Nursing Homes Ground Zero for COVID-19

The pandemic is highlighting an international shame.

There was an interesting sidebar discussion on the recent post about the value of the comments rating feature about repeated claims from a regular commenter that Democratic governors had forced nursing homes to accept people diagnosed with COVID-19, thereby spreading the disease to the most vulnerable population. This was characterized as an outrageous lie but it’s simply a needlessly partisan oversimplification of the truth.

It’s absolutely true that Democratic governors were ordering nursing homes to admit COVID-positive patients released from hospitals. And it’s also true that fully a third of all deaths from the disease in the United States are people who lived or worked in those facilities.

New York Governor Andrew Cuomo has been under fire for weeks for his order to nursing homes to accept COVID-19-positive residents. New Jersey Governor Phil Murphy did the same thing and is being excoriated for it by state Republicans. One presumes others did the same thing, probably including Republican governors. (There’s a flap over nursing home data in Indiana, where Republican Eric Holcomb is governor, but I can’t confirm he ordered patients admitted.) But New York and New Jersey are getting the most attention both because they’ve had far and away the most deaths in their nursing homes and because they’re where the national media are headquartered.

The controversy got a boost from an Associated Press report last Friday headlined “AP count: Over 4,500 virus patients sent to NY nursing homes.”

More than 4,500 recovering coronavirus patients were sent to New York’s already vulnerable nursing homes under a controversial state directive that was ultimately scrapped amid criticisms it was accelerating the nation’s deadliest outbreaks, according to a count by The Associated Press.

AP compiled its own tally to find out how many COVID-19 patients were discharged from hospitals to nursing homes under the March 25 directive after New York’s Health Department declined to release its internal survey conducted two weeks ago. It says it is still verifying data that was incomplete.

Whatever the full number, nursing home administrators, residents’ advocates and relatives say it has added up to a big and indefensible problem for facilities that even Gov. Andrew Cuomo — the main proponent of the policy — called “the optimum feeding ground for this virus.”

[…]

Cuomo, a Democrat, on May 10 reversed the directive, which had been intended to help free up hospital beds for the sickest patients as cases surged. But he continued to defend it this week, saying he didn’t believe it contributed to the more than 5,800 nursing and adult care facility deaths in New York — more than in any other state — and that homes should have spoken up if it was a problem.

[…]

The state order “put staff and residents at great risk,” CEO Stuart Almer said. “We can’t draw a straight line from bringing in someone positive to someone catching the disease, but we’re talking about elderly, fragile and vulnerable residents.”

The Society for Post-Acute and Long-Term Care Medicine, known as AMDA, had warned from the beginning that Cuomo’s order admitting infected patients posed a “clear and present danger” to nursing home residents. Now, Jeffrey N. Nichols, who serves on the executive committee of the group, said “the effect of that order was to contribute to 5,000 deaths.”

Nationally, over 35,500 people have died from coronavirus outbreaks at nursing homes and long-term care facilities, about a third of the overall death toll, according to the AP’s running tally.

Nursing homes are notoriously poorly run, not just in the United States but practically everywhere. Sending people who need to recover from COVID-19 to such a facility is just mind-bogglingly stupid.

But it’s not that simple.

CNN (“Cuomo says New York followed federal guidelines when sending coronavirus patients to nursing homes“):

New York Gov. Andrew Cuomo’s office deflected questions about a report from The Associated Press that the state sent more than 4,500 patients recovering from coronavirus to nursing homes by saying they followed guidance from federal agencies.

“I just want to reiterate once again that the policy that the Department of Health put out was in line directly with the March 13 directive put out by (Centers for Disease Control and Prevention) and (Centers for Medicare and Medicaid Services) that read, and I quote, ‘Nursing homes should admit any individuals from hospitals where Covid is present,'” said Secretary to the Governor Melissa DeRosa on Saturday during a briefing. “Not could, should … that is President (Donald) Trump’s CMS and CDC.

“There are over a dozen states that did the exact same thing, many of whom were concerned about hospital capacity. … Obviously any death is an unfortunate death,” DeRosa said, listing the totals from other states amongst New York’s. “It’s been a national and international tragedy that everybody has had to grapple with and it is something that we’re trying to learn from every day and move forward.”

Cuomo, a Democrat, said later in the briefing that he was trying to depoliticize the issue by saying, “New York followed the President’s agency’s guidance, so that de-politicizes it. What New York did was follow what the Republican administration said to do.

“So don’t criticize this state for following the President’s policy.”
The Centers for Medicare and Medicaid Services issued a memorandum on March 13 stating, in part, “Nursing homes should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present.”

New York’s Department of Health issued a statement Friday saying it was still compiling its data and followed the guidelines from CMS about nursing homes admitting people who had Covid-19.

A March 25 order by the state’s Department of Health mandated that nursing homes must not deny readmission or admission to people “solely based on a confirmed or suspected diagnosis of COVID-19.” Cuomo announced a new policy on May 10, saying a hospital cannot discharge a person who is Covid positive to a nursing home.

Aside from the fact that shifting the blame from the Democratic governor the Republican President is the opposite of “depoliticizing” the matter, it seems rather obvious that admitting people who happened to have been in a hospital that treated COVID patients is wildly different from admitting those diagnosed with COVID.

But it’s not obvious what better alternatives existed. Hospitals were overwhelmed with ICU patients and didn’t have the capacity for housing recovering elderly patients. And nursing homes ought to be equipped to provide convalescent care; they have “nursing” right there in the name, after all.

Alas, it’s hardly a state secret that nursing homes are awful. It’s a national, and indeed international, shame.

A May 9 New York Times report, “Push for Profits Left Nursing Homes Struggling to Provide Care,” which may indirectly have helped fuel the controversy in question, rightly puts the onus on the system itself.

When the pandemic struck, the majority of the nation’s nursing homes were losing money, some were falling into disrepair, and others were struggling to attract new occupants, leaving many of them ill equipped to protect workers and residents as the coronavirus raged through their properties.

Their troubled state was years in the making. Decades of ownership by private equity and other private investment firms left many nursing homes with staggering bills and razor-thin margins, while competition from home care attendants and assisted-living facilities further gutted their business. Even so, many of their owners still found creative ways to wring profits out of them, according to an analysis of federal and state data by The New York Times.

In many cases, investors created new companies to hold the real estate assets because the buildings were more valuable than the businesses themselves, especially with fewer nursing homes being built. Sometimes, investors would buy a nursing home from an operator only to lease back the building and charge the operator hefty management and consulting fees. Investors also pushed nursing homes to buy ambulance transports, drugs, ventilators and other products or services at above-market rates from other companies they owned.

These strategies paid off handsomely for investors, but they forced nursing homes to skimp on quality. For instance, for-profit nursing homes — roughly 70 percent of the country’s 15,400 nursing homes and often owned by private investors — disproportionately lag behind their nonprofit counterparts across a broad array of measures for quality, The Times found. Also, they are cited for violations at a higher rate than nonprofit facilities.

The toll of putting profits first started to show when the outbreak began. No nursing home could be completely prepared for a pandemic as devastating as Covid-19, but some for-profit homes were particularly ill equipped and understaffed, which undercut their ability to contain the spread of the coronavirus, according to interviews with more than a dozen nursing home workers and elder-care lawyers.

While the emphasis is on greedy capitalists—and they provide data showing that nonprofit and government-run facilities are indeed much higher rated—it’s long been the case that eldercare is just awful. This stands to reason, since quality care is incredibly expensive to provide and few people can afford to bear that cost indefinitely.

A quick Google search for ‘shame of nursing homes’ returns some 20 million results. Among them a 1999 article by Eric Bates in The Nation, a recent op-ed in the Chicago Sun-Times, and a whole host of scholarly articles at the National Library of Medicine. Venture capitalism is contributing to the problem but it didn’t create it.

And it’s not just in greedy, capitalistic United States that has this problem. It’s happening in Canada and Sweden. Long-term care facilities in Europe have been called “death traps” and account for half of Europe’s COVID deaths.

Charles C. Camosy, who teaches bioethics and moral theology at Fordham University, had a sobering op-ed in the New York Times a few days back under the headline “What’s Behind the Nursing Home Horror.”

We knew it from the beginning. A nursing home in Washington State was the center of the first known coronavirus outbreak in the United States. We knew that institutions caring for the elderly and disabled in close quarters would be particularly vulnerable during the pandemic.

But we did not act. Personal protective equipment, special training and extra staff went almost exclusively to our critical care facilities. Nursing homes got virtually nothing. Well, that’s not entirely true. In New York and other places we gave them patients, and even nurses, infected with the virus.

The result has been a raging wildfire of infection and death.

[…]

Even before the pandemic, these were places where what I call “throwaway culture” was thriving. The staff aren’t paid a living wage, often have poor training and are hopelessly overworked. The residents face elder abuse, and large percentages of them are desperately lonely. A good number get no visitors at all, which pushes rates of dementia among residents to unbelievable levels.

[…]

The pandemic doesn’t have many silver linings, but as the number of nursing-home deaths piles up, the news media is being forced to cover a world many of us would prefer to ignore.

It is understandable that we would. Part of the price we pay for living in a death-denying, consumerist, throwaway culture is that we must push these kinds of grim realities to unseen places that afford us plausible deniability. The pandemic forces us to look. If we want to understand the current phase of the coronavirus pandemic, we can no longer look away.

[…]

Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us? To honor the moral and social equality of every human being, regardless of their mental or physical status?

Why not? Many of us are staying home and practicing physical distancing, not primarily for ourselves but for the benefit of our elders and others who find themselves at risk. Let us build on that good and decent impulse by challenging a throwaway culture that, right up until this very moment, has marginalized these populations and made the nursing-home crisis a tragic inevitability.

While that’s obviously the right thing to do, there are no cheap, easy solutions. Few families are equipped to care for their sick, elderly relatives for years on end. We’ve built our economy around all adults in the family working full-time jobs. And, even if we got out of the two-income trap, the social burden of eldercare would almost inevitably fall disproportionately to women, a price that seems awfully high.

That would seem to beg for a government program but, as already noted, even countries with much more robust social welfare cultures than ours are failing miserably at dealing with their elderly.

Regardless, it’s a real problem and not one limited by political party.

FILED UNDER: COVID-19, Government, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Kurtz says:

    Aside from the fact that shifting the blame from the Democratic governor the Republican President is the opposite of “depoliticizing” the matter

    James, is there really any way to depoliticize this issue? Silence just lets the “seeding” framing fester. Not mention Trump and let him tweet about it in ALL CAPS? Throw it at Fauci’s so that he can get more death threats from nutjobs?

    I’m not really disagreeing with you here. I’m just pointing out that this is part of the reason Trump can maintain a solid floor of support is because much of what his approach to politics does is make it impossible to respond without feeding some of his bullshit.

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  2. gVOR08 says:

    My beloved Gov DeSantis /s is reopening FL. The only reason I can think of that he thinks it won’t rekindle exponential growth is if knows the prisons and nursing homes are already saturated.

    3
  3. OzarkHillbilly says:

    Maybe we could just put them in cages.

    s//

    3
  4. Michael Reynolds says:

    My wife (and I, by extension) is dealing with this exact problem. Her mother, 87 IIRC, has dementia, not end stage, but to the point where she frequently thinks she’s living with long-dead relatives. So, right at the line between, ‘you know it’s actually kind of funny,’ and, ‘oh, this is taking a very dark turn.’ She was in a nursing home in Virginia. Two of four siblings live there, one, Saintly Sister, is carrying all the weight of daily interaction.

    When cases started popping up at the home we yanked her out, put her with the Saintly Sister in a hotel, then moved her to an executive rental. And we’re at the point of, OK, now what? We’re still mostly spending the mom’s money but if she lives more than a year that will be all gone and it will be the Bank of K and M bankrolling Saintly Sister. Saintly Sister’s house and circumstance in no way allows care in her home, so we offered to buy a home which we’d resell when Mom croaks.

    You’d think that having enough money would solve everything. Nope. It quickly descends into a morass of complications of personality, and work obligations, and Covid exposures, and balancing of odds where we don’t really have decent data. There is no easy, well-trod path, you end up creating customized, often temporary, always inefficient and some times just plain wrong solutions.

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  5. Sleeping Dog says:

    The nursing home industry, and in particular the for profit sector should get some blame, but the public’s unwillingness to adequately fund reimbursement also needs to be noted. Medicare pays for 100 days of skilled nursing care after which the resident becomes private pay or Medicaid. If you can afford the $10-20K a month that the home costs, you’ll get pretty good care, at least until you exhaust your assets and you go onto Medicaid.

    Medicaid reimbursement for nursing home care is one of those line items, like university funding and public schools that state legislatures hack away at during recessions and like those other categories the legislature seldom returns funding to the earlier level when the recession recedes.

    If you need to place a family member, religiously affiliated and not-for-profit homes, usually will provide the best care. Among for profit homes, those that are family run businesses, where the family is actively involved in the day-to-day management, i.e. administrator, director of nursing, director of social services usually are your best bet. Medicare surveys all nursing homes periodically and the reports and ratings are available at the Medicare website.

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  6. James Joyner says:

    @Kurtz: Agreed. It was more an aside than a criticism; I just found the “let’s depoliticize this—it’s Trump’s fault, not mine” framing comical.

    @Michael Reynolds: Neither of my parents lived long enough to need long-term care but, even though I make an above-average living, there’s no way I could have afforded it.

    @Sleeping Dog: Yes, one of the NYT reports cited above has a pretty good chart with the breakdowns. I was a little surprised that religiously-affiliated facilities were the highest-rated.

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  7. Scott says:

    Decades of ownership by private equity and other private investment firms left many nursing homes with staggering bills and razor-thin margins

    Is there any failure in this country that is not preceded by this?

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  8. Sleeping Dog says:

    @Michael Reynolds:

    Michael, we’re in a similar circumstance. My mother-in-law was in an assisted living when the virus struck and slipping to dementia. We talked about bringing her to our place as we have a nearly separate apartment that we use as a den and guest room. If she were simply old and need some assistance and medication supervision that would have been fine, but the predictable slide into dementia made that too risky. She has since moved to the memory care unit and believes she is there with her dead husband, who is on another unit. Fortunately, she won’t outlive her money.

    And yeah, it’s $10K /month.

    The facility is a continuing care community, independent>assisted>memory care, no SNC. So far they have one Covid 19 infection in a staffer and that has not spread. We’re lucky in not being in an urban area that has helped minimize the spread of the virus.

    1
  9. Sleeping Dog says:

    @James Joyner:

    I was a little surprised that religiously-affiliated facilities were the highest-rated.

    Its a matter of mission. The largest operators of religiously affiliated homes are Catholic, Lutheran and Baptist, all denominations with strong social service components. Methodists, Presbyterians and Episcopal have homes as well. One thing about the religiously affiliated homes and not-for-profit, is that your loved one doesn’t get kicked out when they run out of money and the quality of care doesn’t diminish.

    Many of us rag on religious organizations, but in this area they are truly a god send.

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  10. Michael Reynolds says:

    @Sleeping Dog:
    There is – as you say – a huge difference between ‘old’ and ‘old with dementia.’ It’s a bit like caring for a toddler in that left alone they can quite literally burn the house down around you.

    Last scene of all,
    That ends this strange eventful history,
    Is second childishness and mere oblivion,
    Sans teeth, sans eyes, sans taste, sans everything.

    How’s that for some cheery poetry?

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  11. Electroman says:

    I’m relatively affluent, but my mother’s assisted-living bill would be brutal if she had no private funding. And that’s only about US$6600 a month, far less than skilled nursing.

    1
  12. Kurtz says:

    @gVOR08:

    knows the prisons

    Well, he’s lost the mechanism to keep them from voting once they are out. So how else is he going to keep them from voting?

    Note: this is a joke. My cynicism about DeSantis only goes so far. If it was Rick Scott on the other hand…I still wouldn’t buy it. But it would seem less absurd.

    3
  13. charon says:

    In Sweden, people are being kept in care homes regardless how much they need to be hospitalized. Sweden’s elderly death stats reflect that.

    https://www.bbc.com/news/world-europe-52704836

    The headline:

    Coronavirus: What’s going wrong in Sweden’s care homes?
    By Maddy Savage
    BBC News, Stockholm

    Excerpt:

    Now, increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital, and prevent care home and nursing staff from administering oxygen without a doctor’s approval, either as part of acute or palliative (end-of-life) services.

    ‘We were told not to send them in’
    “They told us that we shouldn’t send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in,” says Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic.

    “Some can have a lot of years left to live with loved ones, but they don’t have the chance… because they never make it to the hospital,” she says. “They suffocate to death. And it’s a lot of panic and it’s very hard to just stand by and watch.”

  14. steve says:

    Nursing homes were not prepared, most of them, and start out with a poor baseline of care. So when people talk about targeting the at risk groups and trying to make them safe so everything else can re-open, I think people need to know how bad the places are to begin with. A lot of the staff just arent going to be able to train up well to manage infected pts. There arent enough people with training who will want to work at a nursing home, unless you raise salaries sky high and then you end up short on staff at hospitals. I have not seen, nor do I expect to see, a plan that will really work for nursing homes.

    What is needed is a long term approach to improve them in general. If we are starting at a higher baseline then, maybe, we can have realistic plans to make nursing homes safer when infectious diseases are present.

    Steve

    1
  15. charon says:

    @charon:

    Logan’s Run comes to Sweden.

  16. Daryl and his brother Darryl says:

    Regardless, it’s a real problem and not one limited by political party.

    We, as a society, have in no way figured out how to deal with our elderly population.
    For sure…that’s not political.
    But when Obama tried to do something about it, in just a small way, with Obamacare…Republicans screamed “DEATH PANELS!!!”
    So yeah, it’s not limited by political party, but one political party is far worse than the other. In myriad ways.

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  17. SC_Birdflyte says:

    @James Joyner: We moved my parents to a large facility formerly associated with the Presbyterian Church because it offered a spectrum of care, from independent-living apartments to assisted living (my father) to skilled nursing (my mother). We were fortunate to have adequate financial resources to pay for a very long period of care, which proved to be unnecessary when my mother died after only three months there and my father moved back to my hometown. But even that limited period of financial exposure would have been ruinous to most Americans. The care, BTW, was first-rate.

    2
  18. KM says:

    I think my biggest problem with the nursing home argument as is was continually brought up by certain posters was how it was used not as a deflection per se but as justification. As in, “you can’t blame the GOP for deaths if Dems are also responsible” and “since y’all screwed up first, it means you can talk about our bigger F-ups”. It’s used to deflect blame from everything from mismanaged stockpiles to bad logistics to straight-up “100K isn’t a problem since you lets a couple thousand die in this specific circumstance.” It’s very much like a teen arguing that since their younger brother broke a window throwing a ball inside the house last year, you can’t bitch they caused a 10-car accident drunk driving in a stolen car. Someone else’s sins or fault do *not* excuse your own failings- your actions are you own.

    There should have been a plan for what to do with elderly folks in nursing homes during an highly-transmittable contagion. There should be a state AND federal plan, with the federal plan being the general framework/ logistics and the state filling in the local details. If Cuomo was screwing up and getting people killed, it should be able to easily remedied by a competent federal structure that had a viable alternative ready to go. Hell, they could have sent the elderly to the ship that sat in harbor virtually empty – why wasn’t that on offer when folks started complaining about the nursing home issue? Also, not to be indelicate but as NY was one of the early hit states, they got to be the guinea pig for what does and doesn’t work. All the other states claiming to have “done better” benefited from seeing what didn’t work and what lead to disaster. If it had been FL hit first, you better believe those nursing homes would have been devastated by the governor’s choices.

    I’m not excusing, validating or vindicating Cuomo – I’m reserving judgment on this issue till we get more info. I will say though that those trying to use it as a Get Out of Moral Jail Free card are missing the point; even if Cuomo is responsible for needless deaths in this case, it doesn’t absolve Trump, the other governors or anyone else in power of all the OTHER needless deaths. I despise the argument as we’ve seen it used here in the comments for what it is – a “Don’t Blame ME, you’re not angel” rationale.

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  19. James Joyner says:

    @Daryl and his brother Darryl: I was reflecting on the charge that Democratic governors were sending infected people to nursing homes, more so than on the overall problem. Democrats have long been more forward-leaning on social programs, including Social Security and Medicare, but neither party has done much to address the eldercare crisis.

    4
  20. James Joyner says:

    @KM: While I think that’s fair, I’m not all that bothered by the partisan pushback by JKB and others. Specifically, while I have been condemning Trump’s handling of this crisis for quite some time now, I do think his opponents have been over-the-top in blaming him for essentially the entire death toll. While there’s little question in my mind we’d have saved a lot of lives with more competent leadership from the top, we’re a federal system and states and localities are responsible for many of the decisions that really matter. While Cuomo has been practically Churchillian in comparison to Trump, he’s being touted as some sort of heroic figure when he has in fact made some bad decisions.

    Further, while I think the lockdowns have saved a huge number of lives and earlier ones would have saved many more, it’s also fair to note that a huge percentage of the deaths are in eldercare facilities and in a handful of densely populated metropolitan areas. I don’t think tying that to party politics is the least bit useful but they’re otherwise perfectly reasonable points in a cost-benefit calculation.

    7
  21. Sleeping Dog says:

    @Michael Reynolds:

    The sad thing for my wife and it eats at her everyday, is that she hasn’t seen her mother since mid March and won’t, till who knows when.

    4
  22. Kathy says:

    I said before, and I maintain, that everyone was behind the curve at the start.

    This is natural, since a new virus is, evidently, largely unknown. Based on prior outbreaks like SARS and H1N1, I expected this to end with the widespread lock downs. This was before we knew is transmits presymptomatically and asymptomatically. For that matter, we’re still learning just what it does and how.

    I also keep saying this, but this is why we need a plan in place, which will seem like an overreaction whether ti is or not, and it will be most of the time. It will cost a lot of money, but less money than a global pandemic does.

    This slow acquisition of knowledge about SARS-CoV2 does not excuse failure to take even elementary measures at the start, nor of failing to take preventive measures now. Hard as it may be to believe, lots of other countries are doing even worse than the US. Like Mexico and Brazil, for instance. Neither has an excuse, as Mexico dealt, much better, with H1N1, and Brazil faced Zika. It’s bad leadership at the top.

    The important thing about the nursing home debacle is not whom to blame. Rather, as James points out how to improve the lot of people in such facilities, and what measures to take in the next pandemic.

    We can’t be guaranteed good leadership next time, either, so government agencies must be empowered to enact preventive measures next time, without waiting for executive approval.

    6
  23. Michael Reynolds says:

    As long as people are defined primarily as producer/consumers we’ll go on treating old people badly. Sure, they used to consume, but now not so much, so screw ’em. Same for veterans and homeless people and the mentally ill. If you don’t consume and produce you have no value, quite frankly we wish you’d just die. Why do we still worship youth? Because a 10 year-old has decades of production and consumption ahead. Why are old folks packed off to piss-smelling dumps? Because they aren’t going to buy a new car, now, are they?

    And this is how much we give a damn about veterans:

    The Associated Press reported Saturday that the VA would not stop use of hydroxychloroquine, citing responses to Congress in which the department stated that it had never “encouraged or discouraged” the drug’s use. At the same time, AP reported, the department acknowledged that Secretary Robert Wilkie had been wrong to assert that the drug was shown as effective in younger veterans. In the first week of this month, VA data showed that 17 patients had received hydroxychloroquine for Covid-19, and AP estimated based on an analysis of the department’s hospital data that hundreds more had received it by early April.

    Old guys who once went in harm’s way on orders from our government, who may have watched friends die, who may have had to take lives in service to their country, screw ’em, they can be sacrificed so that the Secretary of Veteran’s Affairs doesn’t have to worry about an angry Twitter attack from the CinC. Especially since, hell, they just cost money they don’t contribute. They have no value.

    In this country everything is money. We talk a lot of facile rot about family and justice and patriotism and individual worth, but what we really care about is money.

    Money, it’s a hit
    Don’t give me that do goody good bullshit
    I’m in the high-fidelity first class traveling set
    And I think I need a Lear jet.

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  24. KM says:

    @James Joyner :
    Technically, Churchill shouldn’t the reputation he has. I do think it’s apropos you picked him as the exemplar though for the same reason Churchill got his reputation: an previously controversial SOB who took the reins during a crisis and came out smelling like roses even though he made some major mistakes in the process. Both just happened to be in the right place with the right temperament to make things happen and benefited extremely from being compared to other ineffectual and criminally incompetent Power That Be. I agree that partisan pushback on Cuomo-love is valid since everybody deserves a critic. I do not agree that holding him accountable is the GOP pointing out valid criticisms but trying to shake off the fleas their Master brought home. Trump didn’t cause the pandemic: true. Many would have still died had he been perfect: true. Trump’s criminal incompetent has killed 10Ks that would have lived had he not been so bad at all this: still true.

    I’ve got a Never Trumper friend down in NYC. She, like yourself, still holds to many conservative ideals but hates how the party’s going down a bad road. She used to bad-mouth Cuomo all the time, right up there with Hillary (at least until Trump came along). Her nickname for him would get me banned for typing it. Ever since COVID, though? She jokes his new nickname is “Daddy”. She’ll bitch about the nursing home thing to me but will jump right in to defend him should one of her conservative friends online bring it up. She, like many others, gets a bad choice made under terrible circumstances doesn’t invalidate the hard work he’s done; it also doesn’t hurt he’s repeatedly taken responsibility for mistakes and misjudgments. I’ve seen her on my FB feed struggle to communicate to others that finger pointing at Cuomo is just as useless as all the ass-kissing some liberals are doing. Cuomo’s worst decision has killed less than Trump’s best one…. and that’s had devastating consequences for the nation. However, she has little success since they are like the posters who invoke it here – it’s not meant to be a good-faith engagement or bring back down to reality. I can meaningfully debate with her because she still has rational points and understands how her position has been handicapped by being associated with such a leader; I can barely reply to some posters here since their focus is to deflect blame from POTUS instead of talk about why he might be getting blamed (legitimately or not) in the first place.

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  25. Blue Galangal says:

    @Sleeping Dog:

    If you need to place a family member, religiously affiliated and not-for-profit homes, usually will provide the best care.

    “Best” is entirely relative. My dad ended up separately in two not-for-profit centers for long-term care/rehabilitation. The first one had multiple issues, up to and including the head of nursing not knowing how to open a patient’s care chart and residents not getting meds (coincidentally, narcotic meds…). Multiple staff there told my mom to just let my dad starve to death, it was the kindest way. Reported to state of Ohio… when they finally responded and announced an inspection, everything was FIIIIINNE when they got there.

    Fast forward 7 years, dad battling cancer and multiple falls lands him in another not-for-profit care center, not the same one. The first thing the PA tells him is that he’ll die of pneumonia so he might as well go into hospice and save us all trouble. As it happens, pneumonia did kill him, not the cancer, but when she told him he was going to die no matter what, he became very depressed and lost his will to fight. First do no harm?

    Also fast forward 7 years: the first care home has been the subject of multiple state fines. We suspected 7 years ago they were at the center of an opioid ring. We might have been right.

    Long term care facilities are the worst place to send someone with mobility issues and they are a place to warehouse elderly while we kill them by neglect or starvation. It doesn’t matter who’s running them. I’ve asked my kids to just put me on an ice floe.

    2
  26. Blue Galangal says:

    @James Joyner:

    neither party has done much to address the eldercare crisis.

    Well, one party consistently tries to cut the safety net, including SNAP, the ACA, and Medicaid, and threatens SS and Medicare. The other party tries to enhance the safety net, including safeguarding SNAP, SSCHIP, ACA, etc. But, sure, both parties are equally responsible for not addressing the eldercare crisis.

    The only thing keeping many of our elderly alive is Medicare, period, paragraph. But after we patch them up and treat them, we send them back to substandard living conditions and substandard therapy regimes (when they qualify to receive therapy at all – and if they don’t get therapy they end up in a vicious cycle bouncing between hospital / ICU and nursing home).

    (You know how much an elderly recipient gets for spending money each month when on Medicaid in a nursing home? $40. Show me how that pays for a hair cut, gum, and, oh, yeah, a cell phone.)

    7
  27. DrDaveT says:

    @James Joyner:

    I do think his opponents have been over-the-top in blaming him for essentially the entire death toll.

    I’m pretty sure you’re making that up. Even the Trump Death Clock only attributes about 60% of the deaths to Trump (in)actions (thus far), and I haven’t seen anyone here take a harder line than that. The facts are bad enough; we don’t have to exaggerate them.

    1
  28. Kurtz says:

    @James Joyner:

    While Cuomo has been practically Churchillian in comparison to Trump, he’s being touted as some sort of heroic figure when he has in fact made some bad decisions.

    This is an excellent point. The tendency to grade on a curve right now is a serious issue that definitely does not have a real short-term answer. Long-term? Maybe. But it would take the partisanship fever breaking

    1
  29. Raoul says:

    One question, once the patients are treated and released, are they still spreading the virus?

  30. OzarkHillbilly says:

    @James Joyner: While Cuomo has been practically Churchillian in comparison to Trump, he’s being touted as some sort of heroic figure when he has in fact made some bad decisions.

    Churchill made some bad decisions too. Jus’ sayin’…

  31. Sleeping Dog says:

    @Raoul:

    It depends. An individual maybe able to be released from the hospital, but are still actively ill from the virus. Typically these individuals still need care and are discharged to some sort of supportive living environment, nursing home, dormitory that has been established to supervise these folks or even home. My understanding is the until the body kills off the virus, the person can still spread it.

  32. Kathy says:

    Imagine the year 2023:

    Biden is the 47th President, Trump languishes in a New York minimum security prison for state crimes, and as he awaits a ruling on whether the pardon given him by president Pence covers federal crimes he committed after the pardon was issued, and COVID-19 is a quickly fading memory as the many vaccines developed have kept it at bay.

    Then a new virus, causing respiratory issues as well, emerges in some small country. As the UN’s WHO and other multinational teams rush to identify it, the new virus spreads to China, India, and the UAE*, from where it begins to spread to Europe, Asia, North America, and Australia.

    We don’t yet know how lethal it is or how contagious it is, but people have died of it and it is spreading.

    Say the US finds there are ten positive cases. Would people even in the bluest states consent to a lockdown on the strength of ten positive cases?

    I think not. New Zealand imposed a very thorough lock down, as well as testing and tracing, and has had very few cases en deaths (and yay for them!). But I just don’t see the same happening in America, or most other countries, fresh memories of COVID-19 or not.

    A more likely strategy would be to ban travel to and from affected areas, mandatory quarantine of anyone who has traveled through them, or who arrived before the ban, extensive testing and effective tracing. But also closing down, temporarily, mass events like sports, concerts, etc., and instituting mandatory social distancing in restaurants, bars, theaters, etc., and masks in public again.

    I figure as most people won’t get infected with SARS-CoV2, their bad memories of the pandemic will be of lockdown and a wrecked economy. Maybe then asking them to comply with preventive measures to avert another lockdown and wrecked economy would work better.

    Me, at the first report of any new potential pandemic virus in Mexico, I plan to social distance, wear a mask, avoid any gatherings of people, and limit my movements to work, grocery shopping, and nothing else.

    I admit I say this now, deep in the Trump pandemic, and might not want to go through all that effort three years hence. That’s possible. But I had done all I mentioned above, except wear a mask, as of March 8th, when cases here were very few.

    * The United Arab Emirates are a major hub fro intercontinental travel between North-America and Asia, Europe and Asia, and Australia and New Zealand to Europe and North America. It’s likely to re-emerge as such after the pandemic. Competition may come from Istanbul, though.

    1
  33. James Joyner says:

    @KM:

    Technically, Churchill shouldn’t the reputation he has. I do think it’s apropos you picked him as the exemplar though for the same reason Churchill got his reputation: an previously controversial SOB who took the reins during a crisis and came out smelling like roses even though he made some major mistakes in the process.

    @OzarkHillbilly:

    Churchill made some bad decisions too. Jus’ sayin’…

    Oh, absolutely. But anyone faced with that many hard decisions is bound to make some really bad ones.

    I use “Churchillian” here in two senses. First, being a compelling, comforting orator who people rallied around during perilous times. Second, being resolute in the face of a crisis bigger than any faced in living memory. Cuomo is getting too much credit for both, precisely because he’s being compared to Trump and not Churchill.

  34. Gustopher says:

    it seems rather obvious that admitting people who happened to have been in a hospital that treated COVID patients is wildly different from admitting those diagnosed with COVID.

    I’m going to stand by my assessment of JKB’s comments as “drive-by blood libel”.

    Because that’s what it is. A claim that Democratic governors alone are responsible for a bad decision, apparently deliberately, which was allegedly implemented under the threat of force, and then scurrying back into the darkness rather than explaining or defending.

    It was a bad decision among a choice of bad options, made at a federal level and implemented at the state level, and reflecting a number of long running problems, including a lack of data because of a lack of available testing… but we would never know that from JKB.

    It’s like “The Jews killed Christ” — completely neglecting the role of the Romans, or the complex history and conditions at the time, or that it was #NotAllJews. It’s just hate, pure and simple.

    8
  35. @Gustopher: I will agree that his use of the word “seeding” and the way he presents it makes it sound like Cuomo and others purposefully put sick people into these facilities with malicious intent and I agree that deserves to be called out.

    I will admit, however, that in general I have found JKB largely incoherent on this entire Covid-19 topic, so try not to pay too much attention to him.

    5
  36. tyrell says:

    I have heard that on the tv and radio news about the nursing homes. So my take from that is not to be near any nursing homes. I recall a few weeks ago there was a lady who had recovered from the virus. She is 102 years old!
    If I was killed in a car wreck close to a nursing home, they would probably put: “probable cause of death Coronavirus”.
    Dr. Birx says the focus should be on the elderly and others who are vulnerable, not young and middle-aged people. Which still makes me wonder why close the schools.
    According to some statistics, one of every three older adults will die of Alzheimer’s. For the Corona it is about one out of every 120. (Insurance analysts)

  37. steve says:

    “One question, once the patients are treated and released, are they still spreading the virus?”

    We arent really sure how long pts remain infectious. CDC has changed its guidelines a few times on when we should consider pts to be infectious. We also dont really know what it means if people continue to test positive. There was a recent paper that suggests that pts who have recovered but still test positive are shading virus particles, but not ones that are capable of infecting anyone.

    Steve

  38. Gustopher says:

    @tyrell:

    If I was killed in a car wreck close to a nursing home, they would probably put: “probable cause of death Coronavirus”.

    No they wouldn’t. That’s dumb.

    Thumbs Down.

    10
  39. Jax says:

    @tyrell: No, Tyrell, if you died in a car accident near a nursing home, they would not list your cause of death as COVID-19. (So many eyerolls)

    They closed the schools because they are stinking pools of viral infection. I don’t know how long it’s been since you’ve been around kids, but they don’t understand “social distancing”, “wash your hands”, or anything involving personal hygiene. Those kids then share boogers, cough on each other, lick the same foods on a dare, and take it home to their families, many of whom fit one or more checkboxes on “extremely susceptible to COVID”.

    My kids have been out of school since mid-March, and nobody has been sick that entire time. In a normal spring quarter, we’ve all usually gotten at least one round of flu and then a secondary cold, occasionally strep, and definitely some puking flu after Spring Break….you know, just to keep you on your toes. 😉 It’s been so great, I’m thinking about homeschooling the high schooler next fall just because she’s healthier and happier, no cold’s or flu exacerbating her severe asthma.

    School’s need to do better, in general, on not cramming people who eat boogers 30 to a room.

    8
  40. Kathy says:

    @Gustopher:

    Thumbs Down.

    Thumbs up to your thumbs down. Well done.

    8
  41. An Interested Party says:

    The only thing keeping many of our elderly alive is Medicare, period, paragraph.

    Can you imagine what the elderly population would look like without Social Security and Medicare? And yet we still have idiots who would like to get rid of both programs…

    I will admit, however, that in general I have found JKB largely incoherent on this entire Covid-19 topic, so try not to pay too much attention to him.

    And then tyrell comes along and shows how he too should be added to that ignore list…

    2
  42. Scott O says:

    @tyrell: Not worth replying to but I wish to add another virtual down vote.

    2
  43. Pete S says:

    In Canada the armed forces were sent to assist in several retirement and nursing homes, when the staff started falling ill. The last report I saw showed that 82 percent of covid deaths in Canada have been residents and staff in nursing homes.

    After a few weeks in the forces have issued a report blasting conditions in the homes where they were working. They found limited PPE, bad cleaning, covid patients mixing with other patients, residents not being fed. All this mind you, when they were only dispatched to the homes a month after the outbreaks had started.

    My father’s retirement home is not one that was bad enough to get help from the forces. They had 60 of their 95 residents catch the virus and 18 died. He is one of the “lucky” ones, he was sent to the hospital with a minor non-covid ailment 6 weeks ago and is still there. They are keeping him in the hospital for his protection but it is a pretty lonely existence being in the hospital with no visitors and not even being allowed to go out of your room. All seniors homes are not allowing visitors since mid-March but this home had their residents come to a “pub night” on the last Saturday in March. By the following Monday they had to lock residents in their rooms and 2 weeks later the deaths started.

    We like to pat ourselves on the back sometimes that our health care system is better than yours but problems with senior care seem to be universal.

  44. Matt says:

    @tyrell:

    If I was killed in a car wreck close to a nursing home, they would probably put: “probable cause of death Coronavirus”.

    That’s just a stupid comment with no basis in reality.

    Dr. Birx says the focus should be on the elderly and others who are vulnerable, not young and middle-aged people. Which still makes me wonder why close the schools.
    According to some statistics, one of every three older adults will die of Alzheimer’s. For the Corona it is about one out of every 120.

    Your question is answered with your second “paragraph”. Just because the kids die at a lower rate doesn’t mean they can’t spread the virus to grandma. Your complaint seems to be that since SARS-CoV-2 hasn’t reached the infection rate on par with the common cold that we shouldn’t worry about it because other things are killing more people so far…

    Are you really that stupid that you can’t see how the virus is still establishing itself and it’s only had a few months in the USA to do it?

    EDIT : @Scott O: Now that I think about it in the past I’d of just down voted and moved on. Guess the lack of that cathartic experience has caused me to actually post instead.

    2