Opinion

We need to rethink nursing homes

There is a reason they became early focal points of the coronavirus outbreak in this country

Let's talk about the devil. He has been on my mind lately, and I somehow doubt that I am the only person of whom this is true. It is remarkable how little we actually know about the evil spirit who "tempts us because he hates goodness, and does not wish us to enjoy the happiness which he himself has lost." This is probably a good thing. But that has not stopped people from writing or telling stories about him. (For me the most chilling, and almost certainly the subtlest, is "An Encounter," from Joyce's Dubliners.)

If Old Scratch were going to appear in human form today, what sort of guise would he assume? Pace Sir Michael Jagger, I do not believe he would be a dapper, well-spoken gentleman. But I also think that even Satan would recognize that horns and hooves and a forked tail is overdoing it ("the devil is wiser than we are; for, being an Angel, he is more intelligent, and he did not lose his intelligence by falling into sin"). I would be afraid of encountering him not at a lonely crossroads at dusk but in the suburbs of a medium-sized American city, standing in the lobby of a McMansion complex with a name like "Shady Acres" or "Harvest Lane" or (insert algorithmically generated combination of vaguely pastoral adjective and noun here). It would be totally unsurprising to me to find that Satan is the owner of a for-profit nursing home.

Very few things about the American economy are capable of astonishing me. But even I must admit to being shocked whenever I recall that some 70 percent of nursing homes or — to adopt the somehow even more inhuman-sounding term of art — "elder care facilities" have been established as money-making ventures. Depriving workers of their just wages, preying on the vulnerable with usurious loans, even just outright stealing: all of these are ghoulish, but they exist for me safely within the limits of human greed. The idea that any man or woman could wake up one day dreaming of the opportunities for making a profit from the gruesome fact of senescence is too horrifying to admit of merely terrestrial origins. It must literally be from hell.

This at any rate is what both my instincts tell me and what one gathers from reading about the conditions in which many of the more than one million Americans abandoned in nursing homes live. Outbreaks of influenza and scabies are depressingly common. Federal authorities are routinely overwhelmed by the number of institutions that require 15 months of special oversight due to repeated violations of basic sanitary and other regulations. According to The New York Times, of the 524 nursing homes ruled "special focus facilities" (bureaucratese for illness-ridden dens of misery and abuse), more than 50 percent continue harming patients after federal oversight is removed. Meanwhile, the persons who work in such facilities — for many years one of the fastest growing sectors of the American economy — are themselves paid miserable wages and asked to work indecent hours.

There is a reason that nursing homes in Washington state and elsewhere became the early focal points of coronavirus in this country. A recent review by the Washington Post found that about a quarter of all deaths from the virus in the United States had taken place in such institutions. This is extraordinary even when one considers the apparent predisposition of the elderly to this and other viruses. It turns out that putting dozens of Americans with compromised immune systems in close quarters all across the country is a bad idea at the best of times and a nightmare when there is a pandemic.

It is no doubt pointless at the moment to speculate about what the consequences of the new coronavirus will be for American institutions. But I, for one, would be heartened if months from now it were widely agreed that the nursing home, like the madhouse of old whose inmates often included persons with Down syndrome and others who would live happily with their families today, is an institution that we can do without.

This is not just because of the very real risk to health posed by such facilities. There is something almost indescribably wicked about the idea of leaving a beloved parent or grandparent to the care of strangers. While I understand that some elderly people with serious medical conditions require the around-the-clock attention of medical professionals that nursing homes can (in theory anyway) provide, the vast majority would be better off living in the care of their own loved ones. There is a beautiful symmetry in looking after those who once looked after us, a chance, perhaps unique in all of human affairs, to show the people who love us most how much we love them in return.

That, I suspect, is why the devil, in his lair at Autumn Lake Estates, hates the idea so much.

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