Harrowing Blame Game

floridapolitics.com

Nearly 4 in 10 people who have died from the COVID-19 outbreak in the United States have been residents and staff at nursing homes and other long-term care facilites—45,000 out of 115,000 total deaths as of this writing. This points to a major concern for readers of SeniorLifestyle, some who may already have been personally affected by that news, all who need to be aware of the added problems related to health care as we age and the need to give serious attention to wellness long before hitting "the second half" of life.

An Associated Press report by Ricardo Alonso-Zaldivar in our local paper today addressed this issue. It begins:

WASHINGTON -- A grim blame game with partisan overtones is breaking out over COVID-19 deaths among nursing home residents, a tiny slice of the population that represents a shockingly high proportion of Americans who have perished in the pandemic.

The Trump administration has been pointing to a segment of the industry -- facilities with low federal ratings for infection control -- and to some Democratic governors who required nursing homes to take recovering coronavirus patients.

Homes that followed federal infection control guidelines were largely able to contain the virus, asserts Seema Verma, head of the Centers for Medicare and Medicaid Services, or CMS, which sets standards and pays the bills. "Trying to finger-point and blame the federal government is absolutely ridiculous," she says.

Verma says data collected by her agency suggest a connection between low ratings on safety inspections and COVID-19 outbreaks. But several academic researchers say their own work has found no such link.

Advocates for older people say the federal government hasn't provided needed virus testing and sufficient protective gear to allow nursing homes to operate safely. A White House directive to test all residents and staff has been met with an uneven response.

"The lack of federal coordination certainly has impeded facilities' ability to identify infected persons and to provide care," Eric Carlson, a long-term care expert with the advocacy group Justice in Aging, told lawmakers. "That absence remains important as facilities are attempting to open up, which requires an extensive reliance on testing."

Alonso-Zaldivar then goes on to descirbe the back-and-forth blame game between Democrats and Republicans, agencies and health-care providers, at the federal and state levels. You can read that secion in the full report. With so much focus in the media and public concern for fixing blame, the following was significant:

But Harvard researcher David Grabowski, who serves on a nonpartisan commission advising Congress about Medicare, says neither state policies, nor "bad apples" among nursing homes, have driven the outbreak.

Instead, Grabowski says it's simpler: Because the virus can be spread by people who show no symptoms, that means if it's already in a community, the staff can unwittingly bring it into the nursing home. Once inside it easily spreads among frail residents living in close quarters.

"The secret weapon behind COVID is that is spreads in the absence of any symptoms," Grabowski told lawmakers at a recent briefing. "If COVID is in a community where staff lives, it is soon to be in the facility where they work."

He proposed a federal effort to regularly test nursing home staff and residents, along with greater supplies of masks, gowns and other protective gear.

"The federal government needs to own this issue," said Grabowski.

He said his own research, along with studies by experts at Brown University and the University of Chicago did not find a relationship between facilities with low federal ratings and COVID-19 outbreaks.

At a retirement community near us, with nearly 500 residents, the occurence of COVID-19 and deaths associated with it were largely confined to the skilled nursing area and assisted living. It is my understanding that such nursing facilities within retirement communities may take patients from local hospitals who are not residents of that community, thus representing the threat of introducing a virus into an otherwise safe (but vulnerable) environment.

As an example, in my own area, DuPage County, Illinois (a "collar county" west of Chicago), I have been following the county's COVID-19 Dashboard. One chart shows cases by community.

• Of the 37 communities included, 14 had "outbreak associated deaths" far in excess of "community deaths." All of those communities have hospitals, nursing homes, or retirement communities.
• 18.3% of cases but 75.8% of deaths have been associated with long-term care facilities in DuPage County.
• Similarly, 28.6% of cases and 87.0% of deaths reported in DuPage County had underlying medical conditions.

An interesting sidebar to this discussion is the impact on black and Hispanic/Latino populations. Even before the George Floyd incident intensified attention, it was already being widely reported that people of color—blacks in partiular—were suffering a greater burden under COVID-19 than whites.

• In DuPage County, Hispanic or Latino cases at this date are 5.5 times higher than non-HIspanic/Latino.
• The mortality rate among Hispanic or Latino residents, however, has been 1.1 times lower than the non-Hispanic or Latino residents.
• Cases among black residents of DuPage County have been 2.1 times greater than whites and 1.7 times higher than Asian residents. The hardest hit sector by far is blacks age 80 or above.
• The mortality rate among blacks is 1.5 times higher than white residents, but 2.3 times higher than Asians.

The AP report concludes with the following observation and a single anecdote that captures the tragedy of COVID-19 experienced by too many around the world::

Rep. James Clyburn of South Carolina, the third-ranking House Democrat and chairman of a special panel on the pandemic, says the crisis in nursing homes should not be a partisan issue.

"Nursing home residents have died from the coronavirus in states governed by Republicans and Democrats, in big cities and in small towns, in rural and urban communities," Clyburn said.

Appearing before Clyburn's committee last week, Alison Lolley of Monroe, Louisiana., told of losing her 81-year-old mother, Cheryl, to COVID-19 in a nursing home outbreak this spring. The family was not allowed to be with her.

"My family was robbed," Lolley said. "Mama was trapped in a petri dish, and we were shut out. Mama died alone and our family will forever be scarred by this tragedy."

This article was first posted on Stu's InfoMatters blog.