Chronic illnesses, close quarters, little transparency: Inside nursing homes during COVID-19

Nursing homes nationwide have been centers of COVID-19 outbreaks. One nursing facility in Kirkland, Washington is thought to be one of the first major outbreak sites in the United States. According to the CDC, 129 cases were documented at the Seattle-area home. To date, 37 people have died there.

Nursing homes provide the “perfect setup” for COVID-19 and residents there are highly susceptible to the virus, says Dr. Michael Wilkes on today’s Daily Dose. He’s a professor of medicine and public health at UC Davis.

Why residents and caregivers might transfer infections

More than 1.5 million people ages 65 or older currently live in nursing homes.

Many have chronic illnesses, such as lung disease and diabetes, which can make them vulnerable to the novel coronavirus.

Residents are often moving from room to room in close quarters. Wilkes says that movement can make it harder to quarantine patients, which can lead to coronavirus transmissions.

When it comes to caregivers, they often don’t have paid sick leave or work at other facilities, which could lead to COVID-19 transmissions, Wilkes explains.

A lack of training and resources might play another factor.

Wilkes adds that in some cases, hospitals will send COVID-19 patients to nursing homes. These are folks who are too unstable to return to their homes, but still need care.

However, it’s unclear how many coronavirus deaths have been linked to nursing homes in total, due to a lack of COVID-19 testing.

“We just don’t know how big the problem is in nursing homes or in the community, and I think this is really still unexcusable,” Wilkes says.

What are staff doing to protect each other and patients?

Nursing homes have restricted the majority of visits, including those from volunteers and non-essential workers.

There are exceptions for compassionate care visits, when families visit patients with terminal diseases.

“I've heard of a number of cases recently where the compassionate care people were dying, or families were confused and screaming and yelling,” Wilkes says. “They still wouldn't let family visit, for fear of having somebody bring the virus into the nursing home.”

Group activities at facilities, such as communal dining, have also been cancelled.

Unanswered calls

Altogether, Wilkes says COVID-19 has led to a socially isolating — and unbearable — environment for residents. That’s led to confusion and misunderstanding.

It’s particularly difficult when there’s a lack of transparency.

“It's been really hard for me to try to get good data on infections in nursing homes and how many staff have been sent home. I'm not sure why transparency is so restricted. … I know families have frantically called nursing homes to try to find out the status of loved ones. Their calls have been unanswered or go to voicemail and perhaps sit there forever,” he says.