COVID-19 will change many things about America. One may be the care our older Americans get at nursing homes of skilled nursing facilities as they are largely known nowadays.
Much of the war against COVID is being waged in these homes. Here in Connecticut, 40% of all deaths have been nursing home patients. Many of the patients coming into our hospital are coming from the same nursing facilities where others have tested positive. The radio patch comes over: “89-year-old female, short of breath, room air sat is 88%, fever of 103.1. Not tested yet, but many in her facility are COVID positive. Respiratory isolation precautions in effect.”
There is one nursing home in our service area where I work as a paramedic that has a very poor reputation, made worse by their COVID response. We in EMS judge a nursing home on several things, smells, appearance, readiness of the staff to give us a report when we arrive, but most of all on the condition that the patient is found in when we arrive.
Some nursing homes the 911 calls are never very interesting. High blood pressure, altered mental status, abnormal lab values; others are always bad-respiratory distress, sepsis, cardiac arrests. The first group sends their patients out at the first sign of trouble; the latter group sends them when they are in common parlance, “shitting the bed.”
The best way to rate nursing homes, if you could do it this way, would be to count what percentage of the time the ambulance leaves for the hospital lights and sirens after picking up the patient versus going with speed of traffic which is how the majority of EMS 911 trips to the hospital go.
When you show up at a nursing home and you can’t find a staff member and the patient is severely hypotensive or in major respiratory distress and they can’t tell you when they were last seen normal, that is an issue. The other response we often get is, “I don’t know, I’m just an agency nurse. I’ve never seen her before.”
This happens frequently. The worse the nursing home the more it happens. If a home can’t keep its staff, you end up temps and agency nurses. That is not good for patient care.
Today we pick up a woman found on the floor with a severe gash on her forehead. No one knows how she fell. She can’t tell us. The nurse looks at her medical records and tells us the woman has dementia. “How does this compare to her normal?’ we ask. “I don’t know. I’ve never seen her before.” Any other medical history you can tell us about?” She hands us a mimeographed sheet of paper from several weeks ago that is barely readable both due to penmanship and the number of times it has been copied.
Because of the reputation of this facility, as a COVID hot spot, we came in fully gowned with face masks on. The woman’s pulse saturation is fine, she is not feverish, but she is talking gibberish and the lac on her head is deep. We take her to the hospital. On the way I read through the stack paperwork the nurse handed me in a red envelope.
I can barely make out the words COVID. I have to put my glasses on underneath my goggles to make it out but there it is COVID +.
There was no sign on her door, The nurse said nothing about it. I’m glad we had our PPE on.
I know many people labor in these facilities for low pay and they are horribly understaffed, so I am not blaming the workers. I blame the system. We all saw how COVID devastated the first nursing home in Kirkland, Washington when the epidemic was first beginning.
We had to know it was coming. COVID is burning like gasoline in their homes, and even if we turn the corner on this wave of the epidemic, if we have flattened the curve and the numbers drop, does anyone thing we are prepared for the next wave or the next epidemic.
Let’s have an economic come in and look at where the money is going in these homes. The nurse’s aren’t rolling in dough. Many ride the bus to work and have two and three jobs. They leave at first chance for better work. No wonder there are so many pool or agencies nurses in these places or nurse’s who say, today is my first day. The money has to be going somewhere. How much do the administrators make? Who are their bosses? Are these homes run by for profit corporations. Or maybe the problem is the state. Maybe these places are truly underfunded for what they do in our society. Maybe we need a different model. This can’t happen again.
COVID targets nursing homes and prisons. Think about that.
I remember what my old partner Arthur used to say when we came out into the sun after leaving another patient at a nursing home.
“Just put a bullet in my head,” he’d say.
Tonight when I get home, there was a story in the paper about the state boosting Medicaid payments to nursing homes and sending state regulators out to each home to inspect them.
Here’s the best part: The state’s increased financial support will be applied toward employee wages, including staff retention bonuses, overtime and shift incentives, new costs related to screening visitors, personal protective equipment for staff and cleaning supplies.