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An estimated 40% to 50% of all Americans whose deaths have been attributed to the novel coronavirus lived in nursing homes. The vulnerability of the residents and the shortcomings in many of the facilities were pre-existing conditions whose effects were magnified by the pandemic.

The question for government policymakers and operators of the homes is how can they learn from the tragic consequences of the past three months and prepare to handle future waves of Covid-19, as well as other threats.

Four primary areas need to be addressed: testing for Covid-19 and isolation of those who test positive; providing sufficient personal protective equipment for the staff; infection control; and staffing levels inside the homes.

Gov. Andrew M. Cuomo has taken flak for a well-meaning but ill-advised directive his administration gave in late March, when the Department of Health declared that nursing homes had to accept residents who were suspected or confirmed to have Covid-19.

The mandate, announced on March 25, was based on fears that hospitals would be overwhelmed with Covid-19 patients unless they could discharge individuals who had recovered.

Also, the states directive included a statement that nursing homes unable to care for Covid-19 patients would need to transfer them somewhere else. That made the whole directive a bit vague, and nursing homes throughout the state struggled to properly accommodate Covid-19-infected patients, as well as protect their workers. The governor finally revised the policy on May 10, announcing that a hospital could not discharge a person who is Covid-19-positive to a nursing home.

Confusion over the policy no doubt contributed to unnecessary spread of Covid-19 among nursing home residents and staff. At the same time, there is plenty of blame to go around in the handling of the virus in the state. Reporting by ProPublica and other news outlets shows that the federal government and State of New York could have slowed the progression of the virus by taking earlier action.

Testing and PPE

When Covid-19 first asserted itself here in March, there was not enough testing available to gauge the presence of the virus among residents or nursing home employees. There has been improvement, but more rapid testing needs to be available.

The Cuomo administration in May directed that nursing homes need to test employees twice a week for Covid-19, but a fight over who pays for the testing regimen has yet to be resolved.

Testing is important for employees, who sometimes hold down more than one job and have the potential to carry the virus from one workplace to another. It also must be done for the residents, to see who needs to be isolated.

Employees also need to have adequate supplies of PPE to keep them safe while working in nursing homes. There have been media reports of staffers being told to share face masks, gloves or other equipment, or of facilities having to scrounge for supplies. Supply shortages are less apparent now and cases are decreasing in our region, but a second wave of the virus is likely in coming months. The time to prepare is before that takes hold.

Infection control

Preventing infections has been a longtime challenge, but new federal regulations announced last week bring hope for improvement.

The Buffalo News reported in May that more than half of the 46 nursing homes in Erie and Niagara counties were cited by the state for violating infection control standards over the past four years.

Kaiser Health News, in a story published in March based on its analysis of federal records, found that 63% of all nursing homes inspected going back to 2016 had been cited for infection-control deficiencies.

One of the most common infection-control lapses is staff members failing to wash their hands properly. Hand-washing has been a well-publicized tactic for slowing the spread of Covid-19, and it needs to become an ingrained habit for anyone involved in personal care.

The states Health Department performs inspections of nursing homes and issues citations for violations. A criticism in New York and in other states has been that enforcement of infection-control rules is lax, with few stiff penalties.

That could change and it needs to under new penalties announced by the Trump administration and the Centers for Medicare and Medicaid Services. The CMS raised monetary penalties for nursing homes with persistent violations and said it would reduce federal aid to states that dont do enough scrutiny of nursing homes.

New York may not need such an ultimatum, but the message is clear: States need to inspect nursing homes early and often.

Staffing levels

Hiring, training and retaining staff members is a constant challenge for nursing homes. Demand far outstrips supply, partly due to the low wages paid to direct care workers.

The national median wage of Certified Nursing Assistants is $14.25 per hour, or less than $30,000 per year for a 40-hour work week. The Medicaid reimbursement system puts significant cost pressures on nursing home operators, who in turn often hold costs down by keeping staffing at low levels.

The care delivery system cannot be reformed overnight, but something has to change to make it worthwhile for care aides to stick to their jobs rather than flee to less stressful work that pays the same. A nursing home that offered a noticeably higher wage scale would no doubt find new applicants lining up. Hiring them would improve patient care and no doubt lead to higher quality ratings for the facility.

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New York needs a better plan to safeguard nursing home residents - Buffalo News