In many institutions, there aren’t enough of people on duty at any given time. The harsh arithmetic of elder care does not allow for staffing levels adequate to the demanding tasks they are legally required to perform.
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Headlines dwelling on multiple deaths at nursing homes may seem shocking, but they come as little surprise to aging specialists who have watched long-term care regress toward the scenario we’re witnessing now.
The disproportionate vulnerability of frail elders to the insidious spread of COVID-19 is drawing popular attention to a stubborn quandary that has remained unresolved for the past 20 years. In Florida and elsewhere, sophisticated long-term care that adds length and comfort to human life is dreadfully expensive, beyond the means of most older Americans. And state legislators have been unwilling to pay the kind of money necessary to do it right.
Florida’s skilled nursing facilities are filled with dedicated professionals — and equally dedicated, shamefully underpaid workers who cook, clean and perform intimate acts of compassionate care. But in many institutions, there aren’t enough of these people on duty at any given time. The harsh arithmetic of elder care does not allow for staffing levels adequate to the demanding tasks they are legally required to perform.
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This fact alone increases the odds that a relentless infectious disease like COVID-19 will find a way to the residents in their care.
Kathryn Hyer, a professor in the School of Aging Studies at the University of South Florida, led a research team that found a 60% rate of citations for “inadequate infection control” at Florida nursing homes between 2017 and 2019.
“There’s good evidence that if you have more RN hours” — a higher presence of registered nurses — “you have fewer infections,” Hyer says. But in Florida, Medicaid reimbursements are too low to achieve the staffing levels experts agree are needed.
“Our legislators don’t want to pay more money for long-term care,” Hyer says. “Some of this has come home to roost.”
Case studies of the notorious loss of life at The Rehabilitation Center at Hollywood Hills during Hurricane Irma in 2017 found that when the facility’s power failed, there were not enough employees to move fragile residents away from areas where the heat reached unsafe levels. Gov. Rick Scott’s solution was not to enable elder care facilities to hire more people; instead he required them to buy backup electrical generators.
Lobbyists for Florida’s long-term care industry regularly ask for — and receive — concessions from the government that allow them to trim costs. They succeed in such efforts because there’s no argument that the business model for nursing homes is broken, and we have no replacement as yet.
Imperfect as it is, life in a nursing home or assisted-living facility is still better than what most elders would have in a family setting, Hyer says: After residents were taken home from facilities during Irma, for example, “they came back not in good shape.”
For now, Florida’s elder care centers deserve every assistance the state can deliver. Later, there needs to be a realistic conversation about building a better system — and taxpayers’ willingness to fund it.
The Sarasota Herald-Tribune Editorial Board