How ageism killed older adults during COVID

MW How ageism killed older adults during COVID

By Jessica Hall

Nursing homes during COVID-19 lockdowns were 'crime scenes hidden from the public'

In the first days of the COVID-19 pandemic, Margaret Morganroth Gullette immediately became concerned about older adults' access to ventilators since a patient's age was the only explicit reason someone could be barred access to those medical devices during a public health emergency.

Then her anger intensified as nursing homes became an epicenter of COVID-19 deaths. Among more than 1 million U.S. nursing-home residents, 8% or 179,000 people died as of May 2022. That compared to 0.33% of the overall U.S. population that was lost, Gullette found. Nursing-home residents were 26-times more likely to die than the general population, she said.

"There was this stereotype of people in nursing homes that they were going to die anyway. What everyone missed was that in 1,950 nursing homes no one died. And that's out of 15,400 nursing homes. So it was possible to protect these people and when you protected them, they lived and survived," Gullette said.

Gullette started writing and researching as a "passionate protest," and what emerged was her recently published book "American Eldercide." The book includes interviews with COVID survivors, family members who lost loved ones and health experts. It aims to put a name and face to those who were lost.

Gullette, the author of several books, including "Agewise," "Aged by Culture," and "Ending Ageism, or How Not to Shoot Old People," said she believes that fighting ageism will be one of the great public-health battles of the next few decades.

As more than 10,000 Americans turn 65 every day through 2027 and the nation will have more older adults than children by 2034, the healthcare system will be face-to-face with an aging population that it will be ill-equipped to handle, she said.

Gullette is pessimistic about the future of healthcare - she expects to see cuts to Social Security, Medicare and Medicaid, more purchases of nursing homes by for-profit businesses and private equity owners, and an erosion of safety standards in nursing homes.

During the pandemic, when deaths in nursing homes rose sharply, Gullette said there was a lack of understanding and assumptions by the American public that the older adults were near death already, so not much could be done.

The lockdown stage of the pandemic added to the ease at which the public was able to shut out news of surging nursing home deaths, she said.

"If you didn't have a relative in a nursing home, it was easy to forget them. You have to remember how self-enclosed people became with the lockdowns, the closing of the schools and community places. People were protecting themselves from more suffering," Gullette said.

Health experts realized there was something going wrong in nursing homes, but Gullette cited systemic failures such as weak inspection regulations and apathy by the nursing-home owners and operators. When the pandemic hit, 70% of the nursing homes were run by for-profit companies, Gullette said.

While the bulk of the public may not have understood what was happening in nursing homes, Gullette said relatives and loved ones of the residents struggled to get answers.

"It wasn't that nobody cared. Millions of people cared. Everyone who had a friend or a relative in a nursing home was concerned or aghast when people began dying in clusters, locked in, segregated, crowded in rooms with others who were coughing and disappearing," Gullette said.

The medical community and healthcare researchers Gullette interviewed said they knew from the beginning that the older adults in nursing homes were not dying normally, but from lack of staffing, abuse and neglect.

"Nursing homes were crime scenes hidden from the public," Gullette said.

Gullette also took issue with the pandemic guidelines that the only people who could be excluded from ventilators during a shortage were older adults.

"You can't exclude people on the basis of race or sex, but you can exclude them on the basis of age. I want the guidelines to change. I want the medical community to say 'We're wrong here.' We want some kind of equity. There's a solution to this. It can be done by lottery," Gullette said.

Without wholesale change to the healthcare system in the U.S., improved safety and staffing standards in nursing homes and evolved attitudes towards older adults, Gullette fears a future pandemic could be just as deadly as the COVID-19 crisis.

"The next pandemic will find us unprepared. A lot depends on who is running things," Gullette said, citing the different responses to the pandemic under the Trump and Biden administrations.

Earlier this year, Biden set for the first time national minimum staffing requirements for nursing homes to improve the care that residents receive and support workers by ensuring that they have adequate staff.

The new requirements call for nursing homes to provide each resident a daily minimum of 0.55 hours of care from a registered nurse and 2.45 hours from a certified nursing assistant. A registered nurse would staff homes at all times. Nursing homes, which blasted the new rules as expensive and difficult to meet during a nationwide nursing shortage, will have until May 2026 to meet the staffing rules.

Gullette said the minimum staffing rule was a big step forward, but did not go far enough.

"Understaffing is the problem. Eldercide continues to go on but it just can't be measured in the same mortality data because people die by understaffing one by one and their relatives don't know that it's a systemic problem," Gullette said.

She said the U.S. healthcare system needs wholesale change, but she's not optimistic it will happen.

"It's about who cares and wants to make change. I think there's now outrage about UnitedHealthcare and stewards of hospitals and millions of people who realize that the health system in the United States puts them at incredible risk and is a corrupt system. And really has to be transformed. And not just fiddling around the edges but totally transformed," Gullette said.

-Jessica Hall

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December 19, 2024 12:15 ET (17:15 GMT)

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