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Nursing Homes

Tom Cassidy with his late father, Hugh 'Joe' Cassidy. Photo by Jonathan Spier

By Thomas M. Cassidy

Thomas M. Cassidy

Artificial Intelligence (AI) will cost many people their jobs. But some occupations desperately needed by a rapidly aging population cannot be replaced by computers or machines. For example, nurse assistants in hospitals and nursing homes.

Research conducted by Goldman Sachs estimates that 25% of current work tasks could be automated by Artificial Intelligence (AI). Unlike prior technological advances that replaced workers in labor intensive occupations, this time “it’s the higher-paying jobs where a college education and analytical skills can be a plus that have a high level of exposure to AI,” according to The Pew Research Center.

During my twenty-year career as an investigator for the New York State Attorney General’s Office, I conducted many investigations of potential patient abuse in nursing homes and other health facilities. I had the privilege of meeting hundreds of nursing assistants. Most were dedicated, knowledgeable and compassionate, but a few were not. Nursing aides dress, bathe, toilet and ambulate patients among many other services. Sometimes they also interact with families, which can be a difficult task. Let me explain:

I was assigned to investigate a possible case of patient abuse at a nursing home. An elderly woman with a doctor’s order for a two-person transfer was helped from her bed for a bathroom trip by only one nurse aide. The elderly woman fell and fractured her hip. The nursing assistant was immediately suspended pending an investigation. My assignment was to investigate this incident as a possible crime. Here’s what happened:

The nursing home patient had a visit from her daughter. Mom told her daughter to help her get out of bed and walk her to the bathroom. The daughter obeyed and helped mom get out of bed. The daughter tried to hold her up, but mom was weak and started to slip. The daughter screamed for help. A nursing assistant rushed to help the falling patient, but it was too late. Mom fell and fractured her hip. There was no crime. The nursing assistant returned to work the next day.

Fast forward twenty years. My father, a World War II combat veteran and a decorated NYPD Detective Commander, fractured his hip at age 80. I visited him at the Long Island State Veterans Nursing Home in Stony Brook. He was alone in his room. He says, “Tom, help me get to the bathroom.” I say, “Dad, let me get an aide to help you.” He says, “YOUR MY SON, just do this for me. I don’t want anyone else to help.” I told him about the elderly woman who fractured her hip when her daughter tried to help her. He said, okay, go get someone to help. If not for my experience as an investigator, I might have tried to help my father. I was taught “To Honor Thy Father and Thy Mother.” But instead, two aides moved my dad safely to the bathroom and back into his bed. Nine months later he walked out of the nursing home to live at home with my mother. 

Not every resident of a nursing home is elderly, but most are. In the United States today, one in every six Americans is age 65 or older. That number will increase dramatically in the next six years to 20% of the population or 70 million older Americans. Incredibly, nursing homes are closing, instead of opening. 

The American Health Care Association reports that since 2020 almost 600 nursing homes have closed, and more than half of nursing homes limit new admissions due to staffing shortages. As a result, there is a shortfall of hospital beds nationwide because displaced nursing home patients remain in hospital beds until they can be safely transferred home or to a care facility.

The Massachusetts Hospital Association reports that one out of every seven medical-surgical beds are unavailable due to patients remaining in the hospital when they no longer need hospital care. Keep in mind that hospitals are required by federal law to provide emergency care, stabilize patients, and discharge patients to a safe environment.

The Bureau of Labor Statistics reports that nursing assistants have one of the highest rates of injuries and illnesses because they frequently move patients and perform other physically demanding tasks. For these, and many other tasks, nurse assistants are paid a median wage of less than $18 per hour; not even close to a salary that is in line with the responsibilities of their job. Small wonder that a survey by the American Health Care Association found that one of the biggest obstacles for hiring new staff in nursing homes is a lack of interested candidates.

Reversing the hemorrhage of nursing home closures requires leaders with Natural Intelligence (NI). It benefits all generations of Americans when hospitals fulfill their mission for acute care and not operate as quasi-nursing homes. After all, languishing in a crowded emergency room “Can Be Hazardous To Your Health!”

Thomas M. Cassidy is the creator of the TV series, Manhattan South, which is in development. (ktpgproductions.com)

Nursing homes have become a hotbed of discussion over the large percentage of their residents who have died from COVID-19 while in New York facilities. Stock photo

When the initial COVID-19 surge occurred in New York State, nursing homes were the site of rampant infections and deaths. According to a New York State Department of Health report released earlier this week, the infection was spread by community transmission and asymptomatic staff members. 

The agency aimed to study the impact of the state’s March directive that nursing homes could not refuse admission or readmission to patients because of a confirmed or suspected coronavirus infection. The directive was meant to free up space in overcrowded hospitals as the pandemic intensified.

The number of nursing home staff reporting COVID-19 symptoms peaked March 16, 23 days prior to the peak of nursing home fatalities, which occurred April 8. 

“It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection,” the report states. 

Critics of the directive argue that it allowed infected patients to return or come into these facilities and in turn spread the virus to other individuals. The findings of the study show 

37,500 workers — one in four of 158,000 nursing home workers — were infected with COVID-19 between March and early June. 

A number of elected officials took issue with the guidance given to nursing homes by the state. U.S. Rep. Lee Zeldin (R-NY1) disputed claims that the state was simply following the federal government’s guidance. He said the U.S. Centers for Medicare and Medicaid Services, the federal regulator for nursing homes, had previously issued guidance stating that not only should nursing homes only accept patients for which they can care for, but that nursing homes should focus on “prompt detection, triage and isolation of potentially infectious residents.” 

Zeldin also called on the U.S. Department of Health and Human Services and CMS to launch an investigation into New York State’s adherence to appropriate health and safety guidelines within nursing homes and long-term care facilities.

In a statement following the release of the NYSDOH report, Zeldin reiterated his stance. 

“An internal review by the State of New York is OK for them to initiate, but this is not a situation where the state is going to be able to objectively investigate itself,” he said. “These facilities should not have been required to accept patients who were diagnosed at the time with coronavirus, especially if they did not have the ability to protect the rest of their vulnerable population. It was also a fatal policy to prevent nursing homes from administering coronavirus tests to patients returning from hospitalization. Our seniors and their families deserve answers, and an independent investigation is clearly necessary.”

A statewide nursing home survey conducted by NYSDOH shows that between March 25 and May 8, a total of 6,326 COVID-19 hospital patients were admitted into 310 nursing homes. Of those facilities 252 already had either confirmed or suspected positive patients, confirmed or presumed fatalities or infected workers, prior to admission of someone with the coronavirus. 

Stephen Hanse, president and CEO of the New York State Health Facilities Association said at the onset of the pandemic, nursing homes and assisted living facilities were not the top priority. Bolstering hospital resources and ramping up hospital bed capacity were. 

“Policymakers now know that the men and women residing in nursing homes and assisted living facilities are the most at risk of infection from the COVID-19 virus,” Hanse said in a statement. “Consequently, it is essential that nursing homes and assisted living providers receive the full support and assistance from elected officials and policymakers to ensure they have the necessary resources to defeat this virus and safeguard their residents and staff.”

Signs outside the Long Island State Veterans Home in Stony Brook share thanks to the people working inside the vets home. Seven veterans have died as of April 8 due to complications caused by COVID-19. Photo by Kyle Barr

By Kyle Barr, Leah Chiappino and David Luces

For the elders along the North Shore, those living in communities and places built for people living out their late or twilight years, the coronavirus has sewn both devastation and concern. State data now shows that the virus has made a huge impact on nursing homes, more so in Suffolk than most other New York counties.

Signs outside the Long Island State Veterans Home in Stony Brook share thanks to the people working inside the vets home. Seven veterans have died as of April 8 due to complications caused by COVID-19. Photo by Kyle Barr

Data from New York State as of April 12 showed close to 20 percent of all deaths from COVID-19 came from nursing homes or other adult care facilities — 1,979 of a total of just over 10,000. An additional 459 deaths have come from adult care facilities.

Suffolk County has seen 141 deaths from people in nursing homes and 95 from those living in assisted living places. That is out of the 568 who had perished from the disease as of Monday. The latest number of deaths, as of press time Wednesday, April 15, was 653.

It’s a staggering number that displays Suffolk has a higher percentage of elder deaths compared to surrounding counties, such as Nassau which has a total of 261 fatalities out of 910 as of Monday.

This is also considering in late March, New York officials mandated nursing homes must accept stable or recently discharged-COVID-19 cases into their facilities, partially as an effort to not overload the health system and give these elders places to live when many have nowhere else to go.

Suffolk County Executive Steve Bellone (D) said they had no clear information on why nearly half of all COVID-19 deaths were related to nursing homes or adult care facilities. County officials have said, upon analysis, these homes have implemented all state and county rules correctly.

The county executive added that upon review, the virus was shown to have been inside Suffolk before testing became ubiquitous and before all the calls for social distancing were in place. 

“If the virus was here, and people are going into nursing homes, workers coming in and out — you put those two things together and you’re going to have the kind of numbers that you see here,” he said. “It’s tragic and it’s devastating. This is one of those things why testing early on was important and could have helped to save lives.”

Gov. Andrew Cuomo (D) also said he was concerned with the numbers released about nursing homes.

The Long Island State Veterans Home released a letter April 8 saying that, at that time, seven veterans have died due to the coronavirus as a comorbidity. Forty vets had tested positive for coronavirus, where 35 were still living in the home and another five were being treated at Stony Brook hospital. Fourteen employees also tested positive for the virus and were recuperating at home.

“Each of these veterans answered the call to serve our great nation with honor and dignity to protect the freedoms we all enjoy today as Americans,” the letter read. “Our staff is grieving the loss of these beloved members of the LISVH community.”

Peconic Landing, a nursing home in Riverhead, has already reported nine deaths as well.

Leisure Glen in Ridge, a 55-and-older gated community, have stopped virtually all community activities during the ongoing pandemic. The housing market has also drastically slowed in the community. Photo from Google maps

After numbers related to elder deaths during the pandemic were released, the AARP put out a release detailing questions people should put to nursing homes during the pandemic, including if the home is at full staff, and how many people have tested positive for COVID-19.

“New Yorkers need to communicate with their loved ones in nursing homes on a regular basis and to be aware if the virus is present in the facility.” said AARP New York State Director Beth Finkel in the release.

With so many nursing homes locked down during the pandemic, many were not willing to share much about the numbers of people in their facility, either staff or residents, who had become sick. Still, both Bristal Assisted Living, with locations around Long Island, and the 55+ community Vistas at Port Jefferson are offering virtual tours during the pandemic.

A representative from the Smithtown Center For Rehabilitation and Nursing Care said they have barred visitors since March 9, in compliance with state guidelines. In order to keep families connected, the facility sends out email blasts and has social workers and nursing staff call family members for updates. According to itswebsite, they are also scheduling times for residents to video chat with loved ones. 

It’s not only the nursing homes that are struggling. For communities who mainly house older residents, the virus has been just as disruptive, perhaps even more so than an average neighborhood.

The 646 homes in Leisure Glen, a 55-and-older gated community in Ridge, have also felt the pressure of the ongoing pandemic. Ed Marczak, the homeowner association president at Leisure Glen, said they have been complying with guidelines on social distancing and have cancelled all community events and activities, along with the clubhouse.

“My wife and I haven’t had much contact with neighbors or others,” Marczak said. “If it’s nice out we’ll see some people out, but everybody is trying to be 6 feet apart.”

The real estate sector of the community has also slowed down, with those in the middle of closing or selling homes now having to hold off until an unknown date arrives.

Laura Ruhnke, lead broker at Leisure Living Realty, said before the pandemic, they were experiencing a strong market, but not anymore. Virtual home tours are an option for the group,but it could be tricky as some clients may not be as tech savvy. 

”Business has drastically slowed down since the outbreak,” she said.