Curbing Coronavirus In Nursing Homes

More than 68,000 nursing home and other long-term care facility residents and workers in the U.S. have died from the coronavirus. As of mid-August, the virus had infected more than 402,000 people at some 17,000 such facilities.

While some 8 percent of the country’s COVID-19 cases have occurred in long-term care facilities, deaths related to the virus in such facilities account for more than 41 percent of the country’s pandemic fatalities. In 20 states, at least half of deaths due to the virus have been linked to nursing homes.

There are some obvious reasons for the high rate of deaths at nursing homes. The virus is known to be particularly lethal to older people and those, like in many care facilities, with underlying health conditions. And nursing homes are often fairly crowded facilities, making transmission of viruses more likely.

But a clear factor involved in the transmission of the virus from nursing home to nursing home has been health workers — specifically, the fact that many of them service multiple facilities, often during the same week or even day.

Although it isn’t often possible to identify how the virus has been introduced into a facility, a recent report by the National Bureau of Economic Research (NBER) that looked at geolocation data found that 7 percent of smartphones appearing in a U.S. nursing home also appeared in at least one other similar facility, leading health experts to consider staff members working at multiple facilities to be a clear risk factor.&

In fact, according to David Grabowski, a professor of health care policy at Harvard Medical School, “Staff have been the largest vector towards bringing COVID into nursing homes around the country.”

That conclusion derives in part from things like the cell phone geolocation data but also from the fact that even in states and localities with strict bans on visitors to their nursing homes, new outbreaks have continued to emerge.&

According to the NBER report, the typical nursing home has, on average, staff connections with 15 other facilities. It estimates that eliminating such linkages could reduce nursing home infections by up to 44 percent.

Health workers are not necessarily being negligent in any way. They are, in any event, in many cases tested frequently. About half the states require regular testing of nursing home staff. But they often rely on tests conducted in labs — which are highly accurate but can take days to complete. So a worker who may have tested negative days before and has no symptoms can still be infected when going to his or her job, and become a vector for the virus’ spread in a facility.&

The Trump administration recently mandated regular testing of long-term facilities’ staffs, and is in the process of sending machines that can do on-the-spot antigen testing, which promises results in 30 minutes, to nearly all of the country’s 15,000 nursing homes.

But there are concerns about the rapid-tests’ reliability, and conflicts between state and federal regulations over which tests can be used on nursing home staff are also causing confusion. There are questions, too, about how quickly the needed number of rapid test kits will be available.

Hopefully, those obstacles will be overcome in short order. But an additional avenue for addressing the problem of health care workers inadvertently becoming vectors for transmission of the coronavirus lies in paying such workers a higher wage, one that will relieve the economic pressure that forces so many to work at several different facilities.&

Many nursing home staff members are not employed full time even though they essentially do two full-time jobs a day, sometimes 14-hour-long stretches separated by a break of just one or two hours. Most get paid close to minimum wage and do not get sick leave or benefits.

It doesn’t take a degree in economics to realize that were wages for such workers raised, there would be more incentive for them to limit their employment to one facility.

But, as nursing home advocates are quick to say, it is hard to raise wages when revenue, as is often the case, is fixed by the state or Medicare, barely, if that, covering the costs of maintaining facilities.

Both at the state or federal level, actions to improve the economic lot of those who care for our elders and infirm are called for, not only to limit moonlighting at multiple facilities and the resultant health crises but also simply to communicate to such caregivers that their work and, hopefully, concern for those entrusted to them, are deeply appreciated by society.