Covid-19 Nursing Homes Neglect

My mom’s mental and physical health has deteriorated enormously in the last four months of the forced lockdown in her nursing home. They were kept isolated and bed-ridden without the benefit of any exercise or even wheelchair self-strolling.

The staff lost her dentures for the seventh time in four years and a trip to the dentist did not help as her jaw muscles were too weak to bite down to make imprints for new dentures.  Leg muscles, and most muscles in general have atrophied from lack of movement.

By order of the Virginia Health Department, they shuffled the elderly from the rooms they knew into unknown rooms previously occupied by other patients sick with the flu.

The entire move was done in one day, hardly enough time to sterilize the rooms properly. They hurriedly threw some of their belongings in plastic bags and put them on the floor in the new rooms with a roommate.

The single occupancy rooms were dedicated to Covid-19 patients’ isolation. Of the 101 residents, 76 tested positive for Covid-19 and 26 did not. Most who tested positive were asymptomatic.

Mom was tested twice for Covid-19 and came up negative both times. But she got pneumonia from the flu even though she had a mandatory flu shot. Thankfully, she recovered, her second bout with pneumonia in three years.

Eventually eight people died of underlying multiple illnesses but were marked as Covid-19. One man was 100 years old. In the best of times, caretakes and underpaid careless facility cleaners carry bacteria and viruses from room to room.

Recently, the nursing home resumed admission of new patients, but former residents are still in lockdown and families are not allowed to see them.

Among the many sad lessons, I learned from this flu epidemic called a “pandemic,” was how poorly and inhumanely the elderly were treated in nursing homes.

Jon Rappaport called the Covid-19 the “nursing home disaster.” He wrote that it was “mass murder by cruelty,” and by painful physical isolation, lack of mental stimulation, and loneliness. He added that “The excess mortality of 2020 is largely the result of elderly people dying in nursing homes.”

He explained, “it has nothing to do with a virus, it has to do with patients who are already on a long downward health slide---then hit with the terror of an arbitrary and fake Covid-19 diagnosis, and then isolated and shut off from family and friends---in facilities where gross neglect and indifference are all too often the ‘standard of care.’”

I can certainly attest to the neglect and slowly delivered care despite my weekly insistence. Under the best of times, mom was neglected. Now I cannot have access to her at all, I have no idea of her level of care. There are some good nurses who care about their patients but most of them do not stay long, replaced by foreign caretakers who do not relate to our standards of medicine.

It is easy to overcome nursing home patients with terror and isolation. When I asked to take mom outside for a stroll for fresh air and sunshine, even wearing gloves and a mask, I was told that she would have to be put in isolation for 14 days if I did that. But if she would go out into the world for a doctor’s visit, that would be approved.

And the elderly locked down at home, scared to death by the non-stop media COVID-19 panic, died alone and isolated, afraid to call 911 for help. Those who did go to the hospital, were intubated immediately with breathing ventilators, heavily sedated with several drugs, never came out of sedation to breathe on their own again and died.

Forbes reported on May 22, that in 43 states, “42% of all COVID-19 deaths have taken place in nursing homes and assisted living facilities.” The excess mortality allegedly came from nursing homes and the use of ventilators in hospitals. https://www.forbes.com/sites/theapothecary/2020/05/26/nursing-homes-assisted-living-facilities-0-6-of-the-u-s-population-43-of-u-s-covid-19-deaths/#46e33a6074cd

A study published in the Journal of the American Medical Association (JAMA) looked at charts of 5,700 patients with Coronavirus infections who were hospitalized in 12 hospitals in New York City and the patients’ outcome based on age, sex, and co-morbidities. The mortality rate on ventilators was 88.1 percent.  https://pubmed.ncbi.nlm.nih.gov/32320003/

More About Nursing Homes

Caring for our elderly in nursing homes has become a profitable and very expensive industry that few dare to talk about. It speaks to the resilience of some elderly who remain alive despite the abuse and neglect they experience in nursing homes.

Some nurses and assistants start out and remain caring despite the long hours, the low pay, the back-breaking work, and the unrewarding environment. Other staff members do not care and abuse or neglect patients in front of their loved ones.

Perhaps Americans don’t want to work as CNAs because the pay is low and the hours are long. Many immigrants, legal or illegal, are more than happy to fill the vacuum.  One thing is certain, as I’ve experienced for the last four years in a nursing home in Fairfax, the work ethic in this new wave of immigrants leaves a lot to be desired. There are always a few remarkable exceptions.

Recently one nurse’s aide dropped a patient she attempted to hoist with a broken device, the patient fell and was injured, but she never filed an incident report. She was hoping nobody would find out as the patient spoke only Spanish. The next day the patient was covered in bruises but without broken bones.

I arrived one day to pick up my mom for her doctor’s appointment. She was in wet socks, no shoes, her shirt was on backwards and food-stained, she needed a diaper change, and the male nurse handled her roughly causing her unnecessary pain and suffering radiating from the hip which had been recently operated on. And the nurse helping her did all of this right in front of me. Can you imagine what they do to patients in the absence of relatives?

There is an ombudsman in the nursing home to represent the patients but patients and relatives are afraid to report anything wrong for fear of staff retaliation. I learned the hard way that, every time I would report a bad incident, the nursing staff would treat mother much worse.

Many elderly are so sick, they never say ‘thank you’ or smile even though they may be grateful that they are being taken care of – they are in so much pain to remember to be polite. Other patients no longer know who they are.

Some elderly patients don’t have any relatives; others do but nobody comes to visit, life keeps them busy. Yet many have relatives who do come to visit but never bring as much as a warm blanket which they desperately need because the nursing home blankets are never warm enough in winter. A few only visit at Christmas time to make sure they are still in the will.

The elderly, who have their mental faculties but are immobile, are often depressed despite the bingo, occasional music, ice cream social, and other activities organized by the nursing home. Television becomes the only mental stimulation some may have. A few read Bibles and others wheel themselves in the hallway watching the world go by.

They cannot leave the floor without an elevator code and they have heavy alarm bracelets. Those with their mental faculties who are semi-mobile have hospital armbands with information which tells the outside world that they are patients in the nursing home. It is a loss of freedom that is not unlike being an inmate in a prison. On the other hand, a few patients do not have a clear legal status so they need these bracelets.

Depending on the time of day, there is always a permeating smell of urine and feces mixed in with the smells of food and disinfectant. Diapers, trips to the bathroom, and showers are never done timely because there are too many patients assigned per CNA. And if the CNAs do not take their jobs seriously, they compound existing problems in the quest of earning a paycheck.

Many elderly refuse showers for various reasons, the major one being that the water is really cold most of the time, making it a frigid and painful experience, particularly in wintertime. The elderly are usually cold and should be showered with much warmer water.  I had to shower my mom in the nursing home and the water was lukewarm even though I let it run for quite some time.

The lack of timely diaper changes and showers cause a lot of UTIs in the elderly female population. Cross-contamination occurs because not all of the staff understands bacterial transmission through contaminated gloves not changed between patients.

Other staff members are really hard-working but the job gets to them eventually after seeing so much pain and misery.  The last chapters of our human lives are not pretty and are made worse by chronic disease and pain.

The indignity of incontinence is very hard to deal with in a fully grown adult. It is difficult sometimes to change the diaper of a small baby, can you imagine changing the diapers of adults who cannot be placed on a changing table and are often combative?

Five star facilities can be abusive and neglectful too. Many reject people who do not speak English under the pretense that they cannot meet their needs. It is a subtle form of discrimination. 

Most people cannot afford the $7,000 per month assisted living fees or the $12,000 per month in-home care. Insurance does not even begin to cover such outrageous costs. Medicaid pays nursing homes a little over $6,500 a month for their patients that require specialized nursing care which is just about everybody already there.

The Alzheimer patients are separated in a locked area unfortunately called Arcadia. Many are ambulatory and would disappear without a trace if left to their own devices.

Western societies are supposed to deal with their elderly in a more humane way but, in the process of insuring that they are taken care of, the family may suffer terrible financial burden even with two income-earners. And they cannot possibly care for the really sick loved ones who need shots, blood drawn, emergency trips to the nearest ER, and other measures to save that patient’s life.

Because they do not want to be a burden on their loved ones, many choose to have a do not resuscitate (DNR) order in their wills and others move to countries that allow euthanasia. They prefer those measures as opposed to lingering in a nursing home and be forgotten, neglected, and abused while in pain.

Rhonda, not her real name, was blind, unable to talk, and on dialysis for several years before she passed in her sleep. She wailed from the top of her lungs all day long.  She was transported twice a week to have her blood cleaned. Her tiny bony frame was covered in large, purple bruises from the dialysis needles.  

Some societies use the entire tribe to care for the elderly in the last part of their lives. They treat them with love, dignity, and the respect they deserve.

A Nordic country allows students to live in a wing of the nursing home, rent free, as long as they adopt an elderly person and interact with them on a daily basis.

But many patients who still have their faculties prefer visits from and time spent with their loved ones. They don’t want much as they near the end of the lives, just their children’s, grandchildren’s, or siblings’ time.