COVID-19 and the New Death

As I write this blog, over 170, 000 Americans have already died from COVID-19.  It wasn’t that long ago, on January 22, 2020, that the Centers for Disease Control and Prevention (CDC) released interim guidelines for the control of the virus. On March 1, 2020, a Washington state skilled nursing facility reported the first case of COVID-19 in long-term care. In a short period of time, more than one-sixth of the 300 residents and employees of the Kirkland facility reported respiratory symptoms.  Ten days later, the Centers for Medicare and Medicaid (CMS) called for long-term care facilities to actively screen and restrict visitors with active symptoms of the virus. We asked if people had traveled to China or other areas where the virus had significantly impacted. We now know that COVID-19 can be transmitted in asymptomatic people and that understanding where our employees live, with whom they live and whether or not they work at other facilities.

The CMS, CDC, and state health department recommendations have evolved over time.  What we know now about the transmission and treatment of COVID-19 is far different now than it was six months ago, or even three months ago. Americans witnessed the devastation and deaths concentrated in nursing homes and assisted living facilities. We learned that the elderly and those with significant underlying conditions were the primary targets of the virus.  We may have become numb by the sheer number of deaths among the elderly. There may have been people who covertly or overtly felt that deaths among this population were not surprising, significant or important. When COVID-19 appeared to be limited to the elderly, we heard the alarm sounded in long-term care, but others were silent.

Today, more than 45% of all COVID-19 deaths in the US occurred in individuals residing in long-term care facilities. As troubling as that statistic is, the Foundation for Research on Equal Opportunity¹ reported that researchers at the International Long-Term Care Policy Network found that 46% of COVID-19 deaths occurred in nursing homes located in high-income countries. The highest concentration of long-term care deaths occurred in Canada and Ireland with 85% of the total deaths in those countries from individuals living in residential care facilities for the elderly.

How have these 170,000 deaths affected our perceptions of older adults? Will the public change its perception about long-term care facilities? Will we become insensitive to the concept of death? Will our society accept the fact that 45% of COVID-19 deaths occur among the most vulnerable of our citizens? What can we do to shine a bright light on the needs of those who live and work in long-term care facilities?

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration. 

Reference:

1.     Foundation for Research on Equal Opportunity. Nursing Homes & Assisted Living Facilities Account for 45% of COVID-19 Deaths. Freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70. Published online May 7, 2020. Accessed August 2020.