Residents of nursing facilities in Massachusetts are in grave danger. As of April 15, 48 percent of reported COVID-19 deaths in the state were in long-term care facilities. From April 10 to April 15 alone, 283 deaths were attributed to COVID-19 in long-term care facilities. Over the same period, the number of reported cases by residents and health care workers in these facilities increased by more than 95 percent, and the number of facilities reporting at least one case of COVID-19 increased by more than 25 percent.
The state’s recent actions to expand testing capacity, distribute personal protective equipment, and support staff are commendable, but also insufficient in essential areas. The data, as well as chilling daily news reports, clearly demonstrate the need for further immediate action to protect staff and residents in long-term care facilities.
On April 14, the Massachusetts Senior Care Association, a trade association that represents long-term care facilities, issued a clear and powerful call to action, addressed directly to Governor Charlie Baker, Senate President Karen Spilka, and House Speaker Robert DeLeo. We work closely with the Massachusetts Senior Care Association and fully endorse its recommendations, which can be summarized as follows:
▪ Immediately expand and routinely test both symptomatic and asymptomatic nursing home residents and front-line staff. The Commonwealth’s mobile testing program must be expanded to allow for rapid and repeat testing of both residents and staff of long-term care facilities. Mass Health reimbursement, currently made available via the Command Center to only one mobile testing provider under the state program, must be authorized for use by the Senior Care Association’s surveillance testing program (and similar programs run by other associations). Turnaround times for tests must be accelerated to 24 hours or less to enable long-term care facilities to make decisions that will reduce the spread of COVID-19.
▪ Immediately prioritize personal protective equipment for the safety and health of residents and front-line staff. There needs to an adequate supply of N95 and surgical masks, gowns, eye shields, and gloves, which are desperately needed to safely treat residents and protect front-line workers. To the extent the state cannot provide the necessary PPE in a timely manner, all emergency resupply purchases via the Massachusetts Senior Care Association (and other similar associations) should be reimbursed by the state.
▪ Immediately expand state resources to fund a “hero” wage of double time and deploy the National Guard or the Medical Corps of the US Army to help staff the state’s nursing facilities. The state’s latest actions to increase staffing levels, including providing a $1,000 bonus to individuals who apply to positions through a state portal, are steps in the right direction. But the bonus should be available to all new hires regardless of what portal or process they used to apply for these jobs. In addition, the state must do much more to compensate those who are risking their health and lives on a daily basis to care for nursing home residents. These are low- or very low-paid jobs, only little more than minimum wages. The state should provide a $130 million monthly budget specifically to fund overtime costs, hire new staff, provide double time for all front-line staff, and ensure the safety of all staff and residents through the consistent availability of appropriate personal protective equipment.
The residents of long-term care facilities cannot care for themselves. The National Guard has stepped up to aid in testing, but there are not enough of these heroes to plug all the gaps.
The people at greatest risk are our parents, grandparents, and those who care for them. The consequences of failing them are unimaginable.
The COVID-19 Policy Alliance, along with many other nongovernmental groups, works with the state government to protect the residents of long-term care facilities and the people who care for them. With all the brilliant, inspired, and engaged people of Massachusetts — as well as our friends and colleagues worldwide — we will work every problem, find every available solution, and not stop until this disease is defeated.
But there comes a moment in every crisis when we must turn to our elected representatives for the policies that will carry us to a better place. We are at that moment, and we turn — with respect and apprehension — to the governor, the staff of the COVID-19 command center, and the Senate and House of Massachusetts. They alone have the power to put us onto a better path, with significantly fewer deaths.
Yet this is not their responsibility alone. We will all long be remembered for what we do now, together, for the most vulnerable members of our community — or for what we fail to do. We therefore request that our fellow citizens reach out to their elected officials and urge them to adopt the recommendations of the Massachusetts Senior Care Association.
Simon Johnson, Kate Kellogg, and Retsef Levi are professors at the Sloan School of Management at MIT. Johnson and Levi are cochairs of the COVID-19 Policy Alliance. A version of this column was sent to state Health and Human Services Secretary Marylou Sudders.