Clockwise from top left: Dr. Charlene Harrington, gerontologist and professor of sociology and nursing at the University of California San Francisco; Dr. Farida Sohrabji, Associate Department Chair, Department of Neuroscience and Experimental Therapeutics, Texas A&M College of Medicine; Erika Hartman, Chief Program Officer for the Downtown Women’s Center in Los Angeles; and Dr. Fernando Torres-Gil, Director, Center for Policy Research on Aging, UCLA Luskin School of Public Affairs.
Experts have warned people with relatives in retirement homes to take care of them in their own homes during the pandemic, if at all possible.
By: Jenny Manrique
Although only 0.6 per cent of the U.S. population lives in nursing homes, the COVID-19 pandemic has caused 43,000 deaths and 210,000 infections in these care centers, which equals 40% of all Coronavirus-related deaths.
The alarming statistic was shared by Dr. Charlene Harrington, gerontologist and professor of sociology and nursing at the University of California, San Francisco (UCSF), in a panel discussion organized by Ethnic Media Services to study why older Americans exhibited the highest COVID-19 mortality rates.
“The virus has spread like wildfire in nursing homes,” said Harrington. “Fifty per cent of the residents are asymptomatic and that has been the worst scenario for infecting patients and personnel with the virus.”
In the last 20 years, nursing homes have had “serious problems” with the quality of patient care, and even before the virus, 75% of them already displayed shortcomings in the registered nursing staff and 63% registered infection control violations, Harrington explained. As if that were not enough, today 70% of these retirement homes are for profit, which means reduced staffing, low wages, lack of health insurance or paid sick leave.
“Nurses are part of high-risk (for COVID) minority groups due to lack of tests, face masks, gowns or personal protection equipment (PPE),” added Harrington. “Since they live in poverty, they receive food coupons and hold several jobs, they cannot stay home if they are sick.”
This situation partly explains the data the Center for Disease Control (CDC) has collected about who the victims of the pandemic are: 8 out of 10 deaths are adults over age 65 and 70 per cent of COVID-19 hospitalizations are people over 85 years of age.
Twenty states across the country, including New York, have granted immunity to health care personnel working in nursing homes and other care centers, which means they are not liable for any deaths that take place in those businesses. According to Harrington, this only excuses the “negligence” of whoever manages them, since they could be doing “a better job” of properly reporting infections and deaths and testing more.
“If anyone has a relative in a nursing home, the best thing to do would be to take them home,” recommended Harrington.
Isolation and depression
Visiting restrictions and difficulties in communication with elderly family members could contribute to the development of mental disorders.
Several scientific studies have shown that social isolation, imposed during the quarantine, contributes to an increase in cardiovascular disease, heart attacks and strokes, as well as symptoms of autoimmune diseases. In the area of mental health, depression and anxiety can be exacerbated by confinement.
“The impact can be pretty devastating in many ways,” said Dr. Farida Sohrabji, Associate Department Chair of the Department of Neuroscience and Experimental Therapeutics of the Texas A&M College of Medicine.
“There is the concern about the way the illness can go, and the possibility of infecting others,” Sohrabji explained. “And then there is the depression caused by the virus itself. There is a wide variety of mental conditions that include cognitive changes and memory. People feel overwhelmed.”
After studying the events of past pandemics like SARS (Severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome), experts have found that individuals that were subject to social isolation, showed high rates of anxiety and depression. When levels of cortisol, the stress hormone, increase, the immune system weakens and the risk of infection increases, putting senior citizens at a great disadvantage, said Sohrabji.
With suitable nutrition, hydration, exercise and routines, these effects can be counteracted in isolation, the expert recommended.
Homelessness
Even though the situation in the nursing homes is concerning, the place where adult populations are most vulnerable is on the street. Since the beginning of the pandemic there has been an increase of 20 per cent in the number of homeless senior citizens, women of color over age 65 being the most affected, since their rates of poverty are almost double that of white women.
Erika Hartman, chief program officer at the Downtown Women’s Center in Los Angeles, shared the number highlighting that the life expectancy of a woman decreases drastically once she is left without shelter: under normal circumstances a woman lives to age 83, while on the street the average is 48.
“Even before the public health crisis we already saw the impossibility for this population to shelter anywhere,” said Hartman. “Now they are brought together in care centers, without being able to maintain appropriate social distancing or access to resources like PPE at the same level as hospitals or first responders.”
Hartman also highlighted how the pandemic intensified the cases of domestic violence, which sends more women in search of shelter outside the home, and how, by lifting the rent moratorium that was imposed for those who lost their jobs, more urban displacement may be created.
“Women have been disproportionately impacted by unemployment and by low salaries, so we are very worried by the impact of the moratorium,” she said.
Old age and disability
The need for change in public policy related to senior citizens has been aggravated by the virus. The social and economic disparities have put populations at greater risk depending on age, race and even zip code.
According to Dr. Fernando Torres-Gil, Director of the Center for Policy Research on Aging at the UCLA Luskin School of Public Affairs, “we need a paradigm change on how we approach the subject of institutional care.”
Torres-Gil said that at the beginning of the pandemic, several hospitals decided to distribute resources like ventilators to young people with a greater life expectancy, discriminating against the elderly, handicapped and those with pre-existing conditions. “We need to focus on these tremendous disparities and develop new standards of care, so that in the possible resurgence of the virus, there won’t be discrimination based on age or handicap,” said the expert, who is part of California governor Gavin Newsom’s advisory committee on the Master Plan for Aging.
The Plan includes working closely with legislators so that in spite of economic cuts in home support services, adult day care centers or Alzheimer programs, there would be an investment that would allow keeping people in their homes.
“We need a federal commitment to dramatically expand home and community health care, and to educate younger populations so that they understand that they too will be old one day and will face a variety of physical limitations and handicaps,” he concluded.
