On April 15, coronavirus-related deaths in assisted living facilities had topped 5,000, with one in ten nursing homes around the U.S. having reported an outbreak. Just three weeks later, the death toll has now quadrupled.
People living with dementia are especially susceptible to coronavirus, and while experts don’t yet understand why this is the case, there are several contributing factors, including age and abnormalities in immune systems of individuals with dementia. According to a recent study, this already vulnerable population is also more at risk of dying when hospitalized with COVID-19.
Some assisted living facility managers and staff are fighting for their lives at what has been called the pandemic’s “ground zero,” even as hospitals at capacity are transferring COVID-19 patients into nursing homes with extra beds. Others are fending off lawsuits as they come under fire for covering up the pandemic’s death toll. A very small number have found ways to maintain control and protect their vulnerable residents. Now they are desperately searching for solutions that scale.
Dr. Tyson Belanger is the owner and manager of an assisted living center in Connecticut, a state where more than two-thirds of nursing homes have had one or more residents with COVID-19 and where confirmed and probable nursing home deaths represent more than half of the state’s total COVID-19 deaths.
Yesterday, he wrote an op-ed for The New York Times about how he and his staff have managed, so far, to keep coronavirus out of his facility in Bristol, Conn., Shady Oaks.
My family has owned an assisted living home in this town for over 44 years. Both of my grandmothers have lived in it, and my mother might soon need its care. As much as I admired my parents, I did not think I would someday lead it. I went to Yale, served three tours in Iraq as a Marine infantry officer and earned a Ph.D. in political science from Harvard. I had planned to turn my dissertation into a book.
But in 2016, after my father’s health took a turn for the worse, I bought the home, Shady Oaks, and moved in next door. The home is now my life, and that means I am consumed with one thing: trying to protect our elderly residents — and the people who care for them — from Covid-19. As is the case with so many homes for the elderly across the country, it is a battle we are not yet winning.
In some homes, defeating coronavirus is a distant goal. In others, according to reports, the indisputable failure of nursing homes to protect the well-being of their residents and staff has already reached the point of no return. But before nursing homes can even contend with thwarting the spread of the virus through an extremely vulnerable population of residents, they must try to stop it from getting in the door, and according to Belanger, the most common approach is inherently flawed.
Most senior homes presently rely on checkpoints to screen workers as they arrive, “mainly by asking them questions and taking their temperatures,” Belanger explained. “But these checkpoints can easily fail, because people without symptoms can carry and transmit the coronavirus.”
But it doesn’t have to be this way, he said: at Shady Oaks, he instituted a policy on March 22 in which the facility’s staff live on site, helping to “ensure that they do not interact with infected people and then bring the virus into our centers.”
Presently his facility is operating without any confirmed cases of coronavirus in large part because of this closed-off, whole-home quarantine.
Of course, this level of security comes at a price. Belanger wrote that he offered “significant incentives” to caregivers in order for them to be able to agree to live on-site — namely, an increase in pay to $15,000 monthly for on-site aides and $20,000 for nurses.
“My business cannot afford this,” he wrote. “Altogether, I have drawn loans from my personal savings of about half a million dollars. We have also been approved for $343,243 from the Payroll Protection Program.”
Few other facility managers have the ability or willingness to take this on. But Belanger proposed an alternative based on outside funding sources:
“Government funding and donations could accommodate the cost of caregivers living on-site at the nursing homes and assisted living centers where they work,” he wrote. “If Connecticut pays $25,000 per week in matching payroll funds to all of its roughly 365 nursing homes and assisted living centers for six weeks, this would cost taxpayers nearly $55 million.”
Across the U.S., as of 2016 there were 15,600 nursing homes of various sizes. For a sense of scale, averaging out Belanger’s plan across all of them would cost upwards of $2.3 billion — a tall order. But cobbling together funding sources and looking more carefully at how staff travel in and out of homes — especially those who work in multiple homes — could pave the way to safer care in the long term.
“Not every home or caregiver will agree to do it, but we should provide the financial support to make it financially viable for all,” he wrote.
In the short term, other facilities are raising awareness for the need for federal funding to make operations safer. In Texas, the head of the Texas Health Care Association is lobbying for federal bailouts to provide personal protective equipment (PPE) to nursing home staff.
While policy makers and facilities managers look for answers, families are struggling to find their own solutions to mitigating the risk during coronavirus. Some are exploring pulling their loved ones out of homes and providing home care. But even if they are able to manage home care, the question remains: should they continue paying rent to the facility to hold their spot?