compiled a list of 25 ways that COVID-19 has had an impact on the nation’s nursing homes, by consulting news reports, trade and industry guidelines, scientific studies, and orders issued by state and federal governments.
Elderly and frail long-term care residents are disproportionately falling sick and dying. Many have pre-existing conditions—including as many as two-thirds of people age 70 or older—that make them particularly vulnerable. But too many have fallen needlessly sick, victims of neglect and greed by nursing home operators who have fallen far short in their care and compassion. And too many have died as the result of poor state and federal policy that could have protected them.
At a soldiers’ home in Massachusetts, veterans who survived Omaha Beach on D-Day and fought in Vietnam died by the dozens in the virus’ unrelenting spread. Decisions made by the home’s administration were later described in a government investigation as “utterly baffling,” and two former administrators face a host of criminal charges.
A public health official in Los Angeles County told families their loved ones might be better off at home than in local nursing homes, where more than 120 had infectious outbreaks. A nurse tried to tell the world about the failures and lack of care at the home where she worked, and she ended up dying of the virus herself.
The Centers for Medicare and Medicaid Services, the federal agency that oversees nursing homes, has come under heavy fire for doing too little, too late to protect the residents and staff at the more than 15,600 nursing homes across the country.
More than a quarter of the nation’s COVID-19-related deaths have occurred among residents and staff at long-term care facilities, and in several states, deaths in long-term facilities account for more than half the state’s total fatalities.
Keep reading to discover how COVID-19 has impacted American nursing homes.
Feb. 26 - The first concentrated outbreak of COVID-19 in the United States involved the deaths of two residents of Life Care Center in Kirkland, Washington. On Feb. 28, tests confirmed they had the disease.
March 20 - The Centers for Medicare and Medicaid Services, the federal agency that oversees nursing homes, announced a halt to all state surveys of facilities, to be replaced by targeted infection control surveys. Meanwhile, the federal government waived the requirement that nurse’s aides have 75 hours of training and instead allowed people with eight hours of online study to become caregivers. The industry had long sought a waiver, saying the standards were difficult for recruitment.
March 25 - New York state required nursing homes to accept COVID-19 patients who have been discharged from hospitals. The policy was said to advocate for patients needing care, but nursing homes were soon hit by outbreaks and higher death tolls. On March 31, New York Gov. Andrews Cuomo added a provision to the state’s budget negotiations to shield nursing homes and hospitals from lawsuits that claim they failed to protect patients from COVID-19. The provision is retroactive to March 7.
April 7 - The public health director of Los Angeles County told families to consider removing loved ones from long-term facilities to help protect their health. More than 120 facilities in the county are believed to have outbreaks of coronavirus. The following day, in California’s Riverside County, more than 80 residents were removed from the Magnolia Rehabilitation and Nursing Center when more than a dozen employees missed two consecutive days of work.
April 10 - California Gov. Gavin Newsom ordered the transfer of some healthy nursing home residents to the U.S. Navy hospital ship Mercy at the Port of Los Angeles to avoid exposure to coronavirus at affected facilities. The same day, the state of California sent 600 specialized nurses trained in infectious disease control to nursing homes and adult-care facilities to help with infected residents. The state has more than 1,200 skilled nursing facilities.
April 10 - In Littleton, Massachusetts, a nurse who acted as a whistleblower about conditions at a nursing home died of coronavirus. She had publicly accused the Life Care Center of Nashoba Valley of failing to handle the crisis and failing to be upfront with staff and residents.
April 15 - Michigan Gov. Gretchen Whitmer ordered nursing homes and other long-term care facilities to create separate units for residents with coronavirus or send them to a local facility that has a unit. Any facility that is less than 80% full is required to set up such a unit to help stem the spread.
April 19 - The U.S. Centers for Medicare & Medicaid Services announced a requirement that nursing homes report any COVID-19 cases and deaths to local and state health departments and to the U.S. Centers for Disease Control and Prevention. The regulatory requirements also call for nursing homes to inform residents and family members of COVID-19 cases in the facilities.
April 23 - The Kaiser Family Foundation, a non-profit organization that focuses on national health issues, released a report showing that, based on data from 23 reporting states, 27% of the nation’s COVID-19-related deaths occurred in long-term care facilities among residents and staff. In six states reporting data—Delaware, Massachusetts, Oregon, Pennsylvania, Colorado, and Utah—deaths in long-term care facilities accounted for more than half of the fatalities.
April 29 - Maryland said it would require the testing of all nursing home residents and staff for coronavirus. Officials said it was believed to be the country’s first such state mandate. More than half of the state’s coronavirus-related deaths are connected to skilled-nursing facilities, data shows.
May 10: The New York Department of Health rescinded its March 25 order that required nursing homes to accept aged COVID-19 patients discharged from hospitals. The reversal came after the original order was criticized for contributing to, not alleviating, death tolls. Gov. Andrew Cuomo ordered twice-weekly testing of nursing home and adult care facility staff.
May 18 - The federal Centers for Medicare & Medicaid Services (CMS) issued recommendations on how nursing homes can relax restrictions on visitation. It says the guidance aims to address rigorous infection prevention and control as well as residents’ social engagement and quality of life.
May 22 - The federal Department of Health and Human Services announced the distribution of nearly $4.9 billion in COVID-19 relief funds directed at skilled nursing facilities, the first such specified payment since the pandemic began. It said every skilled nursing facility nationwide would get a minimum of $50,000 and an additional $2,500 per bed. That same day, The Journal of the American Medical Association released a report finding nursing home residents comprise about a quarter of documented COVID-19-related deaths despite accounting for fewer than 0.5% of the U.S. population.
July 14 - The U.S. Department of Health and Human Services announced distribution of rapid diagnostic tests to nursing homes in COVID-19 hot spots for on-site testing of staff and residents. The nasal swab-type tests are the type that can provide results within minutes.
Aug. 1- A study published in The Lancet medical journal says two-thirds of people age 70 or older have at least one underlying condition putting them at increased risk of severe COVID-19 if they get infected. That rate compares with about 5% for people under age 20 and about 22% of the global population overall, it said.
Oct. 2 - The National Academies of Science, Engineering and Medicine (NASEM) issued a recommendation that nursing home workers and residents be among the “tier one” population that is considered at high risk for the virus, part of its study on who should have access to a vaccine and in what order. The organization does not set policy, but is highly influential among federal decision makers.
Oct. 7 - The number of nursing home deaths surpassed 2,000 in Indiana, one of the states where nursing homes were hardest hit. Officials say deaths in nursing homes and long-term care facilities comprise about 58% of the state’s COVID-related fatalities. The state’s first nursing home death was reported on March 20; for 35 consecutive days, from mid-April to late May, at least 20 long-term care residents died every day across the state.
Oct 23 - New Jersey Gov. Phil Murphy signed a bill requiring nursing home operators as of early 2021 to increase the number of aides and set a ratio for the number of residents per aide. Industry lobbyists had long blocked the measure prior to the pandemic.
Oct 28 - The Department of Health and Human Services distributed a first round of $333 million in performance payments to more than 10,000 nursing homes as recognition for showing significant reductions in COVID-19 cases and deaths between August and September. More than 77% of the 13,795 eligible nursing homes met the criteria for infection control. To be eligible, nursing homes had to have an infection rate lower than that in their county and a mortality rate of less than 10% among residents that contracted COVID-19. Over the summer, the Journal of the American Medical Association Network published a study finding the staffing performance at facilities is one of the best predictors of coronavirus cases.
Nov 2 - The Centers for Medicare & Medicaid Services unveiled a toolkit for ways that states can practice “rebalancing”—moving money to community programs and away from brick-and-mortar nursing homes. The moves are argued to be less costly and more popular among the public.
Nov. 10 - The American Health Care Association and National Center for Assisted Living, representing more than 14,000 nursing homes and assisted living facilities, issued a report warning that COVID-19 cases are increasing in nursing homes. It said a rise in nursing home cases was linked to a spike in the general population. It also says nursing home residents are so vulnerable that they account for just 8% of COVID cases but 40% of the deaths.
In the ongoing battle against the COVID-19 pandemic, add the names of Mark, Rowan, Dorian and Jabba to the list of front-line heroes quietly toiling away to vanquish the virus.
The four are germ-zapping robots, recruited by Northwest Community Hospital in Arlington Heights to do one job: kill the virus and other pathogens by sweeping rooms with pulsating beams of high-intensity UV light.
Last month, the 3u00bd-foot-tall robots, which bear a striking resemblance to R2-D2, the plucky droid from “Star Wars,” disinfected nearly 700 rooms at the hospital.
“Every COVID room gets treated when the patient is discharged,” said Kris York, director of hospitality services at the hospital. “The robots didn’t get much of a break.”
The four are part of a growing army of LightStrike robots, $125,000-a-pop machines that fire powerful UV blasts at surfaces where SARS-CoV-2, the virus that causes COVID-19, may be lurking.
There is such great demand for their services that Xenex, the Texas-based company behind the robots, announced a $20 million deal last month with aerospace manufacturer Astronics to build hundreds of them at a Waukegan factory.
“We’re playing catch-up right now on all the orders that have come in,” Xenex CEO Morris Miller said. “When the needs hit everywhere, people just upped their orders and they haven’t really stopped.”
Invented in 2009 by two Johns Hopkins University epidemiologists to fight community-acquired infections such as MRSA in hospitals, the robot has proved a highly effective tool in combating the spread of the COVID-19 virus.
A study published in August by the Texas Biomedical Research Institute found the robot destroyed nearly 100% of the virus on surfaces in two minutes.
“When you hit a pathogen with a high-intensity photon, it literally blows apart the cellular wall, basically deactivating it so that nobody else can get infected,” Miller said.
Last year, Xenex generated about $20 million in revenue and sold about 160 robots, mostly to hospitals. This year, Miller expects to sell about 900 robots as the market expands to include hotels such as the Beverly Hilton and Waldorf Astoria Beverly Hills and sports teams such as the NFL’s Carolina Panthers.
NBC TV show “Chicago Med” acquired a LightStrike robot on loan this fall to weave into the storyline as it shoots at Chicago’s Cinespace studios. The season premiere aired Nov. 11, with COVID-19 at the center of myriad dramatic subplots.
It is not clear what role the robot will play, but Universal Television, which produces the show, said it will be a visible prop during the season.
In the real world, its role is much more important.
Since the first prototype was sold in 2011 to the MD Anderson Cancer Center in Texas, the robot has been refined and is now in its 5th generation.
In 2014, LightStrike was brought in to clean up the room at Texas Presbyterian Hospital in Dallas where Thomas Eric Duncan became the first person to die of Ebola in the U.S.
The COVID-19 pandemic, which has infected more than 12 million people and killed more than 257,000 in the U.S. alone, according to Johns Hopkins, has increased the need at hospitals, and broadened the potential applications for the robot, Miller said.
“In three years from now, you’re not going to stay in a hotel that hasn’t been disinfected with a UV light,” Miller said.
While a $125,000 robot isn’t practical for every business, Xenex has rolled it out as a paid service in Texas, disinfecting everything from restaurants to car dealerships at a rate of $299 per hour, with plans to expand to other markets.
Miller said UV robots may eventually find their way into home use, akin to renting an industrial-quality carpet cleaner. But the components are likely too expensive to create a home version.
The biggest potential market remains health care, from hospitals to ambulatory surgical centers. Meeting even current demand will require an ongoing manufacturing agreement with Astronics, he said.
“I could do that if I can get the Illinois facility to make them fast enough,” Miller said.
Astronics, which is headquartered near Buffalo, New York, supplies technology to the commercial aviation, defense and space industries. In 2017, Astronics acquired Telefonix PDT, a suburban Chicago company that makes in-flight entertainment equipment for the airline industry.
Xenex worked with Telefonix PDT to help design an earlier version of the robot. When demand skyrocketed this year, exceeding production capacity at its Xenex’s San Antonio factory, the company struck a deal with Astronics to build several hundred robots in Waukegan through spring 2021.
The Waukegan facility, which opened in 2019 and employs about 300 full-time workers, was able to pivot to robots as airline industry demand slowed during the pandemic, said Astronics spokeswoman Deborah Pawlowski.
Astronics delivered its first batch of Illinois-made robots late last month. Each will be named by its new owner, with an engraved nameplate attached to the robot.
Northwest Community Hospital bought Jabba in March and Dorian in July. Rowan and Mark came aboard in early September.
Rolled into position and plugged into a wall outlet, the robot is activated remotely and operates in a closed room, to keep from blinding the handler, usually a member of the housekeeping staff. Its head rises another 2 feet and a super bright xenon bulb lights up. Two to four minutes later, the cleaning is complete.
“When you open the door, it kind of smells like a thunderstorm,” York said. “It has this very clean smell.”
