Following individual human stories in a sprawling event like a global pandemic is a challenging task. Making thoughtful connections between the two is even harder. But this long read from The California Sunday Magazine on America’s first COVID-19 epicenter, a nursing home in Washington state, does the job with compelling and tragic precision.

It focuses on two inhabitants of a single room in the nursing facility, the Life Care Center of Kirkland, part of the largest privately held chain of long-term care centers in the US. It tracks how the coronavirus spread through the facility “like a spectral haunting,” and how underpaid and overworked staff battled against the odds to bring it under control.

Nursing home residents account for more than a quarter of all US COVID-19 deaths

Around the world, nursing homes have been hit hard by the pandemic, which is no surprise considering that their residents are some of the most vulnerable in society. In the US alone, as of mid-August, 177,129 nursing home residents have tested positive for COVID-19 and 45,958 have died from the disease. “This means that nursing-home residents account for more than a quarter of total pandemic deaths,” writes journalist Katie Engelhart.

In America, though, these individual tragedies connect to larger trends. As Engelhart lays out in rigorous detail, the financial and regulatory landscape of the US has seriously diminished the quality of care in nursing homes. The “freakish architecture” of health insurances is one issue, incentivizing management to treat patients with profit in mind:

“At one Life Care facility in Florida, the entire rehab staff had signed a letter declaring that they had ‘been encouraged to maximize reimbursement even when clinically inappropriate.’”

And the financialization of the industry is another. Nursing homes are lucrative businesses thanks to a regular supply of “customers.” This has attracted buyouts from private equity firms and owners concerned only with making money. Nursing homes are folded into complicated company structures that make it harder for patients to sue, while middle managers are brought in on bloated salaries, draining funds from frontline staff.

The results are grimly predictable, explains Engelhart:

“Earlier this year, a Wharton School–New York University–University of Chicago research team found “robust evidence” that private-equity buyouts lead to “declines in patient health and compliance with care standards.” When nursing homes are bought by private-equity groups, the team concluded, frontline nursing staff are cut, and residents are more likely to be hospitalized.”

Lax government regulations have also played a part. One study found that three-quarters of US nursing homes were understaffed before the pandemic, while 82 percent had been cited by the Government Accountability Office for failing to control the spread of infections between 2013 and 2017. These conditions were ripe for the pandemic to move in.

Engelhart’s piece is extremely affecting when detailing the plight of nursing home residents themselves. These are mothers and fathers, daughters and sons, whose tragedy is simply aging in a country that does not provide for them. As Engelhart puts it, many people see the tens of thousands of deaths in US nursing homes as evidence of a “cultural abdication” on the part of society. We’ve failed to look after our elders and the human cost is staggering. Perhaps this pandemic can at least wake people up to the change that is needed.

Go read Engelhart’s full story right here.


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