Mass. nursing homes need a permanent fix

Emergency response to COVID exposed glaring weakness system

I STARTED MY career in long term care as a nursing home social worker on Cape Cod in 1991 and now operate a non-profit system that includes eight skilled nursing facilities across Massachusetts. COVID-19 changed the world we live in with lightning speed. Thousands of elderly and vulnerable people have lost their lives as the virus worked its way through long-term care facilities across the state, including my buildings.

After months of fighting coronavirus around the clock, my colleagues and I know a lot more about how to protect our facilities and our residents. Now is the time to rebuild our system and address the structural problems that have faced nursing homes for too long.

Over the course of my career, I’ve been proud to work at and to lead high-quality nursing facilities. The Centers for Medicare & Medicaid Services gives five of my buildings their highest rating, five stars. That didn’t save us when the virus hit. In early March, a dietary employee at our Marlborough home was the first to develop symptoms. Then, one by one, the virus appeared in every single one of our facilities, and spread like wildfire once inside.

In the weeks that followed, it was a 24-hour battle just to keep up. Every day was a race to locate new sources of personal protective equipment — PPE. Given the worldwide supply shortage, our traditional vendors simply couldn’t keep up with our needs and had placed us on an allocation of limited amounts of PPE.

We got used to new and totally different routines, like constantly assessing and reassessing our residents for symptoms, and moving them into new groups, or cohorts, to keep positive, negative, and suspected cases separated. Like almost all Massachusetts nursing homes, our facilities had staffing challenges when the crisis first hit, and as infection spread to our caregivers, we struggled to cover shifts.

In April, in an effort to get ahead of the virus, we entered a surveillance testing pilot with the Broad Institute and six other nursing facilities that was the first to offer regular, repeated testing of residents and staff. Ongoing testing to quickly identify residents who have contracted COVID is a critical tool to prevent outbreaks, particularly since over half of cases are asymptomatic positive. We picked a North Shore facility with only one positive case, hoping that rigorous testing would keep the virus out. Unfortunately, when the initial tests came back, we learned we were too late. We had a full-blown outbreak on our hands, dozens of asymptomatic residents and staff. I had never felt so defeated in my career.

The following month was devastating for our system and heartbreaking for so many families. In late May, I got a call from my organization’s lead clinician about our northern Worcester County facility. She told me that we had resolved our last cases and that the remaining infected residents had come through. The facility was COVID-free for the first time since late March, but the loss of life has been unimaginable.

COVID-19 is a virus that targets people in long-term care; elderly, frail individuals in congregate living, who are too ill to live independently. In February, there were 38,000 residents of long-term care facilities in Massachusetts out of a state population of 7 million, yet this group accounts for 63 percent of COVID-19 deaths statewide.

The Commonwealth has supported nursing facilities in many ways, including critical emergency funding that has allowed us to buy PPE (including gloves, masks, shields, and gowns), implement more rigorous infection control procedures, and pay for testing, recruit new staff to fill vacancies, and give our workers bonus pay.

Instead of paying a certified nursing assistant $14 or $15 per hour, we’ve been able to offer $22 to $25 per hour, a wage they have long deserved, but rarely earned. Without these dollars, I know that my facilities and others would still be battling COVID-19, running out of PPE and struggling to find staff. These investments have made our facilities safer and help fortify against a resurgence of the virus. Data show that 80 percent of new spending went to increased compensation and staffing.

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As the state continues with careful reopening, let’s take the learning of these terrible months and build a new model for long-term care. We need continued collaboration with the state to access PPE, implement widespread surveillance testing, support and provide the resources for strong infection control departments within nursing facilities, and establish real career ladders for our caregivers that start with entry-level care roles at living wages. We need a system that adequately funds nursing home care, built upon continued accountability and transparency. We need incentives that protect residents and make sure that all nursing facilities are high quality and held to high standards.

COVID hit our homes like a category 5 hurricane. How we rebuild is up to us.

Thomas Lavallee is chief operating officer of Alliance Health Management Services, LLC and chair of the Massachusetts Senior Care Association board of directors