Nursing homes need to be a priority when personal protective equipment (PPE) is being distributed, and these facilities also need to be required to have a nurse on staff 24 hours a day.

“It’s absolutely critical to have registered nurses 24 hours a day in nursing homes,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, in Washington. “Right now, the only federal requirement is a registered nurse for 8 consecutive hours a day, but people get sick in the middle of the night.” Without a nurse on duty for nursing home workers to consult, “we’re not going to get good care for people,” she said. “It is way past time to have nurses in nursing homes.”

“The federal government, whose prompt response was so desperately needed, failed to surmount the challenge and make PPE a priority for nursing homes,” said Michael Wasserman, MD, a geriatrician and president of the California Association of Long Term Care Medicine. The nursing home industry “had the ability to leverage their assets to acquire PPE, but many chose to wait for a government response which didn’t happen … As a clinician, I don’t care who takes responsibility for the acquisition of PPE, but without PPE, COVID-19 cannot be stopped.”

Wasserman and Edelman were speaking at a roundtable hosted by the House Democratic Caucus Task Force on Aging and Families.¬†Task force members also heard from Chris Brown, a certified nursing assistant working at a nursing home. “I find the work to be very rewarding but to be truthful, I face many challenges on the job, and many of these challenges existed before COVID-19,” said Brown.¬† Brown said nursing home workers are being paid “poverty wages” and often don’t get sick leave. “If I become sick, how can I take care of somebody? And who will take care of me? I have to choose between having the lights on and protecting my health.”

Wasserman worried about nursing homes allegedly dumping vulnerable residents in order to make room for more profitable COVID-19 patients. “I was worried that this type of behavior could and would occur, so when the story came out, it didn’t surprise me,” he said. “The bad apples highlight a couple of fundamental problems in the industry …. Surveyors can only do so much after the fact; we need to work to prevent this type of behavior” from occurring in the first place.

In addition, “medical directors have been kept out of medical management and decision making. We need to make sure the medical director is fully engaged,” said Wasserman. They’re critically important because “unless you have clinical leadership in the building calling this out, the facilities manage to come up with reasons and excuses for why they’re doing it. We need to be calling it out and recognizing that staff and facilities are under tremendous financial pressure and that drives a lot of this type of behavior.”

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