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The Corporatization of Nursing Homes

Maureen Dittmar of Rochester, New Hampshire, was sifting through junk mail one Saturday in early August when she found an envelope obviously sent by a human being. It began: “The content of this letter may be hard to hear … But you deserve to know the truth.” The anonymous author was a staffer at her mother’s nursing home.

Dittmar’s rush of cortisol was familiar. Every day for months, the virus had engulfed another crop of facilities. Residents are elderly, frail, and housed in close quarters; they are sitting ducks for a pandemic. By mid-September, the nationwide death toll from long-term care facilities had reached more than 77,000 residents and staff, 40 percent of the country’s total. For some reason, New Hampshire had only lost a relatively small number, but Dittmar knew better than to believe everything she was told, or assume they were out of the woods.

There wasn’t an outbreak, though; the letter was about staffing. Genesis HealthCare, the 357-facility nursing home chain that ran the Colonial Hill Center and by late May had already seen about 1,500 of its residents die, had slashed payroll so drastically that on many shifts, the primary unit had one nursing assistant responsible for 39 patients. Supervisors helped out on the floor whenever they could, but the last nursing manager who had gone to bat for them had been fired.

New Hampshire had been lucky to avoid the worst of COVID-19, but the minimum staffing requirements it imposed on nursing homes were the most lenient in the Northeast—and now their residents were paying the price. “It has always been a known rule in any health care facility to NEVER mention to family or residents that we are having staffing issues,” the author warned. “We feel that the current restrictions on in-house visitations from the families is allowing a veil of protection for corporate and management. Families are unable to see the full affects [sic] on their loved ones.”

Roughly 70 percent of the nation’s 15,400 nursing homes are for-profit, and the gross understaffing on display at Colonial Hill is the flip side of extreme profiteering. Hundreds of thousands of nursing home residents survived the bloodbath of 2020, only to spend the summer, no doubt, wishing the virus would come back for them. State health departments suspended Medicare inspections during the pandemic; it has been 18 months since Colonial Hill saw one. So management is no longer even trying to avoid the most conspicuous signs of neglect: filthy clothing, odd facial hair, urine on the floor and in the air.

In many hard-hit homes, dead friends are being replaced with psychiatric referrals from psych wards and homeless shelters; in more selective ones, dementia sufferers are being ejected into psychiatric hospitals. At a facility in Pennsylvania with one certified nursing assistant for every 22 residents, eight assistants teamed up to tell the evening news their patients were going months without a bath. The average resident in one facility in suburban Illinois lost 3.7 pounds between February and April alone, with nearly a quarter losing more than 5 percent of their body weight. The evening news in Minneapolis in late September tells us of a bird-watcher in his eighties with Lewy body dementia whose daughter takes him home after spying him through a window, disheveled and confused and so bottomlessly sad. He has bruises everywhere, an untreated infection has turned his genitalia bright red; he dies quickly.

Amplifying this neglect are the dozens of state laws passed hastily in the spring, granting the entire health care industry immunity from legal liability. “Dehydration, malnutrition, falling, bedsores—they’re saying, ‘Look, we’re not liable for any of that right now because of COVID,’” says Steven Levin, an Illinois trial lawyer who has spent his career suing nursing homes and is working on more than 100 wrongful-death suits right now. These laws comprise the single coherent national policy response to the nursing home bloodbath of spring 2020.

In the absence of an accessible long-term care system for all families, older Americans are callously warehoused in these institutions, which in the crisis have descended into death traps. But for decades before the pandemic, for-profit nursing homes have been robbing seniors of their dignity and their money. And where you find extraction of value and indifference toward horrors inflicted on human beings, you inevitably find a financier’s spreadsheet.