New York’s most vulnerable citizens. It is small wonder that nursing homes, and their heroic staff members, feel abandoned amidst this pandemic.