The coronavirus is at its deadliest when it infects senior citizens, particularly those with conditions that require home health services or land them in nursing homes and assisted-living facilities.
Precise statistics on seniors’ vulnerability are hard to come by. But Washington state, which has up-to-date demographic data through its statewide reporting system, has documented the extent to which mortality from the pandemic is concentrated among the elderly.
As of April 14, Washington, which recorded the first known U.S. death from COVID-19 on Feb. 26, counted 541 deaths among its 10,694 confirmed cases. People over 60 accounted for fully 92% of those deaths, even though that age group registered 35% of the cases. That translates into a mortality rate of 13%, or 22 times higher than the rest of the population.
An estimated 2 ½ to 3 million Americans—less than 1% of the population—live in the nation’s 15,600 nursing homes and 36,000 assisted-living facilities. An informal Associated Press tally reveals those residents account for 15% of all deaths from COVID-19.
Clearly, the elderly, especially if they’re poor, black or Hispanic, have the most to fear from COVID-19. They will suffer the most should any state prematurely lift its shelter-in-place order without an adequate testing, tracking and tracing system in place.
Full disclosure: I’m in this group. During my numerous group conversations with friends over the past several weeks, someone inevitably raises the possibility that we may spend the rest of our lives as shut-ins if the government acts precipitously to end shelter-in-place.
Their fear? In order to get back to work, young people will be willing (or be forced) to expose themselves to something that, for their age cohort, is most likely to wind up a mild disease. The businesses, conservative media outlets, and politicians clamoring for a quick return to normalcy are betting they can convert that willingness into a political constituency that demands lifting the restrictions.
But does anyone think oldsters will resume patronizing restaurants, theaters, hotels, stadiums, museums and other public venues in anywhere near pre-pandemic levels if the government (and the general public) accepts an infection curve that’s bent but not broken? A premature declaration of victory will condemn the thousands of U.S. businesses and not-for-profits that depend on senior patronage into permanent shrinkage or bankruptcy.
Meanwhile, surveys and anecdotal evidence show that the nation’s belated pandemic preparedness efforts are shortchanging the front-line workers who feed, bathe and treat seniors in institutionalized settings. A Premier survey of 2,500 facilities revealed nearly one-quarter had no N95 masks for their workers. Fully 96% are taking steps to conserve their limited supplies of masks, gloves, gowns, thermometers and hand sanitizers.
Nursing home operators hit by outbreaks are deploying desperate tactics like concentrating their COVID-19 patients in designated facilities. The CMS sought to aid those efforts by waiving reporting requirements—as long as both facilities were CMS-certified.
But that won’t prevent the spread of infection. Many seniors don’t show symptoms for up to a week after being infected.
Workers coming in from the local community without adequate protective gear can turn even a model nursing home with high quality ratings into a hot spot.
As public health authorities ramp up testing, they need to pay special attention to residents and workers in nursing homes and assisted-living facilities—the places where any outbreak will do the greatest harm. They need to prioritize giving post-acute care workers the same access to personal protective gear as hospital staff and other healthcare workers.
And Congress and state Medicaid agencies need to rethink the absurdly low reimbursement levels that lead to low wages, high turnover and chronic short-staffing at nursing homes—problems that will only get worse in the wake of COVID-19.