Editorials
The Nursing Home Horror Story Never Vanishes
In one of my previous lives I attempted to teach investigative reporting to a class of aspiring journalists who hoped to make a living free-lancing for magazines. This was in the early ‘80s, just about the time most of the print publications which commissioned 5,00 word stories were sinking slowly into the sunset, so few of my students ever managed to support themselves by writing.
But I did have one good idea. I thought it would be possible to put out a journalism textbook of sure-fire evergreen story ideas that would never get stale . I had a whole list, most of which came and went, but one endured and sadly is still with us: shocking conditions at nursing homes.
Forty years later, it’s still possible, any time an editor needs a dramatic story, to find a hellhole of a nursing home within 5 blocks of your desktop computer. Now in the COVID-19 era nursing home exposes can be found in any news source any day of the week.
In the New York Times not long ago, for example, you might have read that Nursing Homes Were a Disaster Waiting to Happen, an op-ed written by Richard Mollot, the executive director of the Long Term Care Community Coalition.
His conclusion:
“A pandemic is a force of nature that cannot be avoided. But years of neglect by nursing homes have left millions of older residents unprotected from it. Many of the deaths we’ve seen could have been prevented. More lives can be saved if we demand more from the industry and from its regulators.”
Well, yes.
Closer to home, and more immediate, we had excellent current reporting in Thursday’s S.F. Chronicle by Sarah Ravani: Asymptomatic staff, untested at many nursing homes, are spreading the coronavirus.
It’s tempting to believe that the horrendous situation now being reported at nursing homes all over the country is a unique outcome of the coronavirus pandemic.
In fact, however, epidemics caused by all kinds of viruses menace many sorts of crowded congregate facilities. Norovirus, for example, though it’s not a coronavirus, causes severe and dangerous diarrhea outbreaks in everything from day care centers to cruise ships to assisted living centers.
The Centers for Disease Control recently added new symptoms to its list of symptoms of the CORVID-19 disease caused by the novel coronavirus.
It now includes almost any complaint any sick person is likely to have, making it almost impossible to conclusively track victims of coronavirus-caused disease using symptoms alone. The first victim in the Bay Area, recently identified by Santa Clara County, was only diagnosed on autopsy.
It turns out that definitional names for such institutions are not standardized medically or legally, which makes them harder to regulate effectively. For example, what used to be called “nursing homes” are often now spoken of as “sniffs”—SNFs, Skilled Nursing Facilities—but they’re not the only dangerous situations where people gather. This is why it’s crucial to test employees, residents and clients at any kind of congregate facility for the presence of this virus.
The City of Berkeley’s recently hired Health Officer, Dr. Lisa Hernandez, on April 16 issued this impressive document which specified many precautionary measures to be followed at the many types of group situations to be found in the city of Berkeley:
It covers a long list of at-risk facilities:
a. Hospitals including General Acute Care
b. Psychiatric Health Facilities
c. Skilled Nursing Facilities
d. Intermediate Care Facilities of all license types
e. Hospice Facilities
f. Home Health and Hospice Agencies
g. Home Care Organizations
h. Chronic Dialysis Clinics
i. Federally Qualified Health Care Centers j. Community Clinics
k. Ambulatory Surgical Centers
l. Residential Care Facilities for the Elderly
m. Residential Facilities for the Chronically Ill
n. Social Rehabilitation Facilities
o. Continuing Care Retirement Communities & Community Services
p. Urgent Care Centers
q. EMS Providers
r. Adult Residential Care Facilities of all license types including:
i. Licensed group homes including runaway and homeless youth shelters
ii. Homeless shelters for adults and/or families
iii. Recovery houses or Sober Living Environments providing group living arrangements
iv. Transitional Housing Programs providing group living arrangement
v. Residential substance use disorder treatment programs
Yes, we have some of all of these in Berkeley. It’s just that the public is not able to learn which of these facilities might be experiencing pandemic crisis. Also, there’s no effective diagnostic mechanism recommended, let alone required. There’s just temperature screening and self-evaluation for symptoms, neither of which is adequate, since we’ve learned that by the time such symptoms appear, the asymptomatic spreader has done considerable damage.
Published data, whether from the City of Berkeley’s own Health Department, Alameda County or the state of California, is woefully inadequate.
Now that we know (and the Order acknowledges) that coronaviruses can be spread by asymptomatic individuals, it’s likely there are many more cases in all congregate facilities than are recognized.
UCSF Professor Emerita Charlene Harrington, a Berkeley resident, said this in an email to the Planet:
“I continued to be amazed and disgusted that the local departments of public health are not releasing the names of nursing homes and assisted living facilities that have COVID-19 staff or residents. Transparency is the most important policy so that families, staff, residents and the community can know their risks and make decisions based on the spread of the virus.
“We believe that some facilities are keeping the virus secret so it won’t hurt the reputation of the facility while putting staff and communities at risk. In many cases, both staff and residents are asymptomatic so they can be spreading the virus without knowing it.
“We need to have the testing of all residents and staff in nursing homes and assisted living as a top priority to stop the spread. The LA County Public Health Officer has adopted this policy and yet the bay area counties have not done that.
“This is a very frustrating situation.”
On Friday, San Francisco Mayor London N. Breed and Director of Health Dr. Grant Colfax announced a new directive which will require all residents and staff working at the 21 skilled nursing facilities (SNFs) in San Francisco to be tested for the COVID-19 virus. The City will begin testing all residents and staff at SNFs next week, with a goal of creating a two-week testing cycle after the first round of tests are completed.
That’s a big improvement, but authorities now recommend much more frequent testing of health care workers. On Thursday infectious disease expert Dr. Brian Schwartz, in a UCSF web presentation of the medical school’s Grand Rounds, recommended no more than a 3-5 day interval between tests, and said that 2 days would really be better.
Berkeley’s Health Department has still not announced even one-time mandatory tests for health care workers in this city, and records of outbreaks at individual institutions are still not available.
And that’s only the health care industry. Similar statistics for all kinds of super-dense living situations , including the full list per the Berkeley Health Officer’s edict, should be a matter of public record, with prisons and meat packing factories being prime examples of high-risk environments which are not starting with sick people.
In North Carolina, a coalition of news organizations, including the non-profit Carolina Public Press, used legal pressure to persuade the state’s Department of Health to begin revealing that information for long-term care facilities.
News organizations in California should follow the North Carolina example and demand release of statistics about COVID-19 outbreaks in congregate settings of all kinds. Admittedly scattered anecdotal reports indicate that at least half of deaths from this disease are in such institutions.
Meanwhile, a good start would be for the Berkeley Health Department to compile an authoritative list of all such establishments in this city complete with statistics. Why do we need a standalone health department if they can’t do this? A Berkeley-based news organization coalition to demand this information with legal back-up would be great.
The best I’ve been able to do as one person under quarantine is to google “skilled nursing facilities Berkeley”, which at the top level produces a handful of appealing ads and some negative Yelp ratings which would curl your hair. And at least one dreadful-sounding one-star place is, yes, within 5 blocks of my home office, but I can’t walk down there to check it out.
Meanwhile, I just got a phone call from a friend whose 96-year-old mother is in an assisted living facility in Pinole, having just moved from another one which evicted all of its residents because the property was sold to a developer. Her mother uses a wheelchair, but is basically healthy.
My friend had just heard from the home that an employee (name not revealed) who worked with her mother had tested positive for COVID-19 and has been told to stay home. Word of mouth among staff has it that their affected co-worker, who has no symptoms, was tested because someone she shares a ride with, a health care worker at another facility, tested positive.
All these tests were administered under the auspices of Contra Costa County at another locatiion.
Her mother’s residence has no regular program for testing either employees or residents. Three more untested employees have now called in sick, but have not been tested, though the employer is trying to persuade the county to do so.
My friend would like to get her mother tested, but has been told by Sutter Health that they don’t provide tests unless the person has symptoms, despite current evidence that COVID-positive people are often asymptomatic. She has no way to get her mother with wheelchair to the county test site. What to do? Who knows?
This is just one anecdote among many, typical of what many Americans are dealing with. What’s needed is not more anecdotes—we need hard data and much more testing. It’s time for our elected officials, state, county and local, to step up to the plate and require both.
It’s pretty clear that after 40-some years “nursing homes” and their modern re-branded equivalent “skilled nursing facilities”, along with other crowded living situations, are still a reliable horror story. It’s past time to do something about that.
