The image of his mother looking back at him through the window of her Michigan nursing home still haunts Dennis Williams. It isn’t just the frail state that his elderly mother was in when she was diagnosed with covid-19. What really haunts Dennis is that even through the glass, he could hear her begging for help.

That was the last time that Dennis saw his mother alive. Wanda Parker died on April 7th from covid-19. Her death came two days after the care home transferred her to a hospital for treatment.

Now, her family is suing the Lapeer Nursing Home for failing to provide the staff caring for her with PPE. Three former employees are supporting their suit. All of them contracted covid-19 after management prevented them from wearing protective equipment and insisting that they continue to work unless they were showing symptoms.

The Care Home Conundrum

The covid-19 pandemic has had a devastating impact the world over. While some countries have been hit harder than others, and some countries have responded much more effectively to the virus, there are some similarities that we are seeing repeated across the globe. One of the most striking constants of this pandemic is the impact that the disease has had on nursing homes. 

Since the earliest days of the pandemic, we have known that older people were particularly susceptible to the effects. Accordingly, governments have had plenty of time to anticipate the arrival of covid-19 in their countries and make the necessary arrangements to protect vulnerable populations. And yet, it seems that care homes worldwide have been hit particularly hard by the virus.

We have heard far too many harrowing tales of care homes where most residents have succumbed to the coronavirus. It is true that older people are more at risk from the virus. It is also true that the nature of a care home, i.e. lots of vulnerable people all living in close proximity, is perfect for coronavirus to spread. But we are now many months into the pandemic. At this point, you would expect every care home in the country to be prepared and ready for the arrival of coronavirus. 

Sadly, reports of care homes being understaffed and ill-equipped to handle the pandemic continue to flood in. Exasperated families are now taking their cases to court as they seek compensation from the government and care homes that have failed their family members. Dennis is far from the only son dealing not only with the grief of losing a family member, but also the stresses of pursuing legal action.

PPE

We have all had to learn about viruses and virus transmission this year. Even people who had absolutely no interest in the subject are now reasonably familiar with terms like PPE and social distancing. Together, these two concepts are essential for combatting the virus.

Personal protective equipment can be as simple as a disposable mask. Frontline health workers who are routinely exposed to coronavirus patients have access to much more robust respirators and other equipment. But for most of us, a simple mask or face covering can make a tremendous difference both to our own health and to those around us.

We all expect care home workers, who spend their days around vulnerable people, to have access to the PPE they need. But according to Mr. Williams, he would regularly see workers interacting with his mother without wearing any protective equipment at all. This situation was particularly galling for Dennis as he had to watch his mom through a window for both their safety. 

Subsequently, Dennis has found the statistics for other care homes in the area, none of which reported as many cases of covid-19 as Lapeer Nursing did. To Dennis, this wasn’t a surprise.

“They [the other care homes] actually took the precautions,” he said. “…when we’d go see Mom through the window, and it wasn’t the workers’ fault – I had talked to several of them – they just were just being told they could not wear the stuff.”

A Virus Unchecked

The coronavirus responsible for covid-19 is highly infectious. We still have a lot to learn about the virus and how it works, but there has never been any doubt that it will run rampant if left unchecked. Thankfully, governments around the world have taken measures to reduce the spread of the virus. Even though national leadership on the issue has been lacking in the United States, most state and local governments have had the good sense to take action to mitigate the virus.

But incidents like that at Lapeer nursing home provide us with grim insight into what the virus can do when left virtually unchecked.

The nursing home accounts for more than half of the covid-19 deaths in the county. 19 residents in the 87-bed facility are now confirmed to have died of covid-19, including Wanda Parker. An audit of the facility began the day after Parker died. This audit supported her son’s claims that management had barred staff from wearing PPE. In fact, the report detailed one instance where a former employee had her mask forcibly removed by the director of nursing under the pretense that it was scaring patients.

A Grim Pattern

While Dennis Williams and his family’s experience is certainly troubling, the problems they encountered are not limited to Lapeer Nursing Home. They aren’t even limited to the United States.

Around the world, frontline healthcare workers are reporting difficulties accessing proper PPE. Some industry analysts are concerned that would-be care home nurses are switching career paths in response to the alarming reports about working conditions. Marymount University is one of many universities that enables aspiring nurses to study online. During a pandemic, courses like these are appealing for people who don’t feel safe on a university campus. But this is of scant consolation to training nurses if they are expecting to enter a dangerous workplace.

Exact figures are hard to come by. However, there are now several studies that suggest 30-60% of all covid-19 deaths in the US have occurred in care homes. More recent studies point to the higher figures being correct.

The picture is not much better internationally. After Spain’s first wave of infections began to survive, harrowing reports started to emerge of care homes abandoned, and residents left to die. In the UK, an ongoing row over the supply of testing kits to care homes and the discharge of vulnerable patients to care homes not equipped for them has damaged public confidence in the government’s handling of the virus. 

Will It Stop?

Dennis Williams is hopeful but realistic about the chances of his lawsuit leading to lasting change. His family’s lawsuit is one of many that are now making their way through the courts.

The United States, like most of the world, had plenty of warning that a pandemic was incoming. We have also known since the very beginning that care homes were an area of concern. Numerous public health experts, doctors, and human rights campaigners sounded the alarm over care homes before the virus arrived in their respective countries. Unfortunately, this means nothing if governments aren’t going to take action.

Routine testing of nursing home residents and staff would help considerably. Unfortunately, many care homes are hesitant to institute such testing because of staffing issues. Some facilities simply won’t be able to operate if even a few members of staff have to take time off to self-isolate.

To the credit of Gretchen Whitmer, governor of Michigan, she issued an executive order that restricted care home visitation rights as soon as the first cases were detected. However, like many measures that states have taken to combat the pandemic, the order’s effectiveness was hampered by a lack of federal coordination. Had the federal government ensured that ample PPE supplies made their way to care homes like Lapeer Nursing Home, residents like Wanda would have been protected.

Instead, because no additional PPE ever showed up, families were still unable to visit their loved ones, even though unprotected care home staff were moving between patients all day. What should have been a difficult but necessary public health measure would ultimately only add to the grief that Daniel Williams and others felt watching helplessly as their loved ones succumbed to covid-19.

The story is not about the failure of one individual care home. As I have noted, the inability to protect elderly and vulnerable care home residents from coronavirus has been a global failing, one that is inexcusable for any advanced health care system. But there is no denying that things did not have to be this bad in the United States. It should not be down to people like Daniel Williams to watch their relative die and then sue the facilities responsible to compel them to do what they should have been doing anyway.

Without serious efforts to get PPE to the people and places where it is most needed, it seems inevitable that there will be plenty more people like Wanda Parker. People who died needlessly because their caregivers cannot protect themselves from coronavirus. We need a federally coordinated response to the pandemic. Anything else will fall short.