Doctors, researchers and advocates for years have been paying close attention to the way in which coronavirus has destroyed care homes – but not in horror.
"Every gynecologist knows what's coming," said Dr. Mike Wasserman, a psychiatrist and president of the Northern California Nurses Association.
Robyn Grant, director of public policy and advocacy for the National Client Voice for Long-Term Care: “The numbers show tremendous fear. The underlying factors that contributed to it were not surprising; they have long been a concern.
Because states report cases in different ways, and some report a small number at all, "all of this can be extinguished," said David Grabowski, a health care researcher at Harvard Medical School. noting that the investigation is still insufficient.
By mid-April, the federal Centers for Medicare and Medicaid Services announced The reporting system to monitor Covid-19 in nursing homes is stored in the Centers for Disease Control and Prevention.
But because the care of the & # 39; s care recipient receives public attention even in the best of times, advocates like Ms. Grant sees opportunity, however sadly they win. People are very shocked by what is happening, and that sheds light on the changes we need to see, she said.
It is not difficult to understand why the virus has spread to nursing homes such as "set fire to dry grass," according to Gov. Andrew Cuomo of New York. Dr. Philip Sloane, the latest editor of the magazine & # 39; The Journal of the American Directors Association & # 39 ;, compare them to ships and prisons for diseases.
Dr. Sloane, a clinical psychologist and director of the University of North Carolina's Aging, Disability and Long-Term Care Program, said. They have food stalls to prepare in the middle kitchen, staff having a lot of contact with the locals. They have activities that bring people together.
The nursing homes, of course, are much lighter and more painful than those on the ship and prisoners. "Home care is the people's hospital," minus the health workers in the field, Dr. Wasserman said.
"We have actually closed the nursing home, but Covid is still spreading because we do not know who owns it and we do not have P.P.E. to protect the staff," Dr. Grabowski said.
In this and the future, researchers and advocates suggest several broader theories of development.
Increased infection control
Even before the arrival of the coronavirus-care centers, they had recorded poor looga disease.
"The centers know it is a problem, but it is still one of the biggest violations in the country" by government-mandated inspections, Ms. Grant. These problems are reported year after year. ”
In 2016, Medicare began requiring each facility to hire a “disease prevention” staff to monitor policies and train staff. But that's usually a part-time place. "The person responsible for controlling the disease always has another job," said Dr. Sloane. "That person also doesn't have a lot of skills."
Last year, Medicare proposed to enact that law, so prevention does not need to be an employee, but must enter "enough hours", which Ms. Grant called it "part of the reform policy of this administration." She thinks the tragedy has instead illuminated the need to prevent full-time infection.
Nursing homes in the United States, on average, about 100 beds, have rooms along a long corridor, where staff move around one another. Residents typically share a small room and bathroom – a plan that many people hate, and one that offers excellent conditions for virus transmission. Buildings appear to have helped quite a bit better during the epidemic, partly because individual homes facilitates decision & # 39; doominta.
"It is time to really focus on the issue of private rooms in nursing homes," said Karl Pillemer, psychologists, science and research fellow at Cornell University. Inside In the Green House model, for example, dozens of residents live in private rooms with shared spaces and dedicated staff who know them well. The model is slowly gaining momentum, with 268 homes, over 15,000 nursing homes across the country.
But the Green House Project said that as of May 21, of 245 properties including 2,653 residents, only nine had received cases & # 39; Covid-19 & # 39 ;, resulting in six deaths. While several smaller buildings are located in buildings rather than large, administrators can also be quarantine easily, said Dr. Sloane pointed out.
While new nursing homes have separate rooms, very few people are being built. But renovations can create small families similar to those kept in people's homes, "said Martin Siefering, senior designer who will lead Perkins Eastman's lifestyles.
& # 39; New Jewish Home & # 39; in Mamaroneck, N.Y., for example, the company transformed 59 of the 300 beds into five smaller communities. She also remodeled homeless shelters in Tulsa, Okla., And Ocean City, N.J., to create smaller families.
Increase employee pay
A common way for coronavirus to enter care homes is through staff, intentionally. "It is the staff who are bringing this issue and spreading the virus to the residents," said Dr. Grabowski.
He pointed out that their assistants who provide nursing care are poorly paid (hourly wage per year last year: $ 13.38, according to PHI), so "they always combine a lot of part-time jobs," possibly spreading not just infections but between centers.
"Our hospital staff are treated like heroes and they are there," Dr. Grabowski. “Nursing home workers are too. They also receive the minimum wage.
Wages paid high risk, health insurance and sick leave paid to employees with at home when they are sick, they can reduce the transmission of the virus and isbadbadala staff. Some long-term care managers are trying to keep staff on campus during the crisis.
Review your visit policies
It makes sense to have people staying during the height of the disaster, and the knowledge of the characteristics of the transmission even in the current incomplete. But for long-term residents, the boat has its problems.
Ms. Grant said: "We already know that families provide care, but the extent of it is eye-opening," Ms. Grant. "They tell us, & # 39; I help my mom eat. & # 39; & # 39; I am the one who helps her get more water. & # 39;"
Some gynecologists have called for nursing homes to appoint a relative or friend to undergo regular tests and learn how to use contraceptives, and then allow admission. Medicare just issued it a guide for governments hoping to gradually reopen the centers.
“The voices of the elderly are missing in this debate,” said Dr. Pillemer. "They may want to make a decision to see their family members, at their own risk."
Making people's homes better and safer does not work for human selfishness, he added. Principals issued orders home-stay-looga to prevent coronavirus from the health care system's excessive, particularly in hospitals. For residents of nursing homes, oddly, patients fill out emergency care units.
"It's not a nail polish – these deaths are in long-term care," Dr. Pillemer. "The elimination of the virus in long-term care, which is fully possible, is the key to re-opening the country."