Staff solutions to honor the fallen

It has been more than four years since the start of the tragic pandemic that claimed the lives of almost a quarter of a million vulnerable elderly people living in nursing homes. Their lives mattered. How they spent their last months, weeks and days should matter to all of us.

These were our elders and they deserve our respect. How have we fared in this area? What have we learned? How can we do better? I said at the time: “An outbreak is not a reflection of the quality of a nursing home. It’s what you do about it that matters.”

The recent response to the nursing home staffing mandate suggests that we still have more to learn.

It is time that responsibility for how nursing homes function is placed with clinical leaders with expertise in geriatrics and long-term care. The Final Rule on Staffing is an important action resulting from President Biden’s 2022 State of the Union call for improved nursing home quality.

The focus on the Facility Assessment provides a historic opportunity to engage the director of nursing and the facility’s medical director in critical decision making. Facility assessments should consider the acuity and clinical needs of residents to determine appropriate staffing levels. While this will rarely result in staffing levels lower than the mandate, the evidence-based literature informs us that this will result in levels significantly higher than the minimum levels mandated by the rule!

Concerns about facility closures should take into account the poor care provided in some of the facilities that have closed. While there are some excellent nursing homes that have been forced to close, the data strongly suggests that this is the exception and not the rule.

I feel the pain of my friends and colleagues affiliated with these unfortunate facilities. However, I cannot escape the deep pain of the tens of thousands of residents and families who will never experience the kind of person-centered care that my esteemed colleagues know how to provide, often despite financial machinations they know nothing about. The needs of the many outweigh the needs of the few. And they certainly outweigh the financial needs of those individuals who benefit from an inadequate workforce.

Four years ago, I channeled my colleagues working on the front lines of the pandemic. They tried desperately to respect, protect and care for our elders. We desperately tried to raise the alarm. Remembering those days brings back feelings of helplessness that should be a clear call to action. The stories shared with me about obstacles that prevent effective action will remain etched in my memory for the rest of my life. Those memories inform and guide my quality improvement efforts. For many of my colleagues, and more importantly for the families of the residents who died and suffered, the nightmares will stay with them forever.

Unfortunately, as time passes, the horrors begin to fade from public view. This is my new fear. The OIG documented 169,291 additional nursing home deaths in the first year of the pandemic alone. The final number was certainly closer to 250,000. These were our parents, grandparents and loved ones. Their deaths should matter.

Debt doesn’t solve problems. We must look for solutions. Well thought out and extensively researched recommendations regarding nursing home staffing are readily available. The importance of a meaningful and empirically based Facility Assessment has been outlined.

Current nursing home residents, as well as the friends and families of those who have died during the pandemic, deserve these types of solutions. Only then can we begin to fully honor those who have fallen.

Michael Wasserman, MD, CMD, is a geriatrician and member of the Board of Directors of AMDA—The Association for Post-Acute and Long-Term Care Medicine. The views expressed here are his and his alone.

The opinions expressed in McKnight’s long-term care news guest submissions are those of the author and are not necessarily those of McKnight’s long-term care news or its editors.

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