Nursing homes became an elder care flashpoint during the Covid-19 pandemic, and while some of the problems were brought on by the virus, others reflect longstanding issues and a lack of regulatory oversight, industry stakeholders told members of Congress this week.
Nursing home workers, policy experts and relatives of people who died were among those who testified before the Select Subcommittee on the Coronavirus Crisis, which held a hearing on Wednesday.
Dr. David Grabowski, professor of healthcare policy at Harvard Medical School, described “dire conditions” in nursing homes in 2020. The pandemic “lifted the veil on nursing home care in America,” he said.
Grabowski shared research with the committee concluding that Covid-19 outbreaks in nursing homes were largely a function of where in the country a nursing home was located versus other specifics about the facility.
“This does not suggest there was nothing that could have been done to prevent Covid outbreaks,” Grabowski said. “Rather, it suggests that policymakers needed to adopt a system-level approach to address this problem,” Grabowski said.
Adelina Ramos, a certified nursing assistant at a nursing home in Rhode Island, described the conditions in the nursing home in the spring of 2020. She recounted to the committee that while working with residents who couldn’t eat, drink, get out of bed or go to the bathroom without help, and who required oxygen to be changed every 15 minutes, she had to “make impossible choices about which residents to help” because the facility was understaffed.
Ramos is now a member of a nursing union, which she attributes to improved working conditions, including paid sick leave and better health insurance. But she said it’s up to the government to look at this struggling industry and provide oversight.
“We want guidelines to ensure that we have safe staffing levels more often,” Ramos told the committee.
“The majority of nursing home workers are women and people of color and we are often called unskilled and uneducated,” Ramos said. “Our jobs are devalued and it’s disgraceful that after two-and-a-half years of a daily pandemic we are still treated this way and we are fed up with the lack of respect from nursing home owners and lawmakers, so our workforce change needs to happen now.”
Racism and structural inequities affect both staff and nursing home residents alike, according to witness Dr. Jasmine Travers, assistant professor of nursing at NYU.
She cited research showing that halls with any black residents experience significantly more Covid infections and deaths than homes with no black residents. This was a problem highlighted during the pandemic, but not created by it.
“Beyond the pandemic when compared to their white counterparts Black or Latino residents are likelier to experience pressure ulcers falls and under treatment for pain, ordered anti-psychotics, put in restraints and are less likely to receive preventative care,” Travers said. Residents who identify as LGBTQ+ and are living with dementia often do not receive required care, Travers said, because of limited staff knowledge, training and a failure to hire staff that is “culturally congruent” to residents.
She recalled the pungent smells that “stung” her nose when visiting nursing homes during the pandemic because the Centers for Medicare and Medicaid Services waived inspection requirements.
“I urge the subcommittee to recognize that older adults do not want to stop living, although they might need help living,” Travers said.
Several witnesses blasted the failure of former New York Gov. Andrew Cuomo to address the crisis in nursing homes, saying he was preoccupied with a book deal. One committee member, Rep. Steve Scalise, R-Louisiana, asked the witnesses for statistics on whether New York nursing homes were pressured to not follow CDC guidelines, after hearing many accounts about Cuomo’s failure to address nursing homes in the state while he was in office.
Though none of the witnesses had statistics on hand about the direct impact of the governor’s orders on nursing homes, one New Yorker described how the virus affected his family.
Daniel Arbeeny, a Brooklyn resident, said in one week in April 2020 four of his family members died from Covid-19, including his father, uncle, and two cousins. Three were in nursing homes. Arbeeny cited guidance he received from the nursing home where his father was that said he needed to bring his father home, where it would safer there than the nursing home. He said the nursing home had been instructed by New York regulators to readmit Covid-19 positive residents to their facility even if they were unequipped.
“It was like a hurricane. I have no other way to describe how my family came together and made a plan,” Arbeeny said, recalling when he received the news from the nursing home that his father would be safer at home. “We were in a race for our lives and we knew it,” though his father eventually died at 88 from the virus while at home a week later.
Rep. Scalise said he would find answers and statistics about directives from the New York regulators that influenced the decisions affecting those like Arbeeny and his family, and would hold to account the authorities that abandoned New York nursing homes.
The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The foundation released a statement following the hearing saying it was “a critical step toward accountability and action to improve America’s nursing homes.”
Photo: Tempura, Getty Images