Figures released this week paint a horrific picture of the suffering and despair caused by the COVID-19 pandemic among the elderly and infirmed of Pennsylvania’s nursing homes and other long-term care facilities, along with the staff who care for them.
As of this writing, Pennsylvania has 71,961 cases and over 5,173 deaths, making it the state with the sixth highest number of cases and the fifth highest number of deaths in the country.
Governor Tom Wolf, a Democrat, made the decision to reopen the state on May 12, despite a gross mishandling of figures on COVID-19 cases and deaths and before the state had even released nursing home data to the public.
According to data released by the Pennsylvania Department of Health, a total of 13,927 residents at nursing homes and other long-term care facilities became infected with the coronavirus, as well as an additional 1,997 staff members working at these facilities.
A total of 2,980 patients and staff members have died. This represents over 57 percent of all deaths in the state. Philadelphia and surrounding counties are the hardest hit area of the state, and is only 80 miles from New York City, the epicenter of the pandemic. The coronavirus is known to be most deadly in older populations and people with comorbidities, with about half of US deaths occurring in individuals over 75. In the Pittsburgh area, nearly 80 percent of COVID-19 deaths have occurred in long-term care facilities.
According to state data released last week, the Brighton Rehab and Wellness Center north of Pittsburgh has had 76 patient deaths, the hardest hit facility in the state. The Brighton nursing home made headlines in March when so many patients became infected that the nursing home management decided not to report the figures. Instead, management made the blanket claim that all 800 patients and staff were infected.
Fifty residents of the Parkhouse Rehabilitation & Nursing Center near Philadelphia have died since March, along with 45 residents of Northampton County Home in Nazareth. The deaths of between 20 and 45 residents have been reported at over 50 separate nursing homes across Pennsylvania.
These deaths have also caused untold suffering for the staff of these facilities. Many front-line employees have been expected to work during the pandemic without the necessary protective equipment. Shifts are often long and fraught with the emotional turmoil of dying patients. Workers, potentially carrying the virus, must then go home to their families.
Even before COVID-19 the nursing home sector was one of the most hazardous in the US, per number of work-related injuries and work-acquired illnesses, according to the Bureau of Labor Statistics.
An article published in the Journal of Applied Gerontology in 2014 by researchers at the University of Massachusetts Lowell found that turnover rates for employees in these dangerous workplaces are very high, with about half of all employees leaving after only one year, and up to 85 percent one-year turnover rates for positions filled by CNAs (Certified Nursing Assistants) and LPNs (Licensed Practical Nurses).
The paper also found that short staffing, difficult physical and mental labor conditions, and perpetual hostility of management toward workers in for-profit nursing homes have led to a reduction in quality in long-term care facilities across the US. The stonewalling of important information about the presence and spread of the disease has only intensified these abhorrent working conditions.
During the first two months of the epidemic, Philadelphia was not releasing any figures about COVID-19 cases or deaths in nursing homes. According to the Philadelphia Inquirer, state officials claimed the data was “too convoluted for public consumption, and later [cited] a decades-old disease privacy law” in its decision not to make data public. Family members and communities pressed for state-level data, arguing that each individual facility couldn’t be trusted to provide the necessary information about infections in residents. Due to the statewide lockdown, family members have been barred from visiting relatives since March.
On May 19, nearly two months since the disease reached Pennsylvania, the state finally released its own figures about the extent of the pandemic. This followed by a month a Trump administration announcement that it would be imposing new federal requirements on nursing homes, mandating them to inform families and Centers for Disease Control (CDC) officials about COVID-19 cases in their facilities. The new federal transparency rules require nursing homes to report directly to the CDC, and put more pressure on states to release their own data to the public.
However, as horrific as the state numbers are, they aren’t accurate. The Philadelphia Inquirer compared the state figures to figures gathered by Philadelphia city officials and found that, overall, the state data under-reports the severity of the problem and is highly unreliable.
In one instance, the state inaccurately reported 65 coronavirus cases in residents at one nursing home, Elwyn Harmony Hall near Philadelphia, which in fact has room for only 16 residents. In another, the city-owned Philadelphia Nursing Home has confirmed that 30 staff members have tested positive for the virus, according to city officials, but the state data reports that no staff from this facility have tested positive, and that only 20 staffers among 47 city-run nursing homes have contracted the disease.
The Pennsylvania Health Department has acknowledged the widespread inaccuracies. According to the Health Department the results represent reporting errors on the part of the individual facilities, such as reporting “current counts” instead of “cumulative counts.” The state is responsible for regulating the facilities, but surprisingly it is not considering any of them as noncompliant as of yet.
This gross mishandling of data on the part of the state suggests that the decision by Pennsylvania Governor Tom Wolf to begin reopening on May 12, before they had even released the nursing home data to the public, was at best uninformed. The state was operating on a pretext of misinformation that is likely the result of incompetence, negligence and mismanagement more so than criminal intent.
But this does not make the result any less criminal. Even the state’s own data indicates that the number of new cases per day is declining but not reduced to pre-epidemic levels. Worse, the state has explicitly said that it cannot provide hospitals, let alone nursing homes, with sufficient personal protective equipment.
Governor Wolf has described the extreme danger of reopening the state as “walking a tightrope between health and the economy,” repeating Trump’s false statements that the choice is between life and having an income. Both Wolf and Trump have falsely claimed that businesses, including nursing homes, simply cannot be run safely, and that workers can't be provided with the resources they need to survive and socially distance.
Managing a pandemic requires accurate epidemiological information about where the virus is. Their data bungling and lack of transparency have made clear that Democratic-led states such as Pennsylvania, like their Republican-led counterparts, cannot fulfill their obligation to support a safe reopening and containment plan.