Nursing Homes in Crisis: The COVID-19 Pandemic Calls for a Mindset Shift about the Elderly and Disabled

Nursing homes are intended to provide a haven of safety and care. But as the COVID-19 pandemic continues to ravage America, those same facilities are now under intense scrutiny regarding quality of service and their potential contribution to the loss of thousands of lives.

By the numbers 

According to the latest available nursing home data (2015) from the Centers for Medicare & Medicaid Services, nursing homes accommodate 1.4 million people in America.¹ About 15.5 percent are under the age of 65. These residents are often disabled or are recovering from medical procedures.

With this data in mind, experts noted early in the pandemic that the elderly and those with underlying conditions appear more vulnerable to contracting the disease and suffer with greater severity. And it soon became clear that the virus is, in fact, no mere flu. 

In mid-April, The Guardian reported that nursing homes were in serious trouble, with the National Guard evacuating a facility outside Nashville after 100 people fell sick.² By the end of that month, the New York Times reported that COVID-19 had killed more than 10,500 nursing home residents and staff, accounting for nearly a quarter of the COVID-19 deaths in the United States.³ 

By June’s end, Johns Hopkins University showed that overall COVID-19 cases spiked after numerous states—lacking unified federal guidance—initiated reopening plans.⁴ And by the middle of September, according to the Kaiser Family Foundation, long-term facility cases stood at 496,708, accounting for 41 percent of total state deaths.⁵ 

As the nation slips into colder weather that will make close contact more common and disease spread more easily, no one knows whether the state of nursing facilities will get even worse.

What’s led to our grim situation

After recognizing the crisis, lawmakers called for an investigation of state nursing home policies.⁶ They questioned whether the governors in Michigan, New York, Pennsylvania, New Jersey, and California contributed to the case and death counts by initially requiring nursing homes to accept people with COVID-19 who had been discharged from hospitals.

The governors argued that their policies were intended to prevent the medical system from being overwhelmed and did not violate guidelines that instructed nursing facilities to turn away COVID-19 patients if they could not provide safe care. Yet, as Politico reports, states also used financial incentives to encourage nursing facilities to take COVID-19 patients.⁷ In general, facilities that need that money the most are those with citations, poor ratings, and difficulty controlling infection. A July 2020 Senate report detailed ways the Trump administration failed nursing homes, including rollbacks in infection control regulations prior to the pandemic, late testing and tracking, and delayed distribution of emergency congressional funding.⁸ In addition, the Occupational Safety and Health Administration is reportedly investigating only a portion of nursing home staff deaths.⁹

If leaders understood that the elderly and those with underlying conditions were most at risk for poor outcomes, then the decision to place the sick with the vulnerable—and even incentivize it—suggests a larger social disregard for those residents. 

And this is not a new disregard. 

Patricia Buck (RN, BSN), a charge nurse working in Michigan, explained to Celebrate Life Magazine that most nursing homes were not built in a manner conducive to social distancing and disease control.¹⁰  

Buck states: “It’s rare to see a facility that offers private rooms to all residents. More importantly, though, many skilled nursing facilities share shower rooms for bathing. Even if an individual has their own room, they may likely share a shower room with the rest of a unit.”

Although facilities are starting to shift away from traditional designs, funding and staffing remain huge concerns. Most homes (about 70 percent) are for-profit centers that rely on insufficient Medicare reimbursements to cover costs.¹¹ A 2017 Kaiser Health News investigation found that nearly three quarters of facilities had financial arrangements to make profits look like costs (e.g., paying fees to firms that owners had interest in).¹² 

For years, facilities have struggled to obtain supplies and pay workers properly. Many personnel alternate between facilities to meet the high-care demand and to earn enough to pay personal expenses. Now, workers are also falling sick or quitting to protest poor management or because they fear contracting COVID-19.¹³

Buck says that shorthanded facilities often turn to staffing agencies to fill these gaps in personnel—a practice that has both positive and negative outcomes. For instance, using these agencies to increase staff can improve care within a facility because it gives these facilities a lower professional-to-resident ratio, which allows the staff to devote more time to each resident. In addition, these workers can get protection through the agency if they are assigned to a nursing home that isn’t properly staffed or that doesn’t give employees the necessary PPE. 

However, agencies often send providers to multiple facilities to help the nursing home industry cope with the ongoing staffing deficiencies. This bouncing around can potentially increase the risk of contracting and then spreading COVID-19 from residents in one location to residents in another. Some authorities and nursing home owners subsequently have taken steps to limit this practice, but recommendations and mandates are not yet consistent.

Yet, even if facilities could limit the movement of workers, in the capitalist crisis approach, nursing homes typically can’t outbid other facilities to buy equipment, and as noted by National Public Radio, they are running severely short on PPE.¹⁴ 

“At the start of the pandemic,” Buck says, “many healthcare workers were provided only one surgical mask a week. They would wear them and store them to wear for following shifts. Staff that were already short in skilled facilities were pushed to their limits and left unprotected. We were called heroes and then handed trash bags to wear to protect ourselves. . . . I used my own N95s and provided them to as many staff as I could. We have proper PPE now [at our facility], but at a [high-monetary] cost.”

Adopting a Christ-centered mindset that honors facility residents

Nursing homes are often representative of societal values. And the problems outlined above have run rampant as a reflection of systemic biases against the aged and disabled. These biases are present even before an individual enters a nursing facility. They connect to other social problems, as is evident in cases of age discrimination at work and a lack of a safety net for the “sandwich generation” that must care for both parents and children. 

Turning to scripture reveals that much of what is happening within nursing homes does not adhere to Christian views on the overall sanctity of all human beings, including their respect and care. Throughout the Old Testament (NABRE), God routinely provided long life as a reward for faith and obedience (1 Kings 3:14). In Isaiah 46:4, God promises to sustain the descendants of Jacob “even when your hair is gray,” while Leviticus 19:32 offers a clear directive to “stand up in the presence of the aged, show respect for the old, and fear your God.” And in the New Testament, Jesus and His disciples repeatedly tend to the sick (Matthew 4:23; 10:1), including healing the woman with a hemorrhage (Matthew 9:20-22) and healing the paralyzed man (Matthew 9:1-8). 

Changing our current harmful system requires a mindset shift toward seeing the elderly and disabled as having innate, irrevocable, and God-given—rather than earned or depreciative—value. That shift might come more easily if we engage the following strategies:

1. Pursue socially visible intergenerational relationships where younger generations can learn about the knowledge, skills, and experiences of the elderly and come to feel close to them and respect what they offer. 
2. Highlight servant leadership, which stresses awareness of and service to others, and which encourages reciprocity in relationships regardless of age or health.
3. Educate people about what the elderly are really going through to normalize aging and disability and to reduce stigma. Offer public care training or volunteer programs so people know what to say and can be sympathetic rather than fearful. Highlight diversity and opportunity within the nursing home population, as well as senior living where people are thriving and contributing in many ways long after retirement. 
4. Express gratitude in ways that include a connection to older generations, such as creating and maintaining traditions.
5. Encourage fair and inclusive social media practices to reduce the spread and reinforcement of stereotypes.
6. Focus on what elderly people CAN do, not what they cannot do.  
7. Ask what the elderly and disabled want, rather than assuming or steamrolling. In cases where a person is not mentally or physically capable of advocating for himself, collaborate and go through proper channels to ensure that everyone truly is acting in the individual’s best interests.
8. Improve or create programs that reduce the hurdles to in-home care, so people are not separated from loved ones due to disability or normal aging.

And of course, giving real help rather than mere lip service to care providers like Buck matters, too. By lifting them up, you lift up those they serve by default.

“Skilled nursing staff love their residents and wouldn’t take on the job if they didn’t,” Buck concludes. “They need to be protected, so they can protect their residents. We want nothing more than for them to be reunited with their families, but we need the support to do so.”

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1. Centers for Medicare & Medicaid Services (2015), Nursing Home Data Compendium 2015 Edition, accessed July 9, 2020, cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf.
2. Chris McGreal, “‘We’re Living in Fear’: Why US Nursing Homes Became Incubators for the Coronavirus,” The Guardian, April 15, 2020, theguardian.com/world/2020/apr/15/were-living-in-fear-why-us-nursing-homes-became-incubators-for-the-coronavirus.
3. Kim Barker and Amy Julia Harris, “‘Playing Russian Roulette’: Nursing Homes Told to Take the Infected,” The New York Times, updated May 7, 2020, nytimes.com/2020/04/24/us/nursing-homes-coronavirus.html.
4. Johns Hopkins University, Coronavirus Resource Center, accessed 7/9/2020, coronavirus.jhu.edu/us-map.
5. “State Data and Policy Actions to Address Coronavirus,” Kaiser Family Foundation, accessed September 21, 2020, kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus.
6. Ina Jaffe, “Lawmakers Call for Investigation of States’ Nursing Home Policies During Pandemic,” NPR, June 29, 2020, npr.org/sections/coronavirus-live-updates/2020/06/29/885018594/senators-call-for-investigation-of-states-nursing-home-policies-during-pandemic.
7. Maggie Severns and Rachel Roubein, “States Prod Nursing Homes to Take More COVID-19 Patients,” Politico, June 4, 2020, politico.com/news/2020/06/04/states-nursing-homes-coronavirus-302134.
8. United States Senate, COVID-19 in Nursing Homes: How the Trump Administration Failed Residents and Workers, July 2020, aging.senate.gov/imo/media/doc/COVID-19%20in%20Nursing%20Homes%20Final%20Report.pdf.
9. Blake Ellis and Melanie Hicken, “Nursing Home Worker Deaths Going Unscrutinized by Federal Government,” CNN, updated July 23, 2020, cnn.com/2020/07/23/us/nursing-home-worker-death-investigations-osha-invs/index.html?fbclid=IwAR2xFyqmdnbEZ1JfE5i9fs378jHooAwLvVqIh-4nLr2jDTDH6gZcYSdbfC8.
10. Patricia Buck, RN, BSN (charge nurse), in discussion with the author, July 27, 2020.
11. Chris McGreal, “‘We’re Living in Fear’: Why US Nursing Homes Became Incubators for the Coronavirus.”
12. Jordan Rau, “Care Suffers as More Nursing Homes Feed Money into Corporate Webs,” Kaiser Health Network, December 31, 2017, khn.org/news/care-suffers-as-more-nursing-homes-feed-money-into-corporate-webs.
13. Chris McGreal, “‘We’re Living in Fear’: Why US Nursing Homes Became Incubators for the Coronavirus.”
14. Jordan Rau, “Nursing Homes Run Short of COVID-19 Protective Gear as Federal Response Falters,” NPR, June 11, 2020, npr.org/sections/health-shots/2020/06/11/875335588/nursing-homes-run-short-of-covid-19-protective-gear-as-federal-response-falters?utm_source=facebook.com&utm_medium=social&utm_term=nprnews&utm_campaign=npr&fbclid=IwAR0C9ae4rx4Be1j0MpHTd-i9ddbyaBrieLy0wlLzbpG_vIV_-cQ0FInzX0U.