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EDITORIAL

Tougher oversight key to protecting state’s elderly

Nursing home deaths that far outpace the national average cry out for real reform from the Baker administration.

A tent at the entrance to the Soldiers' Home in Chelsea, April 6. The Chelsea Soldier's Home and the Holyoke Soldiers' Home have been hard-hit in the coronavirus pandemic.
A tent at the entrance to the Soldiers' Home in Chelsea, April 6. The Chelsea Soldier's Home and the Holyoke Soldiers' Home have been hard-hit in the coronavirus pandemic.Elise Amendola/Associated Press

Even as Massachusetts takes some satisfaction in its latest coronavirus trends, there is one unavoidable fact it must wrestle with: 63 percent of all COVID-19 deaths here thus far have been among residents or staff at long-term care facilities, compared with under 40 percent nationally.

And that raises the critical question of what more can be done to protect the state’s most vulnerable population in the event of a second wave of the virus.

Long before the pandemic hit, nearly 38 percent of Massachusetts nursing homes were earning low marks from the federal Centers for Medicare and Medicaid Services — with 142 of the 376 facilities listed getting only one or two stars in a five-star rating system.

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And, as recently as last month, a third of the long-term care facilities spot-audited by the state Department of Public Health were found not in compliance with a newly mandated COVID-19 infection-control checklist in spite of the financial incentives being offered by the state.

With the nation’s top infectious-disease expert, Dr. Anthony S. Fauci, warning last week of new infections in the United States possibly topping “100,000 a day if this does not turn around,” this is no time to be complacent in Massachusetts. Rather, this should be a time for making sure the tragedies that took place in nursing homes across the state aren’t repeated.

It was no secret back in February that COVID-19 took special aim at the elderly, particularly the frail elderly. By mid-February, the Chinese government was acknowledging that much. Before the month was out, the first US COVID-19 death was reported, along with an outbreak at a nursing home in Washington state.

Massachusetts initially ordered the screening of all visitors to nursing homes and long-term care facilities on March 11 and banned visits days later in the wake of a CMS directive, issued March 13, to “temporarily restrict visitors.”

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By then, “it was too late as the virus had already infiltrated most [nursing] homes through staff or visitors, many of whom were likely asymptomatic,” according to a report by the Pioneer Institute, presented last week to a new state task force assigned to address health care disparities in the state’s response to the pandemic.

Among those “underserved and underrepresented populations,” the Pioneer testimony noted, were “those subject to age discrimination.”

“COVID has wiped out 10 percent of Massachusetts’ nursing home population,” said Pioneer Senior Healthcare Fellow Barbara Anthony, coauthor of the letter with Mary Connaughton, Pioneer’s director of government transparency.

The horrifying tales out of the Holyoke Soldiers’ Home are now well documented in a 174-page report ordered by Governor Charlie Baker. And while a handful of elected officials are demanding a similar investigation of the Chelsea Soldiers’ Home, the deaths of 31 veterans there, in a population of 456 (a death rate of under 15 per 100 beds), don’t come close to the death rate of 45 per 100 beds at the nearby Katzman Family Center for Living, also in Chelsea. Where is the outcry over that?

The point now is not simply to revisit history but to learn from it. There too the Pioneer report points in some promising directions:

▪ Addressing existing shortages of personal protective equipment and requiring a stockpile of PPE sufficient to get through the next pandemic and verified by state inspections.

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▪ Naming what would amount to a nursing home czar who would report directly to the governor during this and future health emergencies — someone with expertise in public health.

▪ Requiring a designated “infection preventionist” at each facility.

▪ Testing, testing, testing — including protocols for future testing, funding for same, and for reporting results directly to the Department of Public Health.

▪ Transparency — about all of the many ways in which nursing homes will be evaluated now and in the future and making that as accessible and consumer-friendly as possible.

None of this is particularly startling. In fact, much of it is rather basic. But when more than 5,000 lives have been lost, it’s time to return to basics, including strong state oversight before the fact, not after. And data on how each and every facility is performing — available to families that need to make difficult decisions about placing their loved ones.

As Governor Baker keeps telling us, “The virus isn’t taking a vacation” this summer. Neither can his administration in protecting the elderly from whatever lies ahead.


Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.