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The Nursing-Home Catastrophe

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eye on the news

The Nursing-Home Catastrophe

Governor Andrew Cuomo’s fateful decision to return Covid-19 patients to care facilities ought to haunt him—and us. July 7, 2020
Covid-19
New York

As more details emerge of the early days of the Covid-19 outbreak in the United States, perhaps the most disturbing chapter is the tragedy that befell nursing homes. According to the Center of Infectious Disease Research and Policy, only 1 percent of Americans reside in nursing homes or long-term-care facilities (LTCFs), but this group accounts for 40 percent of all Covid-19 deaths. This high mortality rate can be explained, in part, by the reality that such populations are significantly more prone to the cardiac, respiratory, and renal comorbidities that predispose individuals to bad health outcomes. Tragically, however, a great deal of the nursing-home mortality rate is also due to a misguided—and arguably negligent—policy of discharging Covid-19 patients directly to these facilities.

The March 25 order by New York governor Andrew Cuomo and state health chief Howard Zucker mandated that nursing homes and LTCFs accept patients discharged from hospitals, even if they received only emergency care and were still infectious; it is now reported that 6,300 Covid patients were sent to nursing homes throughout the state. The motivation behind the order was understandable: in late March, public concern was high that Covid-19 cases would overwhelm New York’s hospital capacity. Yet, despite an impressive deployment of surge capacity from the federal government (much of which went unused), Cuomo’s order remained in place for almost two months, not being rescinded until May 10.

By then, New York had lost 6 percent of its residents in nursing homes to the virus. Michigan would lose 5 percent, and New Jersey a harrowing 12 percent. Florida, which never implemented such a treat-and-return policy, suffered a mere 1.6 percent mortality among nursing-home residents, while California, which changed course in time, managed to keep nursing-home casualties at 2 percent. While the media were preoccupied with Floridians enjoying walks on the beach, Covid-19 raged unchecked through nursing homes and LTCFs throughout America, with little attention paid to the plight of their residents.

The humanitarian disaster in nursing homes—which, even with outstanding research by ProPublica, remains little more than a footnote to the popular narrative about the Covid-19 outbreak—is particularly tragic because it was entirely avoidable. Governor Cuomo asserts that New York followed federal guidance on nursing homes. It’s true that Washington’s instructions permitted the return of patients to nursing homes and LTCFs if the facilities had adequate personal protective equipment (PPE) and sufficient isolation capabilities, but it was left unclear who would make these determinations. At one point, Cuomo said that it was “not our job” (meaning the state government’s) to provide supplies to privately run nursing homes. The federal guidance was written with the assumption that readmission would be preceded by testing—but Cuomo’s March order didn’t make that a condition. The result: a badly informed, poorly executed policy that allowed a deadly pathogen to ravage nursing-home facilities, burning through elderly and at-risk residents like “fire through dry grass.”

Remarkable men and women reside in America’s nursing homes and LTCFs. Many survived the turmoil of the Great Depression, shed their blood on battlefields, fought for civil rights, and helped shape the American century. Their sacrifices paved the way for an age of unprecedented wealth in America, and we remain in their debt—a debt that should include supporting and protecting them in their sunset years. As is often said, the character of a society can be glimpsed in how it treats its most vulnerable. On the count of failing in this duty, many state leaders come out guilty as charged.

Photo by Justin Heiman/Getty Images

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