Opinion

NATHAN BOUCHER: Isolation, variable care, now a pandemic for nation's most vulnerable

Posted April 27
Updated April 26

EDITOR'S NOTE: Nathan Boucher is a federal research scientist with the Veterans Administration and on the faculty at Duke University's Sanford School of Public Policy.  The views expressed are his own.


As the coronavirus pandemic sweeps through North Carolina, acute care hospitals have been a focal point of state policy and aid. However, one of the largest contributing factors to the COVID-19 death toll is fatalities in long-term-care facilities like nursing homes.

In North Carolina, there have been approximately 55 COVID-19 outbreaks at long-term care facilities and this is expected to rise. These facilities have approximately 18% of NC’s COVID-19 cases and about 43% of the state’s deaths from the virus. Individuals 65 and older with underlying health conditions are at the greatest risk of severe illness as a result of COVID-19. Gov. Roy Cooper issued an executive order April 9th ending group meals, increasing resident monitoring, and imposing mandatory temperature checks of employees before entering care facilities. Still more must be done to ensure that these facilities provide the best care for these individuals who are most vulnerable.

North Carolina’s long-term care facilities are primarily responsible for the most vulnerable populations to COVID-19. Even before COVID-19, 380,000 individuals nationwide were dying annually from infections in long-term care facilities, according to the Centers for Disease Control. Not only are the residents of these care facilities vulnerable, but staff members are also at risk. Over the past three weeks, there have been more than seven outbreaks of COVID-19 in Durham, Orange, and Wake County facilities. While skilled nursing facilities must require employees to wear face masks and test residents, these rules are not mandatory for continuing care retirement communities, adult homes, and assisted-living centers. Since Gov. Cooper did not mandate these centers had to take the same precautions as skilled nursing facilities, some may not be complying with these regulations.  They should for the safety of their residents and staff.

Some long-term care facilities in the Triangle area have received complaints about poor conditions in prior years; a pandemic could put hundreds more individuals at risk. In order to mitigate risk for both residents and caregivers, counties need to take steps to ensure their long-term facilities are being proactive and transparent about COVID-19 measures to residents, families, and other stakeholders. Facilities must: Keep COVID-19 from entering their facility; Identify infections early; Prevent spread and; Assess and optimize their supply of personal protective equipment, according to the CDC. Following these actions allows health officials to understand which long-term care facilities need urgent support and helps those in contact with residents and staff to take the proper precautions to mitigate further contamination with the coronavirus.

Many area nursing facilities observed the guidelines mandated by Gov. Cooper before their implementation, but dire concerns remain regarding the welfare of other long-term facilities like adult care homes and intermediate care facilities. Staff and residents are at great risk if they do not practice the same preventative measures as that of mandated healthcare facilities.  Asymptomatic individuals working for or visiting these long-term facilities could put hundreds at risk.

Our state and counties must focus on caring for the most vulnerable members of our community and the staff that risk their health every day to care for them.