There will be countless attempts to sum up the horror of COVID-19 — both in nursing homes and society at large — in the coming years, once we’re collectively a safe enough distance away from the peak of the crisis to process what we’ve seen and heard.
We at Skilled Nursing News, like most people, never expected that the holiday season would also bring with it record numbers of coronavirus infections and deaths in nursing facilities and among the general public.
When we all logged onto our first company-wide video call way back in March, we optimistically assumed that we’d all be back in the office again within a few weeks. A month or two, tops.
Nine months later, we’re still at home. Widespread vaccine distribution is in sight, but the near- and long-term future remains deeply unclear.
We’ll bring you a full recap of the year’s top stories, as well as predictions for 2021 from both our staff and a host of industry experts, in the coming weeks.
But to kick off our end-of-year coverage, we wanted to start by highlighting the most memorable — and frequently heartbreaking — quotes from the worst year in the history of post-acute and long-term care in the United States.
First up, the quotes of the year as selected by SNN editor Alex Spanko. Next week, reporter Maggie Flynn will present her highlights from a devastating 2020.
‘Perfect killing machine’
SNN ran its first story about the potential impact of the novel coronavirus on nursing homes on February 29. I’ve written about my regrets over not sounding the alarm earlier than that; in our editorial discussions, we erred on the side of caution against inciting panic when COVID-19 still felt so far away.
After all, that same day, U.S. surgeon general Jerome Adams was making this public appeal:
A few days later, New York City mayor Bill de Blasio was telling his constituents to go to the movies “despite Coronavirus” — just weeks before the nation’s largest metropolitan area would become the American epicenter of the pandemic.
I continued to go about my normal personal and work lives, flying from Chicago to Southern California and back in early March for a conference. I still took the subway to the office downtown most days. I was already looking forward to attending my first baseball games of the season, and sometime that week I booked a hotel room in Milwaukee for the upcoming Mets-Brewers series in April.
It wouldn’t be until March 10, when American Health Care Association (AHCA) CEO Mark Parkinson went on CNN and issued the starkest warning I’d heard to date, that the looming disaster would snap quickly into view.
“The grim reality is that for the elderly, COVID-19 is almost a perfect killing machine,” Parkinson said.
He went on to make a prescient comment about the year to come.
“In our facilities, the average age is 84, and everyone has underlying medical conditions,” he said. “So when you combine those factors together, we are dealing with perhaps the greatest challenge that we ever have in the history of our sector.”
The wider reality of the COVID-19 crisis would become clear to me the following day, when the NBA formally suspended its season in a move I could barely conceive of happening — an American sports league, a multi-billion-dollar institution, shutting down over an unseen and poorly understood threat.
But the day I saw Parkinson’s comments was the day I knew we would be in for a long, and potentially very dark, 2020 in the sector we cover.
‘I think they’re getting run over’
Plenty of blame for the staggering death toll in post-acute and long-term care has gone around since this spring, with untold heartache quickly turning into political fodder during a presidential election year.
If you supported the president, nursing home deaths were solely the fault of Democratic governors, such as New York’s Andrew Cuomo and Michigan’s Gretchen Whitmer, who issued controversial orders requiring facilities to accept COVID-19 patients during the crucial early days of the pandemic.
If you hated the president, those same deaths were solely the fault of the administration — particularly its relaxation of rules governing the nursing home space since Trump took office in 2017.
I’ve tried to highlight the voices of those who have correctly portrayed COVID-19 in nursing homes as a cascading set of failures that have festered and fermented over the years, creating a system and a model that could not withstand a virus that laser-targeted the elderly.
One of those voices has been Dr. Mike Wasserman, the former CEO of California nursing home heavyweight Rockport Healthcare Services.
Wasserman has emerged as a rare nuanced commentator on the problems that we collectively must fix to ensure a disaster of this scale never occurs again. As a geriatrician, he has advocated for a greater role for the specialist doctors in the development of nursing home policy and planning, and as a veteran of the operations side, he acknowledges the challenges that frontline caregivers face on a day-to-day basis.
But he’s also been outspoken in calling on landlords to provide more material support to the operations of their nursing home tenants, and he issued a warning in a July interview with SNN: Either the industry steps up and leads the way with actual, difficult reforms, or those decisions will be made for them, on someone else’s terms.
“This is one of those pivotal moments — as you said, an inflection point — where the industry as a business needs to decide: Do we want to own this and all work together to improve care?” Wasserman said. “Or do we want the government to change the way we function?
“And I think that’s what’s going come out of this in the long run. I think the advocacy groups — and I’ve seen some of their proposals — are going to gain tremendous strength because of COVID. I think Congress, I think the consumers are going to be asking a lot of questions. And if the non-operational part of the industry doesn’t take a hard look in the mirror, I think they’re getting run over.”
Nursing homes’ grim ‘Groundhog Day’
In the 1993 comedy-drama “Groundhog Day,” Bill Murray plays a jaded TV weatherman who’s cursed to relive the same day over and over again until he rights the wrongs inflicted on an entire small town’s worth of people.
For nursing home operators in 2020, the same cursed day did indeed keep coming ad nauseam — with spiking COVID-19 case counts, a lack of personal protective equipment, and spotty access to rapid testing — but without a magical solution.
Post-acute and long-term care researcher David Grabowski of Harvard connected the two threads in an August interview.
“My wife has now gotten to teasing me about these things, and saying: ‘Are they interviewing you about testing and PPE? You’ve been saying that since March!'” Grabowski said. “It does have this ‘Groundhog Day’ feel.”
The supply of PPE has come along way since March and April, when the percentage markups were in the thousands and procurement meetings felt more like drug deals, but there are still variations in access. Testing is far more widely available now, but the federal government’s rapid-test rollout was shaky and as recently as December 9, AHCA chief medical officer Dr. David Gifford was reporting turnaround times as long as seven days.
But perhaps the most vivid example of the “Groundhog Day” effect is in the statistics that matter most: infection rates and deaths in nursing homes. Those metrics remain higher than they’ve ever been, even during the catastrophic spring, and they will remain that way as long as community spread continues to expand unchecked — and facilities still struggle with staffing, PPE, and testing.