State Actions, Lack of Collaboration During COVID-19 Peaks ‘Threw Nursing Homes into Chaos’

In calling for a complete overhaul of the way the government and society view long-term and post-acute care, a prominent group of geriatricians argued that the fractured response to COVID-19 in nursing homes may have caused more harm than good in many areas.

Three leaders from AMDA, the Society for Post-Acute and Long-Term Care Medicine, pressed the federal and state government to include geriatricians and other elder-care experts in current and future efforts to reform the space, noting that states such as Colorado, Ohio, and Maryland have seen success by incorporating clinical leaders in their policy decisions.

“But we have also seen the opposite, such as in New York, where executive orders mandating that nursing homes accept patients with COVID-19, and test all PALTC staff twice weekly, threw nursing homes into chaos, risked higher levels of illness and death among the residents and patients of New York nursing homes, and had to be rolled back or significantly modified when misery and heartbreak became the inevitable consequences,” the leaders noted in a special article published in the group’s journal. “In other states, aggressive advocacy may have prevented similar policies from being implemented or implemented fully.”

AMDA executive director Christopher Laxton authored the piece along with geriatricians Dr. David Nace and Dr. Arif Nazir, the latter of whom serves as chief medical officer of prominent nursing home operator Signature HealthCARE.

The New York order remains one of the most prominent flashpoints in the early analyses of the government’s response to COVID-19 in nursing homes, serving as a political football for critics of Gov. Andrew Cuomo and the Democratic Party in general ahead of a fall presidential election campaign.

But in AMDA’s view, the problems in the senior health care landscape run deeper than a single order, highlighting the significant distrust that exists between the government and operators in the space.

“At best, this hostility to PALTC and our cultural fear and societal revulsion around aging have simply rendered invisible the patient and resident population and the workforce of PALTC,” the authors wrote.

That distrust, coupled with conflicting information from state and federal governments, led the long-term care landscape down a path toward disaster amid the stresses of COVID-19.

“States have formed pacts and worked cooperatively and effectively to find solutions to support their citizens’ needs, but they have also found themselves in competition with each other and with health care organizations, suffered at the mercy of profiteers out to take advantage of supply-chain constraints, and forced to find clarity in a fog of incomplete, unclear, or simply wrong information coming from the Federal government,” they wrote. “In the time of COVID-19, even at the highest levels of our government, opinion has been granted equal weight to fact.”

Moving forward, the group recommends a multi-pronged reform approach that incorporates the voices and advice of physicians in the field; reform of a “demoralizing and unhelpful” inspection process that AMDA classified as overly punitive; a focus on updating regulations to support new the development of physical plants designed to improve infection control and resident quality of life; and eschewing “one-size-fits-all” strategies and orders when meeting future nursing home challenges.

“The time for change must be now, while we are still in the terrible grip of this crisis, and before we sink back into the complacency and habits of our pre-COVID-19 lives,” the authors concluded.