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Over the past few decades, the popularity of “aging in place,” combined with new medical technologies and longer life spans, has changed the nature of care for seniors and people with disabilities. Residents of the nation’s 15,400 C.M.S.-certified nursing homes are much older, sicker and poorer than they used to be.
“Nursing homes are really little hospitals, yet they’re not staffed like it. If you asked an I.C.U. nurse to take care of 15 people, she’d laugh at you, but that’s essentially what we have,” Chris Laxton, the executive director of AMDA, the Society for Post-Acute and Long-Term Care Medicine, told me.
At the same time, many of these caregivers “are making $12 or $13 an hour,” Alice Bonner, of the Institute for Healthcare Improvement, said. “They can barely support themselves and their families. Some of them are working in nursing homes during the day, then assisted living in the evening and home health at night.”
As a result, workers probably helped spread the virus from facility to facility, home to home. And residents may have done the same. Depending on their condition, it’s not uncommon for a senior or a person with disabilities to go from assisted living to a hospital to a nursing home within a few months’ time.
Early on, when the coronavirus was killing mostly older adults, there was a sense of relief that the young might be spared. Nursing home residents were shut off from ordinary life; they were going to die anyway, commentators implied. And the workers who were getting sick — they weren’t health professionals but glorified babysitters with minimum-wage qualifications. Weren’t illness and death their lot?
A week after the outbreak near Seattle (and months after the first cases in China), C.M.S., run by Seema Verma, whose conflicts of interest outnumber her credentials, began to act. But some of the agency’s decisions merely amplified existing problems.
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