The Broken Nursing Home Industry Exposed by the Pandemic
My name is Linda Witzal and I am a pharmacist who has been serving the nursing home industry since 1989. What does that really mean? I am responsible for providing clinical services and support along with daily medications to the facilities that I have been privileged to contract.
Approaching 60 myself, (hard to believe), I still cannot believe that I have been working with many of my clients for over 30 years-and unfortunately as the cliche of “the more things change the more they stay the same”is very appropriate during this Covid crisis. In my world, I have seen many problems with our current system, affecting the elderly. I have witnessed, the lack of change, the lack of execution of good intentions to fix, and the primary factor, the all-mighty dollar, as the root cause of the problems and the many deaths that we mourn today.
It is very easy to want to blame and point fingers, we feel better when we do that, sorta. The problems that have been highlighted in the nursing home industry and the deaths associated with Covid cannot be blamed on one problem, one person, one administration, or one group of people. The nursing home industry has been broken for a long time right from the start. Prior to the pandemic I started to research and document for a book I am writing, on how the nursing home industry started, the regulations, and what kind of solutions and changes we could make to ensure that our elderly are not taken advantage of or abused. I believe that understanding the history, the evolution of, is the start to correcting and making right the wrongs of the past.
Obviously no one was prepared for what would cause such destruction and death.Historically any outbreak of infection is reported to the state’s Department of Health. My question is what is the required response?Does the DOH have the resources they need to address and assist in a major crisis? If not, how can we address that immediately?As a pharmacist and licensed in NJ, I have a duty to report if I see a patient safety issue. What is the DOH required to do? Is there a process? And again are the resources available to the department? Never have we had an infection spread so quickly and also affect the staff like we saw with Covid. Outbreaks of infection in the past that affected patients rarely affected the staff- but here the staff went down, the patients went down and there were limited people left to care for the patients.
We quickly realized we did not have adequate protective gear. We saw huge hoarding and price gouging events. I tried to order PPE from my wholesaler and I was prohibited because I did not have a history of ordering these supplies so I was “red flagged” as if I was trying to do something nefarious. Again, due to the bad apples everyone gets punished. We were in a world wide crisis and common sense and logic did not play a role in many decisions.There were no supplies to be found which led us to resort to garbage bags and plastic rain gear to improvise.
A major crisis our country saw with infection and death was the “Ebola” crisis. It seems that the supplies our country had in reserve were used up, depleted, to assist in the crisis both inside and outside the US.Those reserves were never replenished appropriately, leaving a huge deficit. Who is watching over that process? I have to have an inventory person to manage my supplies. I am mandated by my contracts with different agencies and insurance companies and facility contracts that I have enough supply on hand to deal with a major disaster.Some times contracts require a “Disaster Plan” to be submitted before even being considered eligible for the contract. Shouldn’t that be a requirement for all who take care of our elderly and receive federal and state monies to take care of our elderly?
A discussion that has not been had is who are the operators and owners responsible for the care and operations of these facilities? When you start to peel the layers, and I mean layers, sometimes 5 layers or more deep, you see a very incestuous, closely interweaved network.Maybe when the digging starts there will be people exposed that helped these bad actors continue and supported them. I anticipate seeing “GF” on these people,(Guilty Face). It will be very embarrasing and harmful to some people’s careers and most significant to their own bank accounts.
When you review the surveys of some of the homes you will often see a pattern of consistent deficiencies and fines associated. Areas involving infection control, staffing deficiencies, lack of timely pharmacy services delivered, building deficencies,lack of security and fire and safety equipment. Yet, they still are allowed to remain in business? In fact sometimes they are allowed to purchase more homes, regardless of past findings.If we continue to allow less than scrupulous enterprises to own and operate these institutions, who have been given the responsibility for caring for our elderly and most vulnerable we will continue to see the system decline and worse see our patients suffer.Each one of us has an obligation to our seniors, we need to ask questions, demand action by the people we elect to champion our cause and never stop fighting for those that can’t fight for themselves.