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Why nursing homes and senior living centers yield COVID-19 ‘perfect storm’

More than 3,600 COVID-19 deaths in the U.S. are believed to be linked to nursing homes and assisted living centers. The number is only an estimate -- likely an undercount -- because the federal government has not released details of what is happening in these facilities. Amna Nawaz hears personal stories of people affected by the phenomenon and talks to Harvard Medical School’s David Grabowski.

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  • Judy Woodruff:

    More than 3, 600 deaths from COVID-19 in this country are believed to be linked with nursing homes and assisted living centers.

    That death toll has shot up in the past two weeks, and the number is probably an undercount, since it is just an estimate.

    Amna Nawaz is going to look closer at some of the specific problems and challenges these facilities face and how families are coping.

  • Amna Nawaz:

    Judy, we can only give an estimate, because the federal government hasn't been releasing a full count of what's happening in these facilities.

    More than one million people live in a nursing home or assisted living center. We're going to begin with some personal stories, what families are encountering right now.

    We will hear from a wife, an adult grandson, and from the head of a company that runs facilities in Florida.

  • Amy Johnson:

    I'm Amy Johnson, and I am 38 years old, living in Windom, Minnesota.

    My husband, Mark, has a rare form of dementia called frontotemporal dementia. And he lives about an hour away from us in Mankato, Minnesota. He has been diagnosed for about three years now. So, he's in assisted living.

    I have got four little kids under the age of 8. And so they are used to going to see daddy. Even if they don't go every week, it's usually every other week. So, they are definitely noticing the huge change. And they have asked repeatedly: When are we going to go see daddy? When are we going to go see daddy?

  • Keith Myers:

    My name is Keith Myers. I am president and CEO of MorseLife Health System in West Palm Beach, Florida.

    We are one of the largest senior care organizations in the Southeast. We offer the full continuum of care.

    We can no longer have communal activities, so we have to look at another way. But that was very hard at first, especially in our independent and our assisted living facilities, because they enjoy eating with their friends.

    We need to let the residents understand, if they want to go out of the campus, they will be quarantined, because I have no idea who they will meet.

  • Jaime Patino:

    My name is Jaime Patino, councilman for the city of Union City, California.

    My grandmother is Emma Patino. She was a resident of Gateway nursing home in Hayward, California. She is currently at Kaiser San Leandro in the ICU, and with a very grim outlook.

    We were only allowed to visit my grandmother through the window of her room. She has dementia, so she didn't really understand why we couldn't go inside and why we couldn't visit her. But that's what we did for about two weeks, until this past Wednesday, when I got a news alert via e-mail from The East Bay Times saying that six people had passed away there at Gateway.

    On Friday morning at 3:00 a.m., my dad received a phone call that she was being transported to Kaiser Hospital San Leandro because her oxygen levels had gone down. And when she got there, they found out that, not only was COVID-19-positive, but it had gone into her lungs, but her kidneys were starting to fail.

    Her heart was being stressed because it was fighting the disease, and she also had septic shock.

  • Amy Johnson:

    The pandemic has definitely influenced the way that we have been able to interact with him. We did go up this last weekend and dropped him off some different clothes, because he — his weren't fitting right.

    And it was basically just, you know, drive an hour, drop it in the entryway, and walk away, because we're not allowed to really be in contact with the staff there even.

  • Keith Myers:

    I have to make sure I have the right amount of equipment to be able to get the resources to our employees, so they feel comfortable in providing the quality of care that our residents and our patients expect.

    Fortunately, we do not have any active COVID cases here. At first, they were making masks. They were bringing in bandanas, until I was able to procure it. So now we're able to offer surgical masks.

  • Jaime Patino:

    If God's going to take her, she lived a great life, and we were all blessed to have her.

    And, as for the future, I'm going to use whatever platform I can to push for more transparency, so that people know exactly what's going on in these nursing homes.

  • Amy Johnson:

    My husband will continue to decline.

    But it's just still hard knowing that we can't — I can't be there. If he did decline to the point where he would require, you know, end-of-life or hospice care, which is — with the form of dementia he has, it's very possible that it could decline that quickly. And with that being the case, you know, that's hard to think about.

  • Amna Nawaz:

    And before we go on, a sad update.

    Jaime Patino's grandmother passed away after we spoke to him yesterday. She was 84 years old.

    And our condolences, of course, go to him and to his family.

    We did reach out to the Gateway Care and Rehab Center, but we have not heard back from management there yet.

    For more on what Jaime and others have been dealing with, and how this industry is grappling with the coronavirus, I'm joined by David Grabowski. He's a professor of health policy at Harvard Medical School.

    David Grabowski, thanks for being with us.

    People are going to look at those numbers that we reported earlier, over 3,600 deaths, up from just a few hundred in a matter of days. It's an alarming rise. What is behind that rise?

  • David Grabowski:

    It's incredibly alarming. And, if you can believe it, it's actually an underestimate.

    What's behind it is just how deadly this virus is in nursing homes. We have older adults with high levels of chronic illness. When this gets started in a nursing home, it's incredibly harmful to the population there.

  • Amna Nawaz:

    You have called it the perfect storm. Explain to me a little bit about why.

  • David Grabowski:

    Well, you have older adults living close together. You have staff members who are moving room the room, potentially spreading the virus.

    Remember, we don't have testing. Many of these workers don't have personal protective equipment, like masks or gowns or gloves, so they're slowly spreading it throughout these buildings. And so it really is this perfect storm of lots of older adults with chronic illness and staff kind of slowly moving it around the building.

  • Amna Nawaz:

    And why do you believe that's an undercount? Do you think we have an accurate tracking system within the facilities? Is there any mechanism at the federal level for tracking this?

  • David Grabowski:

    So, there is no mechanism at the federal level currently to track these numbers. So we're totally dependent on state departments of health.

    Some states have done a great job in tracking these cases and these deaths. Other states are doing nothing. And so that's the first source of this underreporting, is just that we have a lot of missing data. A lot of states aren't reporting.

    But then, even within states, there's going to be a lot of undocumented cases. And then we know there's a lot of asymptomatic cases. That means individuals who aren't showing any symptoms of the virus.

    So I think the number is much higher than the one you reported.

  • Amna Nawaz:

    So, we have heard a lot about nursing homes have obviously locked down, no visitors allowed, right?

    They're barring all the communal activities too. Staff, of course, have to come and go, but what else could they be doing? Could they be banning new entries, new patients from coming into the facilities?

  • David Grabowski:

    That's one step. And I think many facilities have stopped taking new patients from the hospitals.

    So, hospitals right now are looking to discharge COVID-positive patients to nursing homes. Many nursing homes have held the line and said, we can't currently safely care for these patients. So, that's definitely one thing they can do to kind of try to keep those residents that are currently in the facility safe.

  • Amna Nawaz:

    And what about when you look at sort of pre-pandemic, how nursing facilities and assisted care living facilities handled these kinds of things?

    You had to believe there was a plan in place to handle infectious outbreaks, right?

  • David Grabowski:

    Unfortunately, there really wasn't a plan in place.

    This has not been the strong suit of either nursing homes or assisted living. And, unfortunately, I think it's easy right now to just blame the nursing homes and the assisted living facilities. I also think we have to point the finger at how we pay for these services and how we regulate these services.

    We have often underfunded nursing home services in this country. We have had poor models of oversight and accountability. And so, at the end of the day, we kind of get what we pay for here, unfortunately.

  • Amna Nawaz:

    There are a lot of families out there have loved ones in these facilities. They're reading the headlines and they're worried.

    I want you to speak directly to them and tell them what you would advise at this point. Should people be pulling loved ones out of their facilities? Conversely, you should they think twice before moving someone into a facility right now?

  • David Grabowski:

    Yes.

    First of all, my heart goes out to everyone with a loved one in a nursing home. This is an incredibly trying time.

    I don't know that many of us can pull our loved ones out of a facility at this point. I think it may be too late, actually. As we were just discussing, the virus is already in a number of nursing homes around the country.

    If you do bring them into your house, you have to keep your loved ones safe. Are you able to sort of have a high level of infection control to keep the virus out of your home?

    And then, finally, remember, there was a reason they were in this nursing home to begin with. They need lots of assistance with activities of daily living, like bathing and dressing. Are you and your family going to be able to provide those sets of services?

    You could potentially hire somebody into your home, but then you're facing the same set of challenges you might have faced in the nursing home with staff bringing it into your house.

    So, I very much like the idea of pulling a family member out of a nursing home. In practice — but, in practice, I just don't know how feasible it is for most families.

  • Amna Nawaz:

    Before I let you go, David, just let us know, based on the steps you have seen so far, do you think the numbers are plateauing in these facilities, or do you expect them to go up?

  • David Grabowski:

    Oh, unfortunately, they're not plateauing.

    I think they're really going to go up. And I'm really scared for older adults. Here in the state of Massachusetts, where I live, almost half of the COVID-related fatalities to date have been nursing home residents.

    I'm really scared, as we see this go across the country, what the numbers are ultimately going to look like.

  • Amna Nawaz:

    It's such a worrying time.

    David Grabowski of Harvard Medical School, joining us tonight, thank you for being with us.

  • David Grabowski:

    Thank you.

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