Princeton long-term care medical director: Reporting on nursing homes disheartening

By David Barile, M.D.

Letter to the Editor:

As medical director of Princeton Care Center, I am disheartened to read your reporting of our nursing home deaths and current cases of COVID 19.  When death occurs, you publish a photo of the building, state the fact that another patient died and follow with a list of confirmed cases across Princeton.  I presume this information is taken from the New Jersey Department of Health website. (Editor’s note: The information about long-term care deaths was sent to the press from the local health department). While the “numbers” may be accurate, they do not tell the entire story. I’d like to respond with what I believe is important news for your readers.

As of this letter’s date, over 90% of NJ nursing homes have cases of COVID.  Approximately 40% of the 6,044 deaths in our state occur in nursing homes.  NJ nursing home deaths from COVID are high and will rise. In my estimation, without immediate hands-on assistance in these facilities, NJ will lose 30% of our elders who reside there.  That number will be staggering.  Not all deaths will be from COVID.   They will also die from bedsores, malnutrition, and other maladies associated with lack of basic care and hygiene.

For readers who have no knowledge of nursing home operations, nursing aids assist with getting out of bed, bathing, dressing and meals. Dining typically occurs around a table, where residents can interact and one nursing aid can assist elders with meals. Presently, every nursing home patient is confined to their room, isolated from contact, and dependent on dwindling staff for basic needs.  Nursing staff is willing to work overtime hours because agency staffing is unavailable.  Administrative staff is in rooms feeding patients, careful to encourage eating and drinking.

In this time of crisis, the State of NJ has essentially done two things that impact residents of nursing homes.

In March, Governor Murphy suspended all staffing regulations for nursing home facilities, as many staff members would be out sick, and facilities would not be able to maintain state required, patient to staff ratios.  This was important, because with so many out sick, virtually every facility in NJ would have been in violation.

More recently, fearing that families were not getting information from facilities, Commissioner of Health, Judith Persichilli, pushed for the public release of COVID positive cases and deaths for every nursing home. Again,  important and useful information, especially if you are a worried loved one and locked out of your Mom or Dad’s home.

In our nursing homes, where 40% of our COVID deaths occur and where our most vulnerable population resides, state government has made no provision to assist with staffing. How could a government and its health department allow a health care business to operate knowing that deaths will increase without staffing support?

As of today, all they have done for our sickest, most frail population is to loosen requirements and turn on the lights so everyone can watch as cases climb and more people die.  Last week, the governor stated that health care workers from out of state are available and will be coming to help.  We continue to wait.

On April 16, I sent a letter to Governor Murphy and Commissioner Persichilli pleading for our National Guard to assist staff in the most threatened NJ nursing homes and assisted living facilities. The Guard has been called out to three facilities in the state overwhelmed by COVID. We need a more proactive, preventative use of the National Guard. We need medically trained guardsmen to enter vulnerable nursing homes and help with critical staff shortages so residents can be fed, washed, clothed, and safely cared for in their rooms. This intervention will save lives and reduce age-related complications of remaining bedbound. It will also reduce the spread of COVID by keeping residents with dementia from moving room to room. 

I also work for UPENN Princeton Hospital where I oversee geriatric and palliative medicine services. I’ve personally cared for dozens of COVID patients.  Some recover, but many in my field of geriatrics die in the first few days.

In our state and across the nation, hospital staffs are regarded as heroes. In my hospital, we receive cards from school children. I pass signs of support on the lawn of the hospital when I enter each day. We receive salutes from local law enforcement and firefighters, and gratitude from families and patients.  

Meanwhile, we shame nursing homes for not doing a good job to contain the virus and frown upon them as numbers climb. I ask state officials and the general public to not write off NJ nursing facilities.  How many deaths will it take before our government intervenes?   5,000? 10,000? Again, if my estimations are correct, we could lose up to 30% of elders in nursing and assisted living facilities.  And they will die alone, without any family by their side. 

Our local Princeton Care Center held an online town hall meeting recently.  Over 80 family members joined in. We told worried families that we currently have the staff and PPE to safely care for each resident. Every morning when I show up at Princeton Care Center I find staff devoted to their work, unafraid to care for the frailest COVID patient. Princeton Care Center staff work as hard as hospital staff to provide medical care that all people deserve, young and old.

Twenty-five years ago, when I was an intern, I shared my interest in geriatrics with a senior educator in my program. He responded dismissively, with a comment that has haunted me ever since.  I’ve tried not to think about these words over the course of my career.  I did not want to believe them.   Twenty-five years later, it’s occurring to me that what he said may be tragically true:  “Nobody gives a damn about old people.”