A January report from the New York attorney general found missteps in how the state’s nursing homes responded to the COVID-19 pandemic. The investigation detailed that failure to comply with infection control protocols put nursing home residents at increased risk during the pandemic. It also said homes that entered the pandemic with low staffing rates had higher COVID-19 fatality rates. The New York Association on Independent Living says the report is the latest piece of evidence that no person should live in a nursing home.
For more on that perspective, WAMC's Jim Levulis spoke with Doug Hovey, President and CEO of Independent Living Inc., and an association member.
Hovey: Well, clearly, our greatest concern is specific to the COVID-19 pandemic and its impact on people living in nursing homes and other congregate care facilities like group homes for people with developmental disabilities. And so we've seen a disproportionate number of deaths in these settings and particularly for older adults and people with disabilities. And between 40 and 50% of COVID deaths are among people living in nursing homes, here in New York state and across the nation. And, you know, Jim, I’m executive director of Independent Living Incorporated, which is based down here in the lower Hudson Valley, and I'm a member of the New York Association on Independent Living, which represents 41 independent living centers. And we have been adamant for many years, long before the pandemic, that no one should have to live in a nursing home. In fact, prior to the pandemic, 82% of the nursing homes were cited for infection control deficiencies. And during the pandemic, it's gotten much, much more severe. And the state has really turned its back on the oversight necessary to address these issues. They really have no plans in place to assist people to transition out of nursing homes and get out of harm's way. So as we speak, minute to minute, people are being exposed to this continuous virus. There is very high infection rates in the nursing homes. And by design, nursing homes are not a good place to live. And no one should have to live their golden years in a nursing home. You can imagine all your years living in the community, in privacy, and living a life with dignity, and then having to live in a crowded nursing home where people are sharing sleeping quarters and they're sharing bathrooms. This is just not acceptable in this day and age of the 21st century.
Levulis: And if I can better understand your organization and the statewide organization. How is care delivered as it pertains to independent living?
Hovey: Well, we provide community-based services. So for example, homecare is a critically important service. Home care workers are not only essential workers, they're critical workers in the community that help people with disabilities and older adults to remain in the community, as opposed to requiring to go into nursing facilities. One of the greatest challenges we face today in the home care industry is the pay scales. Home care workers are being paid minimum wage. As you can imagine, you can make more money flipping burgers at the local fast food restaurant than you can working in this type of industry where you're literally taking care of people with disabilities and older adults by helping them get out of bed in the morning, get bathed, get showered, and get dressed and get their meals made. So the home care industry needs to be improved. And we're advocating that we increase the salary levels, the base salary levels to be commensurate with other essential care workers in these industries in the long-term care industry.
Levulis: And I know a lot of other social service industries have taken a hit in terms of government funding as a result of the pandemic, you know state revenue, governmental revenues are down, how is your association doing?
Hovey: Well, we've all been facing funding cuts, anywhere from 5 to 20%, depending on the program, and naturally, a lot of whether or not these cuts go through is contingent upon federal aid, and the governor's been requesting $15 billion from the federal government to offset losses as a result of COVID-19. So we're constantly in this sort of holding pattern, it's very difficult to manage budgets for our services that provide care to people with disabilities to keep them well in the community, when you're not certain with what those budget amounts are going to be from day to day. So it's been a real moving target. And some of the other services that we do have amongst the 41 independent living centers are very specific to helping people get out of nursing homes. But we need greater cooperation between the state and the local governments, the counties in order to make the services more effective. There's really no reason why anyone should end up in a nursing home and at this stage, we need to close the front door and start transitioning people out to a better quality of life into affordable and accessible housing units and provide them with the community supports and care that they need in order to live a quality of life in the community.
Levulis: And how are the homecare providers and those that they're providing care to, holding up throughout this pandemic, you know, health wise, workload wise?
Hovey: Well, again, because the minimum wage rate, or the wage reimbursement for home care workers is so low, we do have a high turnover rate. But I will tell you, Jim, that people that live in the community with home care are 10 times less likely to contract COVID-19. And to get sick from this horrific virus. So we are seeing some great results. Obviously, by keeping people in the community, they live a better quality of life at the same time. But they're not contracting COVID-19 by not having to be in congregate care facilities.
Levulis: And how is the vaccine rollout looking like in the community that you serve, both for workers and those that your organization serves?
Hovey: The vaccine rollout has been, it's sort of been a patchwork quilt, I mean they're rolling it out in different phases. And the unfortunate reality is, in our communities down here in the lower Hudson Valley, we continue to run out of vaccines. So people, many people have gotten their first vaccine, and are waiting for the supply, new supply in order to get the second vaccine. And then we have other people who are trying to get appointments to get the vaccine, but they're not able to get appointments. So it's been very difficult. So I think the supply is far from meeting the demand at this time. And one of the big concerns we have to is for people with developmental disabilities who may have co-occurring chronic conditions, they've not been prioritized if they are living at home with their families. And that's been a real challenge. So we've had a lot of families calling us concerned that their family member with a developmental disability has not been able to get vaccinated because they're not on the priority list. But the good news is that congregate care facilities are on the priority list. And we're starting to see more and more people in congregate care setting and have access to this. But this does not solve the long-term problem of institutionalized care, of crowd care, as we call it, warehousing people with disabilities and older adults. We have a long way to go to restructure our long-term care system to build up the community support so that no one ever needs to be referred to a nursing home. And we have the capacity to do that today. We just have to get government collaborating with local community-based organizations to make that a reality.
Levulis: And, Doug, I want to pick up on that point. I think a lot of folks might hear what you said and say ‘Is the infrastructure really there for everybody who is in a nursing home to stay in their own home or stay in something similar to it and is the workforce there?’
Hovey: Yeah, good questions, Jim. The infrastructure in large measure is there, there are lots of affordable housing units. And then there continues to be new development every year. Unfortunately, New York State has not had the foresight to set aside those affordable and accessible housing units for older adults, people who are nursing home eligible. Instead, those units are targeting other disability populations. So we have to start shifting our thinking and include people that are nursing home eligible to live in the community and simultaneous build up our community support systems, including home care, as I discussed before paying better rates for home care, so we don't have such a high turnover rate, and allow people to have the support so they can either stay in their homes, and if they can't stay in their homes because their homes are not accessible, then find an alternative housing situation in their community so they can continue to be members of their community.