Two months ago, I kneeled next to Sarah – an avid drinker of chocolate milk, ex-journalist, and new hospice resident – in a nursing homeroom. We had a knack for discussing emotions, and that day, our conversation reached the idea of suffering.
Her pain-stricken voice shared, “Did you know that we notice? When someone’s health turns for the worst, we notice. There is a special whispering that flutters throughout the building. When someone dies, we notice. We face our mortality too. We sit and live through what feels like death every time it happens. I guess it will only stop when my heart does.”
At the end of our conversation, she thanked me before I could thank her. She elaborated on how grateful she was to finally release these thoughts that had been endlessly cycling in her mind. A lot has changed since this conversation, but I have not been able to shake off those words amidst this SARS-CoV-2 pandemic.
Due to the well-recorded history of long-term care facilities having seasonal, explosive outbreaks of viral infections, the Centers for Medicaid and Medicare Services (CMS) guidance has restricted all non-essential visits — including family– and communal dining. With the aim of protecting the residents, we have isolated long-term care residents to their rooms. These communities that have historically been plagued with loneliness and mental health issues just got lonelier.
As hospitals seek to discharge patients recovering from the disease, skilled nursing facilities seem to be the clearest target. States like New York and New Jersey have been the first to act on this idea by not only pushing COVID-19 positive patients into these areas but by also enacting policy changes to inhibit nursing homes from rejecting the patients. Organizations like The Society for Post-Acute and Long-Term Care Medicines (AMDA) immediately released statements against such potentially devastating actions. Despite such push back and hopes for specialized COVID-19 post-acute facilities, there seems to be no promise that COVID-19 positive patients will not be on the neighboring wing to that of our elderly loved ones.
As the risks of COVID-19 become the reality for Sarah and the millions of other long-term residents, should we allow them to live in fear, alone? Now with over 400+ nursing homes showing documented COVID-19 positive cases and the mortality rate in nursing homes being between 15 to 30 percent, what is the toll on the mental and physical health of these older adults?
While the importance of increased testing and more personal protective equipment for staff cannot be understated, now is not the time to turn a blind eye to the social determinants of health, which account for 80 percent of health outcomes. As long-term care residents are separated from their families and others in their community, we strip their entire social support system. With social isolation comes a 59 percent increased risk of functional decline and a 4 to 5 fold greater chance of re-hospitalization. However, every decision to hospitalize a nursing home resident increases the strain on our crumbling health care system.
Former surgeon general Vivek Murthy has emphasized the role of video chats as the best alternative for social interactions. While the rest of society has quickly shifted to Zoom and Facetime, our older adults have been left behind. While the CDC and long-term care ombudsman programs around the nation advise for staff to facilitate family and social support virtual visits, many long-term care communities have been slow or frugal in implementing. As administrators are squeezed by the desires of the corporate entity to protect the bottom line, we are sacrificing the health and sanity of our elderly ones. Residents with family must be able to readily speak with them, and those without family must participate in longitudinal, social engagement. As we look towards the grim upcoming weeks, it is vital to advocate for those who cannot themselves and tie them back into our communities.
While everyone has a theory on how COVID-19 will change the health care system in the United States, the reality is that the time for change is here. We cannot afford to be reactive, especially not now.
Harsh Moolani is an undergraduate student.
Image credit: Shutterstock.com
