Elderly people were already vulnerable to COVID-19. Then it came to nursing homes.

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Last week, reports of mismanagement and negligence regarding COVID-19 protocol at the Holyoke Soldiers’ Home, a state-run veterans’ nursing home, resulted in the deaths of at least 47 seniors. The administrative fallout, which largely consists of blame-shifting between state and local officials, made national headlines, and several investigations of the incident are ongoing


But Holyoke is just the tip of the iceberg. As of April 15, nursing home residents make up over 40 percent of COVID-19 fatalities in Massachusetts (see Figure 1). People over the age of 70, regardless of their place of residence, have accounted for 85 percent of COVID-19-related deaths in the state. 


Senior living facilities are uniquely vulnerable to this pandemic, especially given the reputation of some for being understaffed, underfunded, and poorly regulated. With insufficient resources available to isolate cases and take safety precautions, COVID-19 has spread quickly among nursing home roommates, between staff and residents, and by family members and other visitors prior to stringent policies being put in place. Triple-digit case counts have become common among senior communities, from Belmont Manor to Chelsea Jewish Life Care to the Holyoke Soldiers’ Home.   


Figure 1: Share of nursing home residents among COVID-19 death toll by state*

* Not all states have reported the number of deaths in nursing homes. Those who have are as of April 15th.  


While it’s difficult to discern a pattern among the states who have lost a disproportionate share of nursing home residents to COVID-19, the early presence of the virus in Massachusetts may have played a significant role in its rapid infiltration of senior living areas. For most of the first half of March, Massachusetts had the 4th-most COVID-19 cases in the country, despite being the 15th-most populous state. Before state-at-home orders and widespread testing, the virus may have tightened its grip on long-term care facilities. 


While the Holyoke example has ignited accusations of mismanagement, some observers urge caution before criticism falls on the long-term healthcare industry as a whole. Even if nursing home residents are dying more frequently than senior citizens as a whole, residents of long-term care facilities are more likely to have pre-existing conditions and frailties


While nursing home staff can help facilitate social distancing, nursing homes are chronically understaffed nationwide. Staffing problems compounded as some employees stopped coming to work over Coronavirus fears, while others came to work already sick. The fact that sick nursing home employees kept showing up to their jobs likely reflects their unstable financial position. Relative to personnel at general medical and surgical hospitals, nursing home care-givers make nearly 50% less in weekly wages and are therefore more likely to live paycheck-to-paycheck.    


Going forward, nursing home residents remain inherently exposed to epidemics like COVID-19, but there’s still more to be done on an administrative level to mitigate the impact. Nursing home employees should be paid more and educated better on viral infections. Managers should redouble efforts to maintain contact with families, isolate sick residents, and reconfigure common areas to facilitate social distancing. Concrete and comprehensive emergency plans should be implemented to improve clarity for all involved in future crises. 


Between 2020 and 2035, the number of senior citizens in Massachusetts will increase by over 430,000 people. Ensuring a safe, comfortable, and dignified end of life for this population can only come with a robust, holistic effort at the state level. In a nation destined for an increasingly large cohort of older people, an investment in eldercare is an investment in our future.     


Andrew Mikula is the Lovett & Ruth Peters Economic Opportunity Fellow at the Pioneer Institute. Research areas of particular interest to Mr. Mikula include urban issues, affordability, and regulatory structures. Mr. Mikula was previously a Roger Perry Government Transparency Intern at the Institute and studied economics at Bates College.