What makes nursing homes a virus hotbed

Residents of nursing homes or similar facilities account for at least one-quarter of US deaths from Covid-19. The true figure might be a lot higher. The coronavirus has spread to nearly 7,000 nursing homes in all 50 states. In at least seven — Delaware, Maine, Massachusetts, Oregon, Pennsylvania, Rhode Island and West Virginia — more than half of all Covid-19 deaths took place in long-term-care facilities. No part of the country has been spared.
The coronavirus has hit nursing homes hard for several reasons. Older people are more susceptible to Covid-19; viruses spread quickly in crowded, closed environments; and, importantly, many facilities still lack tests and personal protective equipment for their employees. But one factor has received too little attention: Low-paid care workers often take jobs at multiple facilities to make ends meet — and can then spread the virus from one to another. That probably happened in Washington state, where evidence suggests employees of the hard-hit Life Care Center nursing home introduced the coronavirus to two other facilities where they also worked. In Wisconsin, a hospice worker who shuttled among at least three facilities was identified as a likely vector for coronavirus. Although it’s difficult to tell just how many cases have been spread in this manner, the Centers for Disease Control and Prevention has identified it as a risk. Health officials and others are sounding the alarm in Arizona, California, Connecticut, Maine, Maryland, Tennessee, Texas and beyond. One recent analysis of nursing homes in the Northeast found that 1 in 6 care workers hold second or third jobs.
It’s easy to see why. Nursing assistants, for example, earn about $13 per hour — a figure that’s barely budged over the past decade. They are the backbone of any functioning nursing home, making up nearly 40% of all staff, yet many struggle to stay out of poverty. One in 3 nursing assistants receives federal benefits; 1 in 4 receives food stamps. Some 40% have no employer-provided health insurance, and 15% have no insurance at all. Meager compensation is a main reason long-term-care facilities were notoriously understaffed even before the coronavirus hit. Healthcare workers shouldn’t have to work two jobs to make ends meet.
What can be done? Several Canadian provinces have temporarily banned long-term-care employees from working more than one job at once, and are making up those workers’ lost income. This will curb the spread of the disease more effectively than merely encouraging workers to stick to one facility, as states such as Texas are doing. But it might also worsen staff shortages in nursing homes that are already overstretched. Local and state authorities should think carefully before taking such action. Many nursing homes have started requesting their employees work at only one job; the hazard pay bills winding their way through Congress could help those workers get by. In the longer term, we need to ensure care workers are paid fairly. Some facilities are offering raises and bonuses to front-line workers now, and one imagines that as demand for elder care rises, wages will as well. But Medicaid is the largest funder of long-term-care facilities, and low Medicaid funding can limit what facilities can do.
States should consider raising Medicaid reimbursement rates — with dedicated funds for increasing wages — and the federal government should make sure states have the resources they need. Boosting wages would have the added advantage of attracting more workers to the field, alleviating chronic understaffing and improving quality of care.

—Bloomberg