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Cases of coronavirus are spiking dangerously in California, and many of those new cases are happening in nursing homes.
The latest outbreak is at a nursing home in Concord, where 15 people have died, including 14 elderly residents. What’s going on in the nursing homes, what can be done about it and should there be greater oversight by the state?
Mike Dark is a staff attorney at California Advocates for Nursing Home Reform, a nonprofit advocacy group that’s been at the forefront of nursing home issues in the state for almost 40 years. He joined KCBS Radio’s "The State of California."
Thanks for being with us this afternoon, and first of all, this is not the first deadly outbreak we’ve seen in a nursing home over the last few months, and yet they keep happening. What is going on, and why isn’t anyone getting a handle on it?
They keep happening and they’ll continue to keep happening. The virus is new, but the reasons why the virus is moving so explosively through our nursing homes actually has to do with problems that have existed in these facilities for decades. And that’s poor infection control, and a lack of staffing. Those two things together have really hobbled the ability of nursing homes to respond effectively and prevent the spread of the virus.
I want to ask you about some of the logistics within a skilled nursing home - social distancing, mask wearing - for example. How difficult is it to implement those strategies inside a nursing home?
That’s a great point. We have been congratulating ourselves in this country until recently, for the fact that we had been flattening the curve. And that was really only the result of social distancing. There's obviously no medications available, there's no vaccines. The problem is that in a skilled nursing setting, social distancing is just not possible. You can't have 6 feet between a nursing assistant who's trying to feed a resident who has trouble swallowing after a stroke. You can't have six feet between roommates in a facility who have dementia. What we needed to have in order to prevent the spread of the virus was effective infection control and enough staff to make sure that people are clean and they're safe, and those things just don't exist in nursing homes.
I want to ask you more about that staffing issue, because for some of the lower level employees that work in the skilled nursing facilities, they have more than one job. They're not getting paid enough, and so if they are asymptomatic, they theoretically are increasing the spread of coronavirus.
Well that's exactly right. One of the terrible ironies about the spread of the virus through these facilities is that early on, visitation was completely shut down out of fear that those visitors might be bringing in the virus. When in fact what we now know is the virus made its way into probably a majority of California facilities, through those healthcare workers. That happened because, as you point out, these people who are delivering care, are mostly not nurses. Their CNAs, nursing aids, who are making 10 or 12 bucks an hour, and as a result have to work two or three jobs at a time just to put food on the table. Moreover, they mostly don't have sick leave. Once one of those nursing aids picks up the virus in one facility, it's just a matter of time before it spreads into another. Until those work conditions change, we're going to see more of that kind of spread in the future.
So, has there been any increase in local or state oversight of these homes since the pandemic began, and what specific steps would you like to see right now?
There have actually been huge changes in the way regulators oversee nursing homes during the pandemic, and not in the way people would expect. What happened is even as conditions got apocalyptic in homes throughout the state, both county and state regulators actually ratcheted back the normal yearly inspections that they would be doing to ensure conditions are safe in these places. They do go in to check for things like infection control, but often that doesn't take into account lots of other problems that lead to the spread of the virus, including understanding. Until those regular inspections start up again, we can expect things to continue to get much worse.
One of the real tragic aspects of this story that we’re looking at right now is the fact that family members so often can't be with their older loved ones in these homes, when they're in fact dying. Are there reforms you would like to see that would allow for some sort of even more virtual contact at this point?
What a great question. One misunderstanding lots of people have about the role of visitors in nursing homes, is that they’re just there for moral or emotional support -- which is not to say that’s not important. The reality is because those nursing assistants are trying to see 10 or 12 or 15 residents in an hour, for medication and bathing and cleaning and feeding, care just wasn't being delivered by nursing home staff. And so family members of residents were going in and feeding them, and brushing their hair, and brushing their teeth and making sure their bed clothes were clean. So those kinds of visitations are actually essential for the survival of many nursing home residents. And what we at CANHR think, is it is way past time to start letting in safe visitation, with appropriate PPE with good social distancing, so that we have another set of eyes on the ground in these facilities to make sure people are safe.
Do you think there's enough testing at facilities? Is there an established protocol there? Is it required?
Facilities are required to have plans for testing. The problem is there's just not the means to execute those plans and the state is doing very little to facilitate that. You can have a plan and a protocol for going through and testing all your healthcare workers and all your residents, but unless you have kits, and more importantly, unless you have people who are actually coming in to do the tests -- because you have to go to facilities to do that -- it's not going to happen. And in California, especially in poor and rural counties, there simply aren't the resources to get the testing done. Because of that, we still don't fully understand the scope of the crisis in this state.
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