Congregate Housing — A Pandemic Perfect Storm

7 min readApr 17, 2020

Pandemic Diary Day 24

April 17, 2020

My 94 year old mother is safe and secure in her own home. She is graced with good health, her sister however, my dear aunt, is in a nursing home.

We are all aware of how this virus is affecting the elderly, and yet, there are no statistics on congregate care facilities. These facilities are not just nursing homes, think Veterans homes, group homes, and residential treatment facilities.

I will be forever haunted by the pictures of families sitting outside windows and holding up signs for their loved ones inside these care facilities, and the heart wrenching stories of people dying within them alone.

What started me down this path was reading the horror story of the sub-par nursing home in New Jersey that was stacking bodies in a shed. Unconsionable and horrifying! Despite the New Jersey facility being rated very low I have a feeling it is likely emblematic of more to come. Oklahoma, and other states are experiencing large amounts of deaths in their Veteran’s Homes. According to Health Secretary Dr. Rachel Levine half of all the coronavirus deaths in Pennsylvania have occurred in long-term care facilities. 72% of deaths in Long Beach, California are in long-term care facilities. In San Francisco, where our death toll has remained fairly low our two congegrate care facilities, Multi-Service Center South and Laguna Honda Hospital account for 12% of the known cases in the city.

Coronavirus broke out in a nursing home in Kirkland, Washington, in late February, killing at least 35 people, this should have set off alarms, and yet, we seem to treat old people as not worth our energy to test and isolate.

While the congregate care facility population is only 0.4 percent of our overall population, their death rate is 22.5% of America’s virus fatalities thus far.

In California we are faring a little bit better, but not all that much. At the behest of local hospitals the California Department of Public Health ordered skilled nursing facilities to accept residents even if they tested positive for Covid19. A mere two days later they changed the policy and issued this statement “The final determination lies with the local health department,” “Local public health officers have this authority in an emergency.” Advocates for the elderly are asking for separate living spaces, such as empty hotels, for congregate care residents with the virus, a prudent request.

On the plus side you have Governor Gretchen Whitmer of Michigan requiring that congregate facilities report all presumed positive COVID-19 cases to the state health department and keep up-to-date information on available personal protective equipment, the first state to do so. More importantly
the edict also provides that employees who test positive or have symptoms of the virus should stay home — and not be fired, disciplined or retaliated against by their employer. I thank those in power that put humanity first.

Like everything in a crisis, money is an important factor.

Nursing home income comes from two sources, First are patients that go in for rehabilitation, usually in the form of physical therapy, these account for only 13 percent of those occupying a ‘bed’ but they are the most lucrative. Medicare pays for these visits and they pay more than it costs the facility to provide.

The second larger, and less profitable, group is residents there for the long term, or basically, the rest of their lives. The majority of these patients pay through Medicaid and in these cases most homes are losing money. As the first type of patient is being turned away due to Shelter in Place, congregate care facilities are hemorrhaging money. No organization can continue to provide quality care when this is happening. The rapid spread of the virus through these types of facilities is also causing the low paid employees that work in these institutions to get sick, unable to come to work, exacerbating the situation even more.

If you would like to go on a deep dive into Nursing Home finances I suggest you begin with this article.

All deaths are tragic, and since the elderly in the United States are often treated as disposable, the lack of focus on this population group by our government does not surprise me, but I am horribly saddened none-the-less.

The loss of family histories, the loss of matriarchs and patriarchs is just a small part of this, the inability for our government to get its act together regarding testing and isolating is criminal in this case.

I am eternally grateful that my mother is sheltered in place in her own home, but I truly worry about the rest of our elderly population, our veterans and others trapped by their circumstances, often beyond their control, in a living hell.

This really is more about how we do not value our elderly in the United States, unless of course they are our own grandmother and grandfather. Face it, America is a youth driven culture.

Asian countries respect and honor their elderly, African tribal societies view their elderly as wise with their life experiences and knowledge revered. And yet, we are structured to ignore and undervalue our elders, whether they be sage or village idiot.

There are a lot of reasons for Americans attitudes. Start with World War II and its creation of job mobility breaking up large extended families. Take the movies from the 1950s that featured and nursed the concept of youth with teen heroes like James Dean and then there were the 60s and never trust anyone over 30. Some place along the line our elderly were no longer useful, and often just considered a drain on the family’s finances.

Ironically much of that is based on misconception. Americans over the age of fifty own 75 percent of all American assets and spend a considerable amount of money in their community. Seventy percent of this population owns their own home. Seniors vote and are active in the community to a greater extent than young people. And for those not in care facilities you will find seniors in your gym, on your tennis court and on a mountain bike hoping to stave off that possible move.

To emphasize that last point, some of this, I believe is a simple failure of the moral compass of this country. We tend to place an extremely high value on people that earn money. Sadly, once their earning potential days have passed, that person is simply worthless. Our society, should, but it absolutely does not, protect the vulnerable.

What kind of country do we live in where the lieutenant governor of Texas, sixty-nine year old Dan Patrick, thinks that those over 70 should put the economy of our country first by ending shelter in place, and telling seniors to sacrifice themselves for the economic future of their grandchildren. While it sounds noble, I am sure the wisdom and lore those same grandparents pass on is something no grandchild wants to loose for the sake of some corporate bigwigs stock valuation.

I would rather think that many of us follow what Harvard political philosopher Michael Sandel has pointed out “The common good is about how we live together in community. It’s about the ethical ideals we strive for together, the benefits and burdens we share, the sacrifices we make for one another. It’s about the lessons we learn from one another about how to live a good and decent life.”

Or Russell Moore, the president of the Ethics and Religious Liberty Commission of the Southern Baptist Convention who said in the New York Times, “I hope the lessons we take from our country’s experience with Covid-19 aren’t about food or avoiding the spread of germs,” …“but about how we treat the most vulnerable among us. A pandemic is no time to turn our eyes away from the sanctity of human life.”

I am an agnostic, but this still resonates: “Discard me not in my old age; as my strength fails, do not abandon me” (Psalm 71).

We are sheltering in place to keep our hospital systems from being overwhelmed, and of course many of those being admitted to the hospitals are elderly. Stop sheltering in place, create a second wave of infection, and it is highly possible that as the hospitals are overwhelmed again the elderly will be triaged right into the morgue.

Where is our compassion? Where is the oversight? Will we learn anything from this?

Trivial Things

My Horoscope for today: Mercury sextile Venus means that certain parties will be dropping hints that are meant to be picked up. Don’t keep them waiting or opportunity will pass you by.

The NYT Crossword Puzzle: Once I got started it went rather quickly, but getting a foothold was not easy.

San Francisco weather: 56 degrees and cloudy

NYSE DOW opened at: 23817

Italian word of the day: esistenza (being)

Spanish word of the day: desechable (disposable)

OED word of the day: brightshine

Days under Shelter In Place: 35

Reading: The Private Papers of Henry Ryecroft by George Gissing

Reading Canto XXV of Dante’s Inferno

My Black and White Picture of the Day