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Why American nursing homes have been hit so hard by coronavirus

Nursing homes across the country are facing a desperate situation during the coronavirus pandemic. In 17 states, more than half of reported COVID-19 deaths have been at these facilities. Chronic staffing shortages, made worse by the virus, and inadequate infection control procedures exacerbate the threat amid the population that is the most vulnerable. Lisa Desjardins reports.

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  • Judy Woodruff:

    As we heard earlier from California's Governor Gavin Newsom, nursing homes across the country are facing a desperate situation, with large outbreaks of coronavirus among staff and residents.

    In 17 states, more than half of reported coronavirus deaths have been in nursing homes.

    Our Lisa Desjardins brings us this report on what has become a front line.

  • Lisa Desjardins:

    In these photos of coronavirus victims is a sometimes hidden aspect of the crisis. Where they died, in nursing homes, are a kind of ground zero.

  • Nicole Catatao:

    He was always kind of a little bit of the life of the party, very funny, always smiling.

  • Lisa Desjardins:

    Nicole Catatao's grandfather, Antonio Catatao, died while living at a nursing home in Massachusetts that had one of the largest outbreaks of COVID-19 in the country.

    She told us that, after he was diagnosed, the family checked on him through a window. And on one afternoon visit, it looked like he had not been fed or dressed since the day before.

  • Nicole Catatao:

    We could visibly see that his diaper was overflowing. So, at that point, you know, my aunt became really upset.

    And one of the administrators of the facility came outside to speak to her, and told her that they had a lack of staffing, that they had multiple staff members out with coronavirus, and that, that day, they had two staff members for the whole facility, which is over 200 beds.

  • Lisa Desjardins:

    I can't — two staff members for the whole facility?

  • Nicole Catatao:


    Then he had also said, we have no doctors.

  • Lisa Desjardins:

    Her grandfather died two days later.

  • Danny Avula:

    The reality is that, yes, this is where COVID-19 is taking its steepest toll. This is — this is who is feeling the brunt of this disease.

  • Lisa Desjardins:

    Dr. Danny Avula is the director for the Richmond and Henrico Health Districts in Virginia. A long-term care facility in his district saw more than 50 deaths from coronavirus.

    In April, it was the nation's deadliest. That outbreak has quelled, but others have started, and his staff is trying to contain the virus in more than two dozen different long-term care facilities.

  • Danny Avula:

    In any other situation, we have got the staffing and the expertise and the capacity to really provide hands-on support for one or maybe two facilities that have different outbreaks going on, but not 26.

  • Lisa Desjardins:

    He says families should consider removing relatives from long-term care, if they can.

  • Danny Avula:

    In so many of these situations, these are patients who have severe dementia and have a high degree of need hour by hour, minute by minute, in terms of support. And that's why they're in homes like this.

    It's really difficult to support that in a residential setting. And so, you know, I don't say that lightly.

  • Lisa Desjardins:

    And that dire concern comes before we know the full scope of the problem.

    Up until this past weekend, nursing homes had not been required to publicly report numbers of COVID-19 cases and deaths. That changed over the weekend, when a new mandate from Medicare and Medicaid kicked in, requiring that nearly all facilities share this data with the federal government, which in turn says it will publish it swiftly.

    Here's what we do know, even without the complete picture. The first major coronavirus hot spot in the country was this nursing home in Kirkland, Washington, with 45 deaths in early March. Two months later, more than 7,000 long-term care facilities have outbreaks. That's according to the Kaiser Family Foundation.

    That includes three separate outbreaks at facilities in New York, Massachusetts and New Jersey that each saw at least 70 deaths, and two major outbreaks in Medford, Massachusetts, with at least two dozen deaths at one nursing home and more than 50 at another, including Nicole's grandfather.

    She has some advice for families dependent on nursing home care.

  • Nicole Catatao:

    Ask the nursing facility about, you know, what is your staff numbers? What is your staff ratio? How has it changed with coronavirus?

    Don't assume that, because the care was there beforehand, that they're able to maintain the same level of care.

  • Lisa Desjardins:

    Charlene Harrington is a professor emerita at the University of California, San Francisco, where she has been studying nursing homes for 35 years.

    Why weren't our nursing homes prepared for this?

  • Charlene Harrington:

    Experts and advocates have known for many years that the nursing homes were not operating at an appropriate level, in terms of staffing and quality.

    And yet we have allowed this to happen over the years. So, this — it's is the first time I think the whole country has become aware.

    Before the pandemic, 75 percent of the nursing homes did not have enough staff, especially registered nurses. And registered nurses are essential for infection control, for assessing residents and managing the staff in nursing homes.

  • Lisa Desjardins:

    That is just one layer. Roughly two-thirds of nursing homes are private for-profit facilities. Pay can be low, and clients often stay two to a room.

    And even before the pandemic, the Kaiser Family Foundation found 63 percent of nursing homes had recently been cited for improper infection control. The CDC says as many as 380,000 people die of infections in long-term care facilities every year.

    Things could be changing. Last week, the Trump administration told governors to focus on testing every nursing home resident and worker for coronavirus over the next two weeks.

  • President Donald Trump:

    Now, some of the states, many of the states are doing that. But I think all of the states should be. They have the capacity to do it. They should be doing nursing homes. That is a real vulnerability.

  • Lisa Desjardins:

    Across the country, some are on the road to recovery. And when they get better, the nursing home staff who have cared for them throughout are there to cheer them on, like for Jack Holzberg, a 94-year-old Holocaust survivor in New Jersey.

    For the "PBS NewsHour," I'm Lisa Desjardins.

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