The larger facilities would have a better ability to truly isolate the infected from the non-infected in quarantine halls or wings. They would also have a greater number of staff - some assigned to the non-infected units, some assigned to the infected units.

At the same time, there are quality of life issues at stake. We are talking about the long term isolation of the elderly from their family members and the rest of society until (and really even IF) a vaccine becomes available which might not happen.

I personally favor the approach of isolating the symptomatic sick people but allowing the folks without symptoms engage in group activities and, yes, even have (asymptomatic) visitors again. Life is too short and tomorrow is not guaranteed.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Most of these facilities are managing the care of their very vulnerable residents with as much caution as possible. But there is no way for these care facilities to completely keep COVID-19 away from their residents.

The healthcare workers do their best to exercise caution, but with their residents coming back and forth from other medical facilities, being transferred in from lower care situations a virus can get introduced into the facility pretty easy. Add in the fact, that many of the residents have dementia and aren't always behaving in a rational, reasoned way towards the staff and other residents - that really complicates the situation.

Even in a home environment, the residents are vulnerable to becoming infected because their caregivers are in/out of the house and the person is at risk of infection every time they are taken to a medical facility to see a doctor.

My friend works in an admin capacity at a home health agency and a lot of staff are calling in sick because of exposure or illness. They're seeing multiple people a week, plus some have other jobs.

Even if you can afford a live-in, you have to give that person days off, so you have to hire backup help for those times, usually. The backup help usually rotates between many homes.

A live in caregiver can also quit at any time or die. In fact, often patients are sent to LTCs after a home caregiver gets too ill to provide care or dies.

A lot of patients also end up in LTC facilities because the home caregiver(s) aren't able to handle the patient anymore safely at home. Particularly true with dementia or Alzheimer's patients.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
It makes sense.

First, Older people are more likely to die from this disease. So age seems like a strong reason for the deaths in nursing homes.

Additionally, it is difficult to practice any form of social distancing in a huge facility where nurses, cleaners, caretakers, cooks are constantly interacting with several people at the time. Additionally, a lot of employees in nursing homes pick up extra work at different facilities.

I think people will move towards finding much smaller facilities for their elderly loved ones.

+1 I think small facilities will become much more popular among those who can afford it (small facilities often do not have Medicaid beds).

Home care might become more popular, too, but it sometimes isn't an option. Even if you can afford aides, some people cannot safely be cared for in a home setting or by one aide/adult. Particularly true for dementia patients and people who have certain medical conditions where care can't easily be provided in a home setting (needs dialysis and isn't a candidate for home dialysis or needs certain therapies, for example).

Small facilities also often only have beds for long term care for versus the big facilities often have beds for rehabilitation purposes and short term care so they have a LOT more people being admitted and leaving.

Good point. Less staff, more new patients coming in and out means a greater risk of contamination.

There are some small facilities in my hometown (my neighbor's mother is at one, I visited and it was nice). I know they don't take Medicaid, they don't take any rehabilitation patients, and they don't take dementia patients with certain symptoms (wandering, violence) because they have no locked memory care unit. So they're able to do a lot more infection control measures. But they also charge a LOT more than the big facility in town which takes Medicaid.

Anonymous wrote:

Anonymous wrote:Most of these facilities are managing the care of their very vulnerable residents with as much caution as possible. But there is no way for these care facilities to completely keep COVID-19 away from their residents.

The healthcare workers do their best to exercise caution, but with their residents coming back and forth from other medical facilities, being transferred in from lower care situations a virus can get introduced into the facility pretty easy. Add in the fact, that many of the residents have dementia and aren't always behaving in a rational, reasoned way towards the staff and other residents - that really complicates the situation.

Even in a home environment, the residents are vulnerable to becoming infected because their caregivers are in/out of the house and the person is at risk of infection every time they are taken to a medical facility to see a doctor.

My friend works in an admin capacity at a home health agency and a lot of staff are calling in sick because of exposure or illness. They're seeing multiple people a week, plus some have other jobs.

Even if you can afford a live-in, you have to give that person days off, so you have to hire backup help for those times, usually. The backup help usually rotates between many homes.

A live in caregiver can also quit at any time or die. In fact, often patients are sent to LTCs after a home caregiver gets too ill to provide care or dies.

Anonymous wrote:

Anonymous wrote:

If the major cause of spread and fatalities have been identified, what makes more sense? Shut society down and send out unemployment checks to millions? Or use a fraction of those funds to provide long term care facilities with proper PPE and rapid tests to quickly identify and contain new outbreaks?

I'm not trying to sacrifice Grandma, I'm saying maybe we should focus on the door to Grandma's house and not Grandma's entire state to protect her.

Yes, I've been saying this over and over! (And I help care for two elderly parents.) Social distancing does next to nothing to actually help the elderly.

In fact I'd sharpen it to:

I'm saying maybe we should focus on directing resources to the door to Grandma's house and not diverting resources to Grandma's entire state to protect her.

If even a fraction of the $$$ spent on stimulus checks and unemployment had been used for training, PPE, testing and hazard pay for nursing/ elderly care workers, (plus delivery services reserved for the medically vulnerable) that would have actually reduced deaths.

Most things that go to grandma's door are because grandma or someone is private paying. Most of the nursing homes struggling are medicaid beds and they are choosing not to buy what they need justifying it as medicaid doesn't pay well, when they do. We used to hear that all the time and we knew the pay rate and would call them out when they'd say it as they refused to show us what they billed to medicaid. Lots of medicaid fraud.

But as everyone says, this whole pandemic points to our need for universal healthcare, right? People: it's just the opposite. What PP describes is what happens when healthcare is reliant on government.

Anonymous wrote:Most of these facilities are managing the care of their very vulnerable residents with as much caution as possible. But there is no way for these care facilities to completely keep COVID-19 away from their residents.

The healthcare workers do their best to exercise caution, but with their residents coming back and forth from other medical facilities, being transferred in from lower care situations a virus can get introduced into the facility pretty easy. Add in the fact, that many of the residents have dementia and aren't always behaving in a rational, reasoned way towards the staff and other residents - that really complicates the situation.

Even in a home environment, the residents are vulnerable to becoming infected because their caregivers are in/out of the house and the person is at risk of infection every time they are taken to a medical facility to see a doctor.

My friend works in an admin capacity at a home health agency and a lot of staff are calling in sick because of exposure or illness. They're seeing multiple people a week, plus some have other jobs.

Even if you can afford a live-in, you have to give that person days off, so you have to hire backup help for those times, usually. The backup help usually rotates between many homes.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
It makes sense.

First, Older people are more likely to die from this disease. So age seems like a strong reason for the deaths in nursing homes.

Additionally, it is difficult to practice any form of social distancing in a huge facility where nurses, cleaners, caretakers, cooks are constantly interacting with several people at the time. Additionally, a lot of employees in nursing homes pick up extra work at different facilities.

I think people will move towards finding much smaller facilities for their elderly loved ones.

+1 I think small facilities will become much more popular among those who can afford it (small facilities often do not have Medicaid beds).

Home care might become more popular, too, but it sometimes isn't an option. Even if you can afford aides, some people cannot safely be cared for in a home setting or by one aide/adult. Particularly true for dementia patients and people who have certain medical conditions where care can't easily be provided in a home setting (needs dialysis and isn't a candidate for home dialysis or needs certain therapies, for example).

Small facilities also often only have beds for long term care for versus the big facilities often have beds for rehabilitation purposes and short term care so they have a LOT more people being admitted and leaving.

Good point. Less staff, more new patients coming in and out means a greater risk of contamination.

Anonymous wrote:

Anonymous wrote:
It makes sense.

First, Older people are more likely to die from this disease. So age seems like a strong reason for the deaths in nursing homes.

Additionally, it is difficult to practice any form of social distancing in a huge facility where nurses, cleaners, caretakers, cooks are constantly interacting with several people at the time. Additionally, a lot of employees in nursing homes pick up extra work at different facilities.

I think people will move towards finding much smaller facilities for their elderly loved ones.

+1 I think small facilities will become much more popular among those who can afford it (small facilities often do not have Medicaid beds).

Home care might become more popular, too, but it sometimes isn't an option. Even if you can afford aides, some people cannot safely be cared for in a home setting or by one aide/adult. Particularly true for dementia patients and people who have certain medical conditions where care can't easily be provided in a home setting (needs dialysis and isn't a candidate for home dialysis or needs certain therapies, for example).

Home care would be a nightmare right now. Can you imagine what it would be like to not have health care aids show up or what it would be like trying to deal with a frail patient whose regular physician has either reduced their office hours or has limited availability via Teledoc?

It is hard enough to provide home care during the BEST of times. Now just trying to find a facility that is taking new residents would be a nightmare.

Anonymous wrote:

Anonymous wrote:
It makes sense.

First, Older people are more likely to die from this disease. So age seems like a strong reason for the deaths in nursing homes.

Additionally, it is difficult to practice any form of social distancing in a huge facility where nurses, cleaners, caretakers, cooks are constantly interacting with several people at the time. Additionally, a lot of employees in nursing homes pick up extra work at different facilities.

I think people will move towards finding much smaller facilities for their elderly loved ones.

+1 I think small facilities will become much more popular among those who can afford it (small facilities often do not have Medicaid beds).

Home care might become more popular, too, but it sometimes isn't an option. Even if you can afford aides, some people cannot safely be cared for in a home setting or by one aide/adult. Particularly true for dementia patients and people who have certain medical conditions where care can't easily be provided in a home setting (needs dialysis and isn't a candidate for home dialysis or needs certain therapies, for example).

Small facilities also often only have beds for long term care for versus the big facilities often have beds for rehabilitation purposes and short term care so they have a LOT more people being admitted and leaving.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Blowing up the global economy (which will cause horrible deaths of starvation, etc by children) to save the elderly is a huge mistake.

It is also misguided and terribly ineffective. There is no way to contain this virus.

Right. As a society we need to decide what the most important public health goal (or small subset of goals) is. Is it simply to flatten the curve? Or to protect the elderly until there is a vaccine? Because the best approach to one is not necessarily the same for the other.

Anonymous wrote:
It makes sense.

First, Older people are more likely to die from this disease. So age seems like a strong reason for the deaths in nursing homes.

Additionally, it is difficult to practice any form of social distancing in a huge facility where nurses, cleaners, caretakers, cooks are constantly interacting with several people at the time. Additionally, a lot of employees in nursing homes pick up extra work at different facilities.

I think people will move towards finding much smaller facilities for their elderly loved ones.

+1 I think small facilities will become much more popular among those who can afford it (small facilities often do not have Medicaid beds).

Home care might become more popular, too, but it sometimes isn't an option. Even if you can afford aides, some people cannot safely be cared for in a home setting or by one aide/adult. Particularly true for dementia patients and people who have certain medical conditions where care can't easily be provided in a home setting (needs dialysis and isn't a candidate for home dialysis or needs certain therapies, for example).

China will pay for this.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Blowing up the global economy (which will cause horrible deaths of starvation, etc by children) to save the elderly is a huge mistake.

It is also misguided and terribly ineffective. There is no way to contain this virus.

It is possible. We just have to want to do it.

Do we value life?

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

Can you please look at data before you shout.

As of 4/28 of the 929 MD confirmed deaths, less than 100 were under the age of 60. 139 were between 60 and 69. The rest were over 70 so approx 74% are over 70. Source MD site.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I love this... 50% are old people... guess who the other 50% are... NOT OLD PEOPLE. FFS!

No. The Op said that 50% of the deaths are in nursing home residents. Even young people can be in nursing homes, btw.

The other 50% of deaths are outside of nursing homes. And most of those deaths are still among the elderly population.

Blowing up the global economy (which will cause horrible deaths of starvation, etc by children) to save the elderly is a huge mistake.

It is also misguided and terribly ineffective. There is no way to contain this virus.

Nailed it.