Nursing homes can help counter pandemic’s toll on older Americans, ethicist says

June 2020

June 22,2020

The forces of nature and the decisions of humans have combined to make life for older Americans who are in long-term care particularly precarious during the coronavirus pandemic, Fr. Myles N. Sheehan says.


While the bodily changes that come with aging make older adults more susceptible to contagious diseases like COVID-19, Sheehan says that natural phenomenon has been exacerbated by the fact that many seniors are crowded into nursing homes and assisted-living centers with lax infection control practices and little means to social distance.

He believes those conditions help explain statistics showing that while only 0.6% of American reside in those facilities, 42% of all COVID-19 deaths have been from this population. He also thinks that if ethically based best practices were closely followed at long-term care centers, many lives could be saved.

"In other words, we have a duty to care. We have a duty to respect life," Sheehan says. "If the place isn't clean, then we're not respecting life."

Sheehan is a physician, bioethicist and lecturer at the Pellegrino Center for Clinical Bioethics at Georgetown University. He is also the provincial delegate for senior Jesuits Maryland and USA Northeast provinces. He was the featured speaker on June 11 at a webinar titled "COVID-19 and the Elderly: Ethical Issues and the Pandemic." It was part of a series on Catholic ethics and the challenges of the pandemic co-sponsored by CHA and Georgetown University in cooperation with the Pellegrino Center.

Macro issues at work
Sheehan blames the pandemic's heavy toll on long-term care residents in part on "macro issues." Those include poor regulations that allow living centers to house multiple residents in one room with a shared bathroom; workers who are forced by low pay to work at multiple centers; and low reimbursements from government programs to centers that care for the poor.

During the pandemic, he says, those ongoing issues have been worsened by several novel factors, including the scarcity of personal protective equipment needed to keep the virus from spreading and orders by some states, such as New York and New Jersey, that facilities not turn away patients with active COVID-19 infections.
Sheehan refers to a commentary published May 27 by the New England Journal of Medicine that says nursing homes were "unstable" even before the COVID epidemic hit, in part because of weak enforcement of regulatory policies. "They were like tinderboxes, ready to go up in flames with just a spark. The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy," the authors write.

"COVID-19 has exposed the cracks in our tenuous system of providing and funding long-term care, and there are no easy fixes," the article says. "But we believe we are well past due for comprehensive policies that take the care of aging Americans seriously and fund it accordingly and in a wider range of settings."

Urging individual action
Even if the broad policies for long-term care are out of the hands of individual facilities and those who work there, Sheehan says they can still act on their own to save lives and improve the quality of those lives. They can do that, for example, by stocking up on PPE and instituting aggressive testing protocols and strict controls to halt the spread of infections, he says.

They can also improve patients' lives by coming up with ways to keep those patients connected with their loved ones despite the well-intentioned limits on visitors, Sheehan says. One suggestion he offers is to hire technology-savvy students who can set up virtual connections between residents and their relatives.

Sheehan says that isolation has been necessary during the pandemic for the safety of high-risk residents of nursing homes and it will continue to be needed to prevent them from becoming infected. "But can we be creative so we can reduce the risk of loneliness and of taking away the joy out of the lives of many of our older residents?" he asks.

The webinar series will continue at 1 p.m. Eastern time June 25 with a discussion on "Developing Treatments and Vaccines for SARS-COV2: Ethical Challenges to Challenge Trials."

Prior coverage of this webinar series

On whether to publicly identify COVID patients, Catholic ethicists can disagree

Reasoned action is needed to restart clinical training for medical and nursing students, ethicists say

Surveillance tools offer great promise, perils amid pandemic, ethicist says

Constraints of pandemic care are potential triggers of moral distress, ethicists say

Crash course: Sully offers inspiration for applying organizational ethics in a pandemic

Resuscitation considerations go beyond patients amid pandemic, Catholic ethicists say

Putting workers first for some treatments amid pandemic is justifiable, ethicists say



Copyright © 2020 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2020 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.