Nursing Homes Deserve Praise, Not Blame

It has happened every night this spring, at 7 o’clock sharp. With the coronavirus pandemic raging on, folks sheltering in place and hospital workers continuing to wage a battle that has no discernible end, New York City residents have opened their windows or gathered on the balconies or rooftops of their apartment buildings to clap and cheer.

It is their way of saluting healthcare professionals, and it is humbling to behold. Such workers deserve abundant applause for their tireless efforts in fighting a devastating (and often lethal) virus. The toll of that fight is often literally etched on their faces, as revealed in some of the photos that have made the rounds of late; they frequently show the imprints left behind by the protective headgear workers wear during their long hours on the job. 

We owe a great debt to this nation’s healthcare workers. At the same time, that credit sometimes stops short of those who toil in eldercare and nursing home facilities. Though they too labor on the front lines -- and do so with a particularly vulnerable segment of the population -- the cheers have been muted, the salutes short-lived. They were replaced instead by concerns over the standards within, and transparency of, such facilities. 

These nursing home professionals include Chelsey Earnest, RN, who despite working at another facility, volunteered to assist the staff at the Life Care Center in Kirkland, Washington, which was ravaged by the disease and indeed became the very epicenter of the crisis as it took hold in the U.S. Over 129 people associated with that facility tested positive for the virus, and 37 died from it. And according to the National Review the disease spread from there not only throughout the Pacific Northwest, but as far away as North Carolina.

Earnest, interviewed by CNN’s Sara Sidner for a report that aired March 23, could not have predicted any of that at the time. All she knew was that she and her cohorts faced a monumental task.

“You’re going off to war,” she said, “and you’re on a battlefield where supplies are limited, the help is slow to get to you and there’s lots of casualties… And you can’t see the enemy.”

“I’m a nurse,” the volunteer told Sidner. “They’re not my patients, but …”

Her voice trailed off, as she choked back sobs.

Then there’s Carl Shrader, medical director at the Sundale Nursing Home in Morgantown, West Virginia. The first patient at the facility to test positive for the virus did so on March 21, and in a scene repeated at many facilities throughout the country over several weeks, Shrader swung into action. 

He made sure the building was closed off to visitors, and that residents were confined to their rooms. He did the necessary testing -- with the help of some National Guardsmen, no less -- while also creating an isolation unit within the building, out of an area normally used for physical therapy. Staff in the meantime sanitized the facility and served meals on disposable china.

Still, 21 of Sundale’s 98 residents were infected. Four, sadly, died. And Shrader had to be content in the knowledge that he had done all he could.

“The scariest part of it is facing something that you’ve never had to deal with before,” he told the Charleston Gazette-Mail. “There’s no guidelines you can point to that would tell us how to manage this.”

There’s no question that professionals like Chelsey Earnest and Carl Shrader are just as deserving of our gratitude. But that appreciation has been dulled compared to the loud cheers for hospital workers and others on the front lines of this pandemic. 

Why is that? It may be, in part, because the stain of a few startling stories is coloring the industry as a whole. Or perhaps we are unable to grasp the full scope of the challenge facing skilled nursing facilities because of reporting gaps. Few realize what it means to be locked in a highly regulated facility that has limited flexibility, while being faced with a resident population that must go to and from hospitals overrun with COVID-positive patients. To make matters more complicated, nursing homes in New York have been ordered by government mandate to accept coronavirus patients to alleviate hospital bandwidth. 

The Washington Post reported on April 20 that one in 10 nursing homes across the country has reported cases of COVID-19, while at the same time noting that data is not readily available from every facility in every state. In reality, in hard-hit regions of New Jersey and New York it would be great if we could report that one in 10 nursing homes was not infected. 

Whatever the case, the good work of those in our nation’s nursing homes has not yet been fully acknowledged. 

That tide is beginning to change, however. New York governor Andrew Cuomo has proposed that front-line workers -- not only medical personnel but policemen, firefighters and mass-transit workers -- be given hazard pay, and New Hampshire governor Chris Sununu has made a similar proposal.

Meanwhile Larry Hogan and Ralph Northam, the respective governors of Maryland and Virginia, have created teams to provide emergency support to skilled nursing facilities. And Facebook donated $25 million to enable California’s Office of Statewide Health Planning and Development to create its Skilled Nursing Facility Hero Awards, $500 stipends to 50,000 nurses who work in skilled nursing facilities.

It is as MSNBC’s Rachel Maddow said during a recent monologue on her television show: Those who work in eldercare facilities are just as deserving of praise as those who work in other facets of healthcare -- especially, she added, since there are so many cases where they are “dealing with more death, with less equipment, less training and with no visibility and no help.”

The brave workers in our nation’s nursing homes should be applauded from every rooftop and every balcony. While not every facility is perfect, the vast majority answer the bell day after day, week after week, year after year. And that has never been clearer than at this point in the nation’s history.