It was Mother’s Day in May 2020 and an elderly woman lay dying in a Rhode Island nursing home. Her children were unable to visit her due to Covid, and although Adelina Ramos, her graduate nursing assistant, longed to comfort herself from her bedside, she had to leave, although she could see the woman eclipsed.
She had 25 other patients to care for that day.
It “really broke my heart,” Ramos said. “Families trust us to take care of their loved ones. I can’t describe how painful it is when we have to make these kinds of choices.
She recounted the devastation caused by the pandemic during a hearing Wednesday before the House Subcommittee on the Coronavirus Crisis.
Although Covid is causing less panic now, especially given the protection afforded by updated vaccines and treatments, older Americans are still seeing their lives turned upside down – and, tragically, entirely ended – by new outbreaks.
As the rest of the country searches for a new normal, millions of vulnerable Americans still remain at risk and in limbo. They now navigate a world torn apart by continued virus outbreaks, shortages of staff caring for them and the grief of more than a million people lost in two years.
Despite this, the US Centers for Disease Control and Prevention (CDC) on Friday dropped its mask recommendations for hospitals and nursing homes, except during times of high transmission or while providers are caring for moderately and severely immunocompromised patients.
The move could make it even more difficult for those at risk, especially the elderly, to safely navigate health care facilities and long-term care facilities.
Prioritizing older Americans during this time is “paramount,” said David Grabowski, professor of health policy at Harvard Medical School. “It’s been the group as a whole during the pandemic that’s been hit the hardest, and yet in many ways… they’ve been an afterthought.”
People over the age of 50 account for more than 93% of Covid deaths in the United States.
“We’re still seeing hundreds of deaths a day, and they’re disproportionately occurring among older Americans,” said Theresa Andrasfay, postdoctoral fellow in gerontology at the University of Southern California.
Life expectancy has dropped for all Americans, but the changes are greater among communities of color, Andrasfay said. “The Native American population has experienced by far the largest decline in life expectancy, followed by the Latino population, then the black population.”
In February 2021, older Americans who caught Covid were 1,000 times more likely to die than teenagers, according to a McKinsey report which predicted that “the arrival of safe and effective vaccines makes the pain of this isolation a problem. limited in time”.
Yet for many, the isolation and stress of the pandemic persists, especially as the protection offered by vaccines wanes without a booster and new variants emerge.
Relatively high vaccination rates among the elderly have contributed to a slight decline in death rates in this age group from 2020 to 2021. But the Omicron variant, which is more transmissible and better able to escape the immunity, has led to a near-record increase in the mortality of the elderly.
In total, 95% of Americans over 65 have received at least one Covid vaccine. But from there, the coverage starts to drop precipitously. Of those who were fully vaccinated in this age group, 70.8% received their first boosters. But only 40% of this the band then got second encores.
That means a total of 14.9 million older Americans are up-to-date on vaccinations, compared to 57.5 million who were ready to get vaccinated for the first time. Recall rates are even lower among Americans aged 50 to 64.
This could have disastrous consequences for their safety in the future, even if the remaining precautions disappear across the country.
In nursing homes, only 57% of residents and 43% of staff are up to date with their vaccines. Rates are lowest in Arizona, Florida, Nevada and Texas.
Less than 1% of Americans live in long-term care facilities, but around a fifth of all Covid-19 deaths are linked to nursing homes, with more than 200,000 residents and workers having died from the coronavirus since the start. of the pandemic.
“Residents, their families and caregivers have long known that nursing care in nursing homes across the United States is disrupted, but this issue has gone largely unnoticed by the general population. Covid changed that,” Grabowski said during the hearing.
The House coronavirus subcommittee has described “disastrous” conditions at for-profit nursing homes in the early months of the pandemic, revealing widespread neglect that led to deteriorating health and death.
Nurses and orderlies cared for up to 38 patients during their shifts. In April 2020, when a single nurse covered two entire floors at a Nevada facility, a resident waited four hours for a sip of water and another resident who vomited on herself was not cleaned up for at least four hours. least two days, according to the House report. .
Yet at least 32 states have passed legislation making it harder for residents or their families to sue long-term care facilities for such treatment.
Some of the worker shortages were due to Covid cases among staff, which could have been partly avoided with better precautions. But a care home worker alleged companies wanted to save money by not hiring extra workers despite needing them.
Long-term care facilities were plagued with staffing shortages and low morale before the pandemic began, and Covid has sharply amplified the cracks in the way America cares for its elderly population.
“Nursing homes are already understaffed and under-resourced. So when you put a profit into nursing homes to get a few extra dollars out of those communities, that’s going to compromise care,” said Ashwin Kotwal, assistant professor of geriatrics at the University of California, San Francisco, School of medicine. .
But it’s not just care home residents who have been affected by Covid – and the damage caused by the pandemic has not been limited to the virus itself.
The pandemic has also caused stress and loneliness, which affects both mental and physical health. In 2019, about 1.6 million adults over the age of 70 were housebound, but this number has more than doubled to 4.2 million in 2020. Staying at home increases the risk of illness and death.
Age was the biggest risk factor for severe Covid consequences, but loneliness worsened poor health, according to a Commonwealth Fund survey conducted between March and June 2021. Pandemic disruptions limited and delayed health care , and they have amplified “considerable” social and economic challenges.
“Compared to their counterparts in other countries in the survey, older adults in the United States have suffered the most economically from the Covid-19 pandemic, with more job losses or use of all or most of their savings,” the report said. Economic hardship for older Americans was four to six times greater than in other countries surveyed, and it was more likely among Latino and black adults than among white adults in the United States.
Disruption and isolation are likely to continue for those who must continue to take Covid precautions.
“What is concerning in the future, as there is more emphasis on individual responsibility, is that it is more difficult for vulnerable people, either because of underlying conditions or because of their age, to feel safe participating in necessary activities,” Andrasfay said. .
These activities may include public transportation, medical visits, returning to work, or visiting family and friends.
Weighing those risks is a cumbersome and exhausting process, Kotwal said.
“It can make even the simplest social activities something that really stresses people out and thinks about them a lot. I’ve seen a lot of anxiety about how people make those decisions to do really normal things like go out for coffee with their kid or hang out with their grandkids.
Keeping up to date with vaccines is an important part of protecting those most at risk, he said. “We can bring this to a place of community – being responsible, trying to protect others – rather than just looking at this from an individual safety perspective.”
Vaccination clinics and vaccination mandates in health systems and long-term care facilities were “really effective,” Grabowski said. About 87% of nursing home residents and staff have been vaccinated due to clinics and mandates – but those requirements have not been updated to include boosters.
An expanded federal mandate for staff to receive booster doses would help, he said. And more facility-based immunization clinics, along with campaigns to reach homebound adults and others facing access issues, could also boost recall rates and protect seniors this winter.
“It’s too important,” Grabowski said. “By all means, let’s make this as simple as possible.”