Do Americans really care about nursing homes?

Maybe it’s time for a national gut-check
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Earlier this week, there was a heart-wrenching story on TV.

A woman was telling the story of the Massachusetts state-run Holyoke Soldiers’ Home that had suffered over 80 C-19 fatalities. Her elderly father was one of the casualties.

She had been trying for weeks, to no avail, to speak with her father, or at least get a status report on his condition. Her first contact was when he was being wheeled to the coroner’s van.

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Of course, the daughter was heart-broken and observed “nobody seemed to care … they’re just old people”.

That struck a chord with me

Of course, people who have loved ones in nursing homes are concerned about their level of care.

At a minimum, they want their loved ones kept safe and comfortable.

But, what do we as a nation really think?

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Sorry, but my thoughts immediately flashed back to the ObamaCare debate…

A constantly repeated fact at the time was the decades old observation that seniors consume a far disproportionate amount of health care (and the costs associated with it) … especially in their final days as they approach end-of-life.

The thinly veiled insinuation: Don’t waste the money … let nature run its course.

No less than President Obama as much as said so in an off-the-teleprompter town hall:

President Obama suggested at a town hall event that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don’t stand to gain from the extra care.

In a nationally televised event at the White House, Obama said families need better information so they don’t unthinkingly approve “additional tests or additional drugs that the evidence shows is not necessarily going to improve care.” Source

That’s not to suggest that Obama is uncaring, or necessarily wrong.

He was just being practical and pointing out an uncomfortable elephant-in-the-room.

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Fast-forward to today…

During the ventilator brouhaha, a 2015 New York Dept. of Health Task Force report surfaced.

It indicated that NY would be short 15,000 ventilators if a pandemic hit. Gov. Cuomo was being criticized for not stockpiling the necessary ventilators.

Cuomo’s rejoinder: “The report didn’t specifically recommend that we procure the ventilators. That wasn’t their job. Their job was to recommend how ventilators should be allocated if we did run short of ventilators.”

See Fact Check: Cuomo was told in 2015 that NY would be15,783 ventilators short

True enough, the report was even titled: “Ventilator Allocation Guidelines”.

Which opens up another whole can of worms …

These sorts of guidelines are commonplace. They’re not unique to NY, which just happens to be a current case on point.

The essence of the economically logical decision rules is that patients should be ranked based on their expected life expectancy, their current and projected quality of life (i.e. other than being old, are they healthy, alert and active … or not? ), and their economic value (think: lifetime earnings potential).

A typical nursing home patient is old, relatively unhealthy (think: comorbidity factors) and economically burdensome.

That’s a bad combination, so they get pushed to the end of the line.

And, it’s understandable … maybe not particularly compassionate, but philosophically debatable and economically rational.

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For month’s we’ve been hearing “we must protect the vulnerable.

Coming from the school of “watch what they do, not what they say”, I was dismayed by Gov. Cuomo’s policy of shipping confirmed coronavirus patients back to nursing homes

Cuomo initially danced around the issue declaring that the decision was in the hands of the nursing homes not him, but that’s not how the policy read:

“No resident shall be denied re-admission or admission to the Nursing Home solely based on a confirmed or suspected diagnosis of COVID-19.

NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.” Source

I understand that, at the time, Cuomo’s greatest concern was keeping the hospitals from being over-run with C-19 patients. Nursing homes had capacity that needed to be utilized. Period.

Cuomo had to know that dropping coronaviral “seeds” into confined vulnerable populations  was a recipe for disaster … and emboldens the question: “Does anybody care?

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Philosophical issues aside, there’s a practical side to the “protect the vulnerables” priority.

In fact, seriously protecting the nursing home population was imminently doable … and, would have saved many, many of lives

See: Nursing homes need tests with instant results!

And, a recent report authored by MIT economists working under the auspices of the NBER concluded that targeted lockdowns aimed at protecting those who are most vulnerable to the coronavirus would have been better for public health and the economy … than was the universal, coast-to-coast lockdown.

Perhaps, we might have fared better by doing good … and walking the talk.

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P.S. For personal reasons, this issue resonates with me.

My mother was confined to a nursing home for a death-defying 15 years with advanced stage Alzheimer’s, finally passing at age 97. Fortunately, she was in a caring facility — run by nuns from the Sisters of Mercy order who do walk-the-talk when it comes to caring for the vulnerable.

And, when my older brother was killed in a plane crash, we were confronted with the legal question of “what’s the value of a life?”.

The same rules that are foundational to allocating ventilators are used to calculate damages in wrongful death cases. Trust me, that’s very unnerving.

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