Yes, that’s exactly what has happened here in the “Hot Zone” of the Seattle area.  The epicenter of the novel coronavirus epidemic in the US is a long-term-care facility in Kirkland, Washington, with the ironic-seeming name of Life Care Center of Kirkland.  It is thought that a patient had a family visitor early this year (exact date unknown), who had been to the Wuhan area of China recently.  That visitor left, and returned to the East Coast, possible seeding that area with the virus also.  That visitor infected a staff member at the center.

Not knowing that she was infected, the staff member went about her duties at the center, coming into contact with multiple patients, and when she became ill, continued to work at the center instead of staying home and taking care of herself.  The Federal investigators who were called in to sleuth out the reason for all the patients who became ill, found out that the highly-contagious respiratory illness was basically spread all over the Life Care Center by ill employees.

And then, those same ill employees left for their second jobs at other area LTC facilities, taking the disease with them.  Nursing-home aides are some of the lowest-paid healthcare workers, and many of them need multiple jobs in order to pay the bills.  And, in order not to lose pay and benefits, they go to work sick.  Here’s where the tradeoffs happen.  Nursing-home aides usually have very little education or training-a course can take as little as three months.  Nursing-home owners have incentive to pay their employees as little as possible, as most patients’ bills are paid by Medicare or Medicaid, which have fairly low reimbursement rates.

The average nursing-home resident is aged, frail, infirm, and vulnerable.  They are very susceptible to any kind of bug that happens to be around as a general rule.  With not enough available staff to meet everyone’s 24/7 needs, patients are sometimes neglected; infection-control rules honored mostly in the breach, and this can lead to the spread of disease within the institutional population.  Then, when underpaid nurses and other staff move among multiple nursing homes, disaster can follow.  Edit on 3-22: RushBabe links to this story, to back up my information above.

That is what is happening now in Washington State.  Deaths are over 70, and the majority of those deaths are occurring in nursing-home residents.  Tradeoffs…  If you pay your staff more, enabling them to give up that second job, you can train them better in infection-control techniques (which start with simple hand-washing), and you will have healthier residents, decreasing the need for medications.  But…your costs increase commensurately, and you have to raise your rates to whatever private-pay patients you have, since Medicare and Medicaid pay fixed rates.  The nursing-home owner is now caught in the cost-trap.

More tradeoffs…  If you are a low-paid healthcare worker, you are trained to take care of yourself, so you can take care of your patients.  You are taught infection-control and avoidance, but hand-washing and disinfecting take time, and your patient is moaning for you.  Your salary is too low to pay all your bills, so you take a second job.  And when you get up in the morning feeling under the weather, with the sniffles, you realize that, if you do the right thing and call in sick, you lose a day’s pay, putting your finances in peril.  So you go to work anyway, and put your patients in peril.  What to do?

Indeed, what to do?  I don’t have any answers.  Better training all around would help keep nursing-home residents healthier.  Nursing homes have been known forever to be substandard when it comes to cleanliness, staffing, and medication-handling.  Perhaps more use of volunteer cleaners could enable staff to concentrate more on residents.  In any case, this coronavirus epidemic has shone a big spotlight on the long-term-care industry, and perhaps new answers will be found.