Linda Searing of The Washington Post wrote the following:

Every 40 seconds, on average, someone in the United States has a stroke — amounting to 795,000 people a year, according to the Centers for Disease Control and Prevention. Most strokes, 80 percent or more, occur when blood flow to the brain is blocked by a clot. Known as an ischemic stroke, it results in brain cells not getting needed oxygen and nutrients, which causes the cells to start dying within minutes.

The other main type of stroke, hemorrhagic stroke, occurs when a blood vessel in the brain leaks or bursts, with the flood of blood putting pressure on and damaging the brain cells. This type of stroke may be caused by high blood pressure (which over time can weaken blood vessel walls) or an aneurysm (a bulge in a blood vessel that bursts).

Both types of stroke can cause lasting brain damage, disability or death, and some 140,000 Americans die each year from a stroke. The likelihood of brain damage and disability increases the longer a stroke goes untreated, making it critical to call 911 and get emergency stroke treatment started as soon as possibleSigns of a stroke usually come on suddenly and may include numbness or weakness in the face, arm or leg, trouble speaking, blurred or double vision, dizziness or stumbling when trying to walk or a very severe headache.

A condition similar to a stroke, known as a transient ischemic attack, occurs when the blood supply to the brain is blocked for a short time (hence its nickname, “mini-stroke”). Though damage to the brain from a TIA is not permanent, it does make the chances of a full-blown stroke more likely. Because of this, the American Stroke Association refers to a TIA as a “warning stroke.”

Nursing home residents and workers may be among the first to receive a coronavirus vaccine, depending on what a federal committee decides. A preliminary plan reveals that critical medical and national security officials would receive any approved vaccines first, followed by other essential workers and those considered at high risk, such as the elderly and people with underlying conditions.

The Centers for Disease Control and Prevention and an advisory committee of outside health experts currently are working on a priority ranking for upcoming vaccines. The committee, which has been deliberating on the vaccine prioritization since April, reports to the director of the CDC. It includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties; 30 nonvoting representatives from across the health field; and eight federal officials focused on vaccines.

“This virus disproportionately impacts older adults, particularly those over 80 with chronic diseases, which comprises the majority of the population we serve,” they wrote in a letter to HHS Secretary Alex Azar. AHCA/NCAL added that top priority is warranted for the groups since “those we care for are the most vulnerable to the virus.”

After COVID-19 has prevented loved ones from seeing their family members. Families are pleading with lawmakers in South Carolina, Connecticut, Ohio and other states to allow cameras to see loved ones. The visitation bans are necessary evils but they have negative effects. There is renewed interest in legislation that would allow families to put remote cameras inside the facilities to help see how loved ones are doing. About a dozen states already have laws or regulations in place allowing residents and their families to install video cameras, subject to certain rules.

The cameras allow families to monitor loved ones in real time or make recordings. In most cases, residents can ask that they be turned off for privacy. There are safeguards to protect roommates from being filmed unknowingly. Signs in rooms alert staff and visitors that the cameras are operating.

Anne Schuchat, director of the Centers for Disease Control (the CDC) said that the virus is spreading too fast and too far for the United States to bring it under control. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, testified he was “very concerned.” “We’re going in the wrong direction if you look at the curves of the new cases,” he said, “so we really have got to do something about that and we need to do it quickly.”  Faci warns we may see 100,000 new cases per day.

The country is now seeing more than 50,000 new infections a day while the European Union is seeing fewer than 6,000. The South Carolina Department of Health and Environmental Control reported that there has been a 413.6% increase in newly reported coronavirus cases in South Carolinian’s aged 21-30 since April 4. DHEC reports a 966.1% increase for aged 11-20.

South Carolina has had record setting days for over a week now.  Official Covid-19 death counts in the United States underestimate the fatalities linked to the pandemic, according to a new study published in the journal JAMA Internal Medicine which found that the number of “excess deaths” that have occurred so far during the pandemic, between March and May, is 28% higher than the nation’s official number of deaths attributed to Covid-19.

“The gap between reported COVID-19 deaths and excess deaths can be influenced by several factors, including the intensity of testing; guidelines on the recording of deaths that are suspected to be related to COVID-19 but do not have a laboratory confirmation; and the location of death,” the researchers wrote in the study.

Meanwhile Nero tweets about Confederate Monuments as the country burns: “This is a battle to save the Heritage, History, and Greatness of our Country,” Trump tweeted. A senior campaign official told the Washington Post, “It’s a great political issue for the president.”

Occupancy at skilled nursing facilities took a hit following the onset of the coronavirus pandemic after showing signs of stabilization for several quarters, new data from the National Investment Center for Seniors Housing & Care (NIC) reveals.

The NIC Intra-Quarterly Snapshot showed that occupancy for nursing care facilities fell 2.2 percentage points to 84.7% in April, the first full month of the pandemic. In April 2019, stabilized occupancy was 87% for nursing care.

“You often see skilled nursing properties work with patients as they come out of hospitals from elective surgeries for rehab. That had an impact on this data, as well. That explains some of the drop, that 220 basis point decline,” she added.

Ashley Z. Ritter, PhD, MSN, CRNP is a Postdoctoral Fellow and National Clinician Scholar at Penn, and an LDI Associate Fellow who wrote an interesting article on how the pandemic  teaches us about today’s nursing home care.

“Nursing homes provide essential care to individuals unable to live in the community. Roughly 1.3 million residents live in nursing homes receiving assistance with daily activities of living such as meals, dressing, and socialization. Additionally, more than 3 million older adults are discharged annually to nursing homes following a hospital stay to receive rehabilitative services like physical therapy and skilled nursing care. Combatting the avalanche of death posed by the novel coronavirus in nursing homes requires concerted effort to align several conflicting priorities that have afflicted nursing homes for years. Covid-19 puts into full view the regulatory structures and payment models that jeopardize care for long term care residents and those receiving post-acute care.

Caring for Covid-19 patients after hospital discharge in a nursing home, alongside those who reside in a nursing home for long-term care, brings into stark relief the spatial and staffing challenges that this setting poses. While the care needs of both groups overlap significantly, patients recovering from Covid-19 infections bring with them the possibility of spreading the virus to a large number of vulnerable long-long term care residents as well as a shared workforce. Once Covid-19 enters a nursing home, stopping the spread of the virus proves challenging and deadly.

Post-acute care following hospitalization has increased over the past decade. Hospital incentives to decrease inpatient length of stay coupled with Medicare funding for post-acute care services resulted in increased utilization of nursing homes as a discharge destination. Post-acute care represents an important line of business for nursing homes. Without post-acute care admissions, many nursing homes face financial uncertainty.

While accepting post-acute care patients recovering from Covid-19 presents clear risks to nursing home residents and the nursing home workforce, the financial consequences of not admitting individuals for post-acute care during this pandemic are also clear, and complicate the protection of residents and staff. Balancing the competing priorities of patient safety and financial stability often favors the latter. While the financial demise of nursing homes would further reduce the limited care options for older and low income adults who are unable to live in community settings, the risks of caring for Covid-19 patients should not be overlooked.

There are several ways we could mitigate this risk. The nursing home workforce requires expansion in size, training, and support to meet current and growing demands. Prior to the current pandemic, projections highlighted the need for additional nurses and nursing assistants to care for nursing home residents. Nursing assistants provide the majority of direct care in nursing homes, accompanied by teams of nurses, therapists, social workers, facility and food services staff. Nursing assistants, mostly female and identifying as ethnic minorities, commonly work more than one job and receive low pay. As a result, retaining the existing workforce and recruiting new providers proves difficult. Protecting the current nursing home workforce requires equitable pay, workers’ protections (including an adequate supply of personal protective equipment), and greater investment in professional development.

Instead of regulating nursing homes at the state level, a regional care strategy should be implemented that involves local departments of health. The existing system of state nursing home oversight lacks the capacity to reinforce care delivery at this crucial moment, and instead imposes fines on facilities that experience outbreaks. Instead, oversight should promote proactive planning and partnership, focusing on shared goals and devoted resources to achieving them.  Nursing homes should be integrated into local public health responses, particularly in times of crisis.  Building and maintaining relationships between nursing homes and local departments of health could stimulate meaningful collaborations in addressing public health issues further magnified by the Covid-19 pandemic, such as food insecurity and social isolation.

Nursing homes caring for the people most vulnerable to Covid-19 need capital investment, a protected workforce, community partners, and a critical analysis of current regulatory and payment practices. On a broader level, we need a national conversation on alternatives ways to financing long term care, as discussed in this new brief by the Leonard Davis Institute. Our current system fails to provide people with social protection against the risk for needing long term care, and fails to adequately fund home, community, and institutional services to meet the needs of an aging population.

While often overlooked by the health system and the communities they serve, nursing homes are essential to the continuum of care across the life cycle, particularly in times of crisis. As we mourn the profound loss of life of nursing home residents in the wake of Covid-19, may we forever honor these lives by learning from this tragedy and creating a better system.

The coronavirus has shown that nursing homes were not prepared either with proper training and supplies or sufficient numbers of qualified and competent staff.  Shortages of safety gear and staff. Workers who may inadvertently be carriers.  These are some of the reasons the coronavirus has hit nursing homes hard. But some experts and advocates claim the design of the buildings should be included.

Many of the nursing homes across the country are laid out like hospitals, and some house hundreds of residents. Most rooms are double occupancy, but some have three or even four residents. With shared resident rooms off long narrow corridors and large cavernous dining rooms where everyone interacts, nursing homes have been designed to be cost effective not safe.

Before the pandemic, a movement under the banner of “culture change” was challenging this institutional model, calling for dividing up large nursing home populations into small, self-sufficient units with kitchens, private rooms and a dedicated staff.  This type has been set up in multistory buildings with a couple of households per floor and in single-story purpose-built structures with homelike interiors. This smaller-is-better approach arose out of a concern for residents’ privacy and dignity, but evidence is emerging that it may also be helping with infection control.

A private room or even an entire household can be closed off more easily, keeping out or confining viruses. Staff members who are focused on a small number of residents may be more likely to pick up on warning signs, such as a lack of appetite, that someone is sick. The preparation of food and laundry in a household — rather than in central facilities and then distributed — also eliminates a few of the ways diseases can infiltrate.
Administrators of nursing homes large and small, as well as the architects who renovate and design their facilities, expect to zero in on disease control in the future as a result of the pandemic. Air circulation and filtration will be scrutinized when heating, ventilation and air conditioning systems are planned, they said.  Nursing home providers and their architects are also talking about easy-to-clean, nonporous surfaces; antimicrobial materials, like copper, for “high touch” features such as hand railings; and voice- or sensor-activated controls for doors, lighting, curtains, faucets and toilets.
The Department of Veterans Affairs began embracing a small-house model in 2011; now, 13 of its 134 nursing homes are organized around communities of 10 to 14 residents. In these settings, only a single veteran has tested positive for Covid-19.
“If we don’t see change in the nursing home market now,” said Jane Rohde, principal at JSR Associates, a design and health care consultancy in Catonsville, Md., “I don’t know when we will.”


Beginning in mid-March, coronavirus deaths surged across much of the country, peaking above 10,000 per day.  We still have not returned to normal death rates. The overall confirmed number is 100,000 but the true count is even higher — closer to 135,000. This larger number includes people who had the virus but weren’t diagnosed before they died.  This includes thousands of nursing home residents.

Alex Spanko for Skilled Nursing News wrote a great article about the financial structure that is the shaky foundation of long term care in America.  “At the base, Medicaid supports long-term care residents who can no longer live on their own without around-the-clock care.  Medicare dollars pay for higher-acuity care that seniors require after hospital stays — and prop up insufficient Medicaid reimbursements that can’t financially sustain a nursing home on their own.”

To protect themselves from liability and ambitious plaintiffs’ attorneys, operators covered up the windows to their offices with complex webs of intertwined ownership and management companies that even veteran journalists have struggled to unravel.

While such legal maneuvering is common and generally accepted in any industry with a significant real estate component, the nature of the clients that nursing homes serve — and the occasional horrific stories of serious lapses in care — made the media and the public deeply suspicious of what exactly was going on behind the curtain.

Then the hurricane-force winds of the COVID-19 crisis blew the whole structure down.

No one paying attention to the news, and watching the rapidly climbing coronavirus death toll at our nation’s nursing homes and other long-term care facilities, can be blamed for being angry. My own blood pressure spikes when I go through my inbox each morning, scrolling past story after story about shortages of protective equipment and temporary morgues in refrigerated trucks.

The federal government has taken some positive steps — restricting visits and focusing on infection-control inspections early in the process chief among them. While the industry itself has been out in front of CMS in many aspects, especially around calls for greater transparency about the number of reported cases, these steps reflect some understanding of how serious the situation would get, even before “social distancing” became a nationwide edict.

But the administration’s inability to coordinate the distribution of personal protective equipment (PPE) and COVID-19 testing kits represents a profound failure. In the United States, nurses should never have to use garbage bags and ponchos to protect themselves and their patients. In the United States, everyone should be able to receive testing during a pandemic, but CMS and states should have pushed nursing homes to the front of the line at the very first signs of danger.

Clearly, we are in unprecedented times, and well-meaning officials are going to make mistakes as they work to fight an unseen enemy. It’s just one example, but it reveals the deep tensions that exist between state and federal oversight of nursing homes, both from a regulatory and payment standpoint.

Operators must rely on the perfect combination of federal Medicare dollars and state-level Medicaid funding to survive. The two care models that those funds support couldn’t be more different, but persistent Medicaid shortfalls have made providing both short- and long-term care a necessity.

Without the Medicare money, a building simply can’t support itself or its residents on Medicaid alone — but as COVID-19 has revealed, bringing post-acute residents into a setting with even more vulnerable long-term care patients can be a recipe for disaster.

Once the danger passes, lawmakers at all levels need to deeply question the ways that federal and state rules around nursing homes overlap and diverge. Big-picture thinkers have long predicted the development of a site-neutral model, but it’s time to seriously consider a single federal payer source for all types of long-term and post-acute care. A split Medicare-Medicaid model, born largely by accident and sustained by inertia, falls apart in a crisis.

When the coronavirus crisis abates — and operators and caregivers are no longer pleading for access to PPE and testing — my personal hope is that providers, lawmakers, and investors take seriously the opportunity to reflect on the failures baked into the system.

Maybe it’s finally time to prioritize across-the-board increases in wages for the people who have spent this crisis putting themselves and their families at risk, even if it’s at the expense at profit margins — temporary hazard pay and one-time stipends aren’t enough to fairly compensate these essential workers.

Maybe it’s finally time to embrace wholesale changes to payment models, instead of perceiving each tweak and update as an attack on the heart of the industry.

Maybe it’s finally time to tear down the wall of suspicion and derision that leaders on both sides have built up between the public and nursing home operators.


At least 30,000 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities in the United States. Confirmed cases of the virus have infected more than 175,000 residents at 7,700 facilities.  While just 11 percent of the country’s confirmed cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities.  In 14 states, the number of residents and workers who have died accounts for more than half of all deaths from the virus. Because of the poor testing in South Carolina, nursing home deaths amount to 32% of all coronavirus deaths.

The Trump Administration still has not tallied the number of nursing homes that have had outbreaks nationwide or the number of residents who have died. And the data is still weeks away from being made public, according to the Centers for Medicare and Medicaid Services, or CMS, the federal agency that oversees nursing homes.  Given the wide variability in the type of information available, the totals shown here almost certainly represent an undercount of the true toll.

The nursing home industry says knowing the scope of the problem and which facilities should get priority is crucial. The need for greater access to testing and protective equipment has become even more urgent as more states are beginning to ease restrictions and reopen, effectively leaving older Americans “to fend for themselves as the virus threatens to wipe out an entire generation,” LeadingAge, which represents nonprofit long-term care facilities, said in a statement.

Under the new requirements, long-term care facilities must begin reporting coronavirus cases and other data to the federal government by May 17 or face monetary penalties. However, they will initially have a two-week grace period to comply, according to CMS.