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Tragedy and hope for nursing homes
By Richard C. Bane
To say these times are challenging in the nursing home business is the understatement of the millennium.
We are only four weeks into this and it feels like four decades. And we have many more weeks of challenge ahead of us. I don’t have to tell you about the virus per se. There is so much information that we are all on overload. And by now it is becoming obvious to the world, as it was to me four weeks ago: the bull’s-eye of the virus is aimed at frail elders.
Our family has been in the nursing home business since 1959, when my dad, George, who passed away last fall, started out to care for what was becoming, and now is, the fastest-growing demographic. The business was a good one, in deed and in reward for nearly 40 years, but as federal and state governments became more involved as payers of the care, reimbursements slowed, so not only did the rewards diminish (and recently disappear), but providers like myself had fewer resources to provide the care, and the foundation of the entire nursing home care sector was weakened, including diminished quality of care to those who needed it the most. Nursing homes had a bad stigma, some would say well deserved, of being places to go to die. In some cases, less committed and more unscrupulous providers contributed to that stigma, and those of us who stayed on the high road were painted with the broad brush.
Either way, underneath the public sentiment was the fact the sector was getting weaker, overall care wasn’t as good as it once was, and in general, we (nursing homes), became old houses in poor repair, both physically and operationally. However, and in spite of it all, the emotional commitment of the mostly good providers and the front-line nurses, nursing assistants and their supporting colleagues, remained at an all-time high. Those sweet little old lady caregivers of the 1970s were replaced by new Americans in the 2000s, for whom many saw nursing homes as a place to contribute to a new society and validate the values of their heritage. Nonetheless, underneath this goodwill, was a wobbly base in need of overwhelming repair.
Onto this fragile house, came an inevitable calamity in the frightening form of the coronavirus. It hit (and is hitting) hard, and is like the tornado in Kansas which ripped Auntie Em’s house off its homestead. The contagion is insidious and furious, and the fact that many of those who have the virus are asymptomatic makes it invisible and impossible to detect and trace.
We know social distancing is the only solution to mitigate and dull the impact of the virus, but what happens in nursing homes is the exact opposite of social distancing. Our caregivers are charged (even required by regulation) to be as close as possible to the residents, proving basic activities of daily living, such as bathing, dressing, transferring and toileting.
The front-line caregivers, in my company and thousands of other nursing homes across the country, are standing up, in the face of personal danger, to come to work and still deliver the care. It’s incredible and I am awed and inspired.
We also know from our leaders that an important weapon in the fight to beat the virus is to test as much as possible — test the resident, test the staff, test everyone — the thought being if we know who has it, we can treat it. But there is a double edge to that sword. If we know more people have it, we will have fewer people who are able to, or want to, provide the care. It is a vicious circle — a Hobson’s choice, a no-win situation. Whatever you want to call it, the nursing home sector is in a losing proposition.
On top of that, our leaders’ first response to the virus was to look at models anticipating the surge and prepare hospitals (not nursing homes) for an overflow of volume. These anticipatory resources were mobilized for hospitals only, including financial support and enhanced supplies of protective personal equipment (PPE). Yet, all the while, right under their noses, the virus had crept into nursing homes. An already-under-resourced sector, with a terribly weak foundation, was provided only limited attention, limited PPE resources, and delayed and meager financial help.
Three weeks ago, before the curve started to slope up, Mark Parkinson, American Health Care Association president, the national nursing home association, called the virus “a perfect killing machine in nursing homes” and no one listened. Should it be any surprise then, the largest percentage of deaths due to the virus in Massachusetts so far has been in residents of nursing homes?
Back to the frontline staff. They are heroes, angels, warriors: there are many names for their brave work. But I must share they are scared, and I am worried, as we head into the coming days and weeks, not only will we lose staff to the virus itself (most staff will hopefully recover and return), but the fear of getting it, stoked by sensationalizing press, will finally keep them away from work, as the families to whom they go home at night will say “please don’t go to work — I don’t want you to get sick.”
Certainly, the headline this weekend of a nurse at a Littleton facility passing away makes this real. To be fair, some support is on the way from state and federal governments. But I can assure you it won’t be enough, and it won’t be soon enough. The optimist in me says when this is all done, nursing homes will finally get the recognition and resources to do their jobs properly, so we can care for our parents and grandparents in the dignified and meaningful way they deserve. But for now, the sector is in desperate trouble.
As for Bane Care, I am proud to say, humbly, we are on the right-hand side of the nursing home bell curve. But as I have shared, the whole curve itself is in big trouble. Our 11 facilities have a few “hot spots” but also a few buildings have little or no virus invasion. Sadly, even with valiant efforts and measures, we have had some resident deaths due to the virus, and will likely have more in the coming weeks. This makes us all heartbroken, angry and mournful. It is random as to which building or person it strikes. I am confident that the infection control process and oversight in our facilities is strong — but if one asymptomatic staff member touches many residents, then the virus can “catch fire.”
My colleagues are simply amazing. Their tireless work — 24/7 over the last month — is otherworldly. I am incredibly lucky and grateful to be surrounded by such committed and giving people. The front-line staff has been superb. I don’t know how long we will have enough staff to provide care at any pay level, but as an organization we are doing everything possible in every way to honor the commitment we have to our residents and their families, including providing increased pay for our caregivers.
A word about the families. We had to restrict visitation four weeks ago and we were ahead of regulatory guidance there. The families are not happy, and I wouldn’t be either. They are scared, they can’t see their loved ones, and the staff is stretched in every way, so communication is often limited to quick phone calls and FaceTime sessions, and not meaningful visits. I believe in full transparency — if I were a family member, I would want nothing less, even if the news is not what they would want to hear. It just isn’t easy for anyone associated with nursing homes right now
So what happens at the end of this? I really don’t know. As I said above, the optimist in me thinks the business and reimbursement model for nursing homes has to get better — our society has to start to recognize if we want ourgovernment to provide care for frail elders then we have to make sure the providers and caregivers have the resources to safely do so.
But I temper this optimism with the reality of the moment. I am just not sure nursing homes — ours and everyone else’s — will come out of this financially. The help may be too late (as I said we started under water to begin with), and it is inevitable that many of the 15,000 nursing homes in the U.S. and the 320 in Massachusetts — maybe 20- 40 percent — won’t make it. It is ironic at the exact time when the silver tsunami hits in the next few years — when the baby boomers (like me and many of you) become elderly or frail and need care — there simply won’t be enough facilities to care for them.
For today, we fight on, 24/7, against the invisible virus striking us. The models and numbers don’t lie. There will be many deaths from COVID-19 and many of them will be in nursing homes, including some of ours. But this doesn’t tell the real story, the one I live every day, one where hundreds of incredible colleagues, direct caregivers and those who support them are standing up bravely and fiercely.
Please do what you can to support us — emotionally, spiritually or otherwise. Defend us when you can, and when the time comes: support better public policy. It has taken a pandemic to start to wipe away the stigma of nursing homes. Maybe we will all learn from this and make things better for the future.
Richard C. Bane, a Swampscott native, is the president of Bane Care, which operates a network of 11 skilled nursing facilities in Massachusetts.