New Orleans      The after-action reports are coming in now on how the US faired in dealing with the Covid pandemic.  The results are mixed, as we all know, and trending downward as the death counts made clear.  One expert claimed that nursing homes rated a “D.”  Our union represents nursing home workers, so this is something we saw from all sides.  Medicare reports that 167,000 nursing home residents were lost to Covid, and “at least, 3100 staff members.”  I’m not sure what curve he might have been grading on, because the body count makes it clear that nursing homes failed abysmally.

Paula Span, writing in the New York Times, does an excellent job of detailing the experience, so I’ll share the low-lights reel:

• In December 2021, the Food and Drug Administration granted emergency authorization to Paxlovid, a pill taken for five days…. Research recently published in JAMA found that only a quarter of infected residents received antivirals, even during the last six weeks of the study — by which time Paxlovid was widely available and free.  About 40 percent of the nation’s approximately 15,000 nursing homes reported no antiviral use at all.
• It took a federally coordinated effort, sending providers “to facilities in late 2020 and early 2021 to vaccinate residents and staff.” By early 2022, Medicare reported, 87 percent of residents and 83 percent of employees had been vaccinated.
• Without the federal intervention, homes “dropped the ball on boosters.” Medicare reported this month that about 62 percent of residents per facility, and just 26 percent of staff, are up-to-date on Covid vaccinations, including recommended boosters.
• Federal efforts prioritized hospitals, leaving nursing homes short of critical protective equipment. With the help of a nonprofit in New Orleans, our union delivered 10,000 pieces of PPP, largely to our nursing home workers in Louisiana and Arkansas, who never had enough.  In the early days, they were washing masks after every day to reuse.
• Nursing homes apparently didn’t make much use of the testing kits. By fall 2020, fewer than a fifth had the recommended turnaround of less than 24 hours. Point-of-care kits that required 15 minutes to read each test couldn’t screen workers arriving for a shift.
• Short staffing was a problem, with the industry claiming that nursing homes lost nearly 245,000 employees during the pandemic and have regained only about 55,000.
• Lockdowns went on too long, preventing visits from family and friends.

I have to ask, “Does any of that should like a passing grade?”  I don’t think so!  Do the experts believe that nursing homes are any better prepared now for the next pandemic?  Oh, Lordie, no!  They say that the homes need to drastically alter their HVAC ventilation systems to better deal with airborne transition.  They need to reconfigure their internal living layout to create private rooms, rather than semi-private and communal arrangements.  They need to move away from industrial style units to create smaller pods, and most importantly create stable staffing assignments to increase relationships, care and reduce exposure from constant turnover and “coming and going,” but that also means significant pay increases.

Perhaps in an understatement, Span writes,

All those changes would require more investment, however, principally from Medicaid, which underwrites most nursing home care. And with more money would come increased federal oversight, which the industry rarely welcomes.

Too much of the industry ownership still sees their nursing homes as a real estate investment warehousing clients while the property appreciates, rather than a health care enterprise that should “do no harm.”  The government is footing a lot of the bill, but needs to speak more loudly with that big stick and replace the land men with real caregivers.  If not, the workers, who are still on the job, will tell anyone, nothing has changed, little has been learned, and there’s worse to come the next time around.