Excuse My Cynicism

16 months ago I quit my job running a company that oversaw the largest nursing home chain in California.  There were a lot of complex reasons for my leaving, not the least of which was the greater understanding that I had gained regarding how the nursing home industry operates.  I've spent most of my time since then reflecting on what I learned.  Being both a geriatrician and a businessman, my lens is unique.  I have been trying to share my knowledge and expertise over the last several months.  I have tried to reach out to my legislators.  I've tried sharing my knowledge with anyone in government whom I could access.  I've written articles.  I've written op-ed's that no one wants to publish.  And then it happened.  Less than two weeks ago, we heard about the first person to die from COVID-19 in the United States.  It was not a coincidence that this person was a resident of a nursing home.  The bells immediately went off in my head.  COVID-19 was going to unmask all of the underlying problems that exist in the nursing home industry.

I reached out to the State Health Department.  I reached out to the State's Nursing Facility Association.  I attempted to get another Op-Ed published.  I tweeted. I posted on Facebook and LinkedIn.  Fortunately, I am medical director of a nursing facility that is part of an incredible organization that cares more deeply about older adults than I do, the Los Angeles Jewish Home.  I have learned new things daily from the incredible individuals who are acting quickly and responsibly to this rapidly developing crisis. I am part of the California Association of Long Term Care Medicine (CALTCM).  We gathered experts and put together a very informative webinar on "What Nursing Homes Need to Know (https://www.caltcm.org/covid-19)."   I wrote another article that McKnight's agreed to publish (https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/). The article described why this virus scares me so much.  It's not just the virus itself, it's how it will interact with the nursing home industry.

Here we are.  Will the realization that all nursing homes should have at least one full-time Infection Preventionist actually take hold?  Will the industry finally recognize the true value of the CNA's who do the majority of direct care?  Will they receive full pay even if they need to be off for two or more weeks?  Will the nursing home medical director be appreciated for their clinical expertise instead of whether they bring in new admissions?  Will having adequate staffing levels and delivering quality care become the industry's priority?  Excuse my cynicism, but my experience informs me that greed and ageism are a combination that is dangerous to nursing home residents.

There is an army that is prepared and ready to help.  The army is made of up geriatricians, geriatric nurse practitioners, physician assistants, geriatric pharmacists, nurses and social workers.  Only a small number of nursing home medical directors are Certified Medical Directors (CMD).  They stand at the ready to engage and help fight the effects of COVID-19.  It's time for Federal, State and Local government agencies to engage experts for WHAT they know, rather than WHO they know.  It's also time for all of us with expertise to be willing to SPEAK TRUTH TO POWER.  It won't always work, which I can attest to based on my personal experience. But, we can't bring about change if we don't TRY.  Cynicism shouldn't keep us from trying.  It certainly won't keep me.