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The Nursing Home Disaster

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Chas Walker has an outstanding essay in the Boston Globe on how the terrible conditions for nursing home workers are now killing our parents and grandparents.

These figures will continue to rise, because although the virus can affect anyone, the residents of long-term care facilities are particularly susceptible to COVID-19, given dynamics such as age, underlying illnesses, and their proximity to one another (including shared rooms and bathrooms) and to their caregivers. But these commonly accepted factors are not the only reason COVID-19 is proliferating in our nursing homes: The poverty wages paid to caregivers and the understaffing of our long-term care facilities are also to blame.

The national median wage of Certified Nursing Assistants, who make up the bulk of the nursing home workforce, is $14.25 per hour — or $29,640 per year with a 40-hour work week. Although wages are somewhat higher locally, they are nowhere close to a living wage. Many who work in these facilities hold multiple jobs — in another nursing home or home care agency, for example — in order to pay rent and put food on the table. Given how COVID-19 is transmitted by asymptomatic individuals, when an outbreak begins in one facility, it is unlikely to be contained there for very long.

In an outbreak across several nursing homes in Washington state beginning in February, investigators from the Centers for Disease Control and Prevention found that in part “staff members working in multiple facilities contributed to intra- and interfacility spread.” If we ever get a full accounting, the same will surely prove to be true here in Massachusetts and across the country.

Many nursing homes were already woefully understaffed before COVID-19, despite efforts to appear properly staffed to government regulators and accreditation commissions. A report in 2019 compared the staffing data nursing homes reported to the Centers for Medicare and Medicaid Services (CMS) to facilities’ actual payroll records, and found that a majority of those studied “met the expected staffing level less than 20% of the time,” and that staffing levels “increased before and during the times of the annual [CMS] surveys and dropped off after.” As the growing footprint of private equity firms and publicly traded corporations (and their tangled networks of related entities) in the long-term care field shows, there is a lot of money to be made by understaffing nursing homes and underpaying workers.

From a care-delivery perspective, the low wages that prevail in the industry create staff recruitment and retention challenges, and high turnover and short staffing undermine infection control training and practice. Even before COVID-19, an analysis from Kaiser Health News found infection control deficiencies in 63 percent of US nursing homes, with higher violation rates “at homes with fewer nurses and aides than at facilities with higher staffing levels.” In Massachusetts, the Globe revealed that prior to the outbreak, almost “two-thirds of nursing homes … were cited at least once within the past three years for a deficiency in infection control.”

It’s astounding that we force the people who take care of our most vulnerable family members–not only the elderly, but also small children–to live in poverty by paying them so poorly. Making care work central to our future is not only critical to ourselves–we are all getting older and most of us will rely on these workers at some point–but also to my belief for government-guaranteed work at dignified wages as a central policy point for a progressive agenda. This is a huge growth area in the workforce and we have the choice whether to make these good jobs or the worst possible jobs we have. So far, we have chosen the latter. And now that’s killing our ancestors, as well as some of the workers themselves. But hey, at least the Trump administration is still trying to push forward deregulating the nursing home industry even further! What would living in the Failed States of America be without taking advantage of a disaster to make it worse?

Once again, natural disasters are in fact the non-human world demonstrating the inequality of the human world.

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