American Eldercide

Transporting a sick nursing-home patient to the hospital in Austin, Texas (John Moore/Getty Images)

Contrary to what many believe, the tens of thousands of deaths of those living in long-term care (LTC) were no inevitable biological catastrophe. Their grieving, angry family members know better: they know the conditions that prematurely deprived their loved ones of the remainder of their lives. By December, just as vaccine distribution started, nearly 110,000 residents and over 1,000 staffers had died. The extra deaths among our elders constitute an appalling number of the diverse 1.4 million Americans who were living in nursing homes before the pandemic. Many people have also died in assisted living facilities, middle-class residences not currently inspected by the Centers for Medicare and Medicaid Services. Until other deaths soared toward 500,000 over the winter, the deaths in nursing and veterans’ facilities alone accounted for almost 40 percent of all the U.S. dead. If we can’t explain why these care homes failed the people they were responsible for, we cannot prevent the next pandemic.

We may need to be reminded that people who choose congregate living in nursing and veteran’s homes include men and women of all races and ethnicities. Some are quite healthy or staying in rehab only temporarily. Other residents are chronically ill, disabled, frail, or living with some level of cognitive impairment. They may have little in common except their powerlessness to avert their fate. All of them should be able to look forward to living nicely, perhaps with some assistance—receiving help with activities of daily life such as showering and taking medications—as well as good meals, exercise classes, access to the outdoors, pleasant and helpful aides, conversation at mealtimes, and visits from loved ones. Many would have lived long lives in their new homes. All this was denied to those who sickened and died.

We don’t know enough stories of the nursing home survivors from their own mouths—their anguish at being neglected, anxiety as they listened to the news of mounting deaths among people like them, compassion for friends who were taken to hospitals and did not return, or stubborn determination to survive. While journalists have interviewed family members and administrators, few have spoken to residents to find out how they felt and what they observed. Aides were overworked, unprepared, and lacked protective equipment. Nurses were overextended. In one harrowing case at the Soldier’s Home in Holyoke, Massachusetts, where union officials had long warned about conditions, staff were instructed by the home’s leadership to merge two dementia units, cramming residents with COVID-19 into wards with residents who were uninfected. At least seventy-six residents died. All across the country, if an aide held an old hand and spoke words of love from the family members whom residents could not see, that was the best death available.

The fact of the matter is this: No resident, however poor, feeble, or impaired, needed to die of COVID-19. Nor did those who work taking care of them. We don’t need to look far for proof. In a small, nonprofit, Baptist-run nursing home in Baltimore, Maryland, whose low-income residents were people of color, many with chronic conditions, not one person had even become infected as late as June 18, 2020. Everyone was protected by best practices, instituted early and with the greatest good will. Derrick DeWitt Sr., a reverend and the CFO of the nursing home, brought in personal protective equipment, more TVs for entertainment and social distancing, hired an extra activities coordinator, and provided food for employees so that they wouldn’t have to leave to buy lunch. They already had a full-time infection-control nurse on staff before the pandemic.

Similar procedures led to lower mortality rates in other residences. A study of New York State LTC facilities showed that 30 percent fewer residents died in unionized than in nonunionized facilities. There were fewer infections. There were better masks and eye shields. Unionization often means better pay and infection...