The Clarion Ledger (September 8, 2020) reported that Gloria Hill, a health provider at one of Mississippi’s largest nursing homes, announced she could no longer take it, and is leaving and moving to California, never to work in a nursing home again.
She describes how horrible it is, watching her patients die alone without their families, and being locked down by this so-called pandemic. Those of us doctors that have been in combat situations will quickly recognize that this is very typical of combat fatigue, or as we would call it today, “burn out,” or post traumatic stress.
This issue must be addressed not only by the medical profession, but also by those in government who have helped impose these conditions.
As a long-time geriatrician and medical director of one of Mississippi’s largest nursing homes, I have studied this problem closely.
Here is what must be done:
1. We need to quit focusing on the positive tests, because as some of us long suspected, and as we now know, the PCR tests give a hugely inflated number of false positives. They only confirm that there are COVID-19 RNA fragments present, which means the patient has or once had the infection. The “positive” test results, in other words, do not confirm that the patient is now infected or capable of spreading the virus. These PCR tests can remain “positive” for many months.
But those false positive results are then used to justify continuing the clamp-down on patients and nursing homes, and then in turn to inflate the true number of “COVID deaths.” In short, we are allowing bad data to drive our public health and political response to the virus.
This is why the powers that be are imposing ridiculous rules about testing and now re-testing people who have already “tested positive.” This over-testing then drives further demands to keep things locked down, so that our patients do not have access to their families.
2. Denying patients access to their families and friends is unethical and violates state laws against elder abuse. It is a violation of the right patients have to be with their families, and forces them to die alone. Not only that, but we providers are observing every day how this lack of contact with loved ones speeds the mental and physical decline of our patients. Stripping patients of their friends and family members is a denial of proper health care, and leads to deterioration and early or even unnecessary deaths.
3. Law enforcement and state medical ethics entities must investigate this ongoing elder abuse. Those public health officials who have, in effect, ordered these poor people to die in isolation without family members, must be brought to justice. There ought not to be immunity from our elder abuse statutes just because public officials decide to prohibit proper health care for institutionalized patients.
4. Because there is no comfort available through family means during these unnecessary lock-downs, health care providers’ morale and mental status are damaged by having to watch this happen to their patients.
On top of the harm all this does to both our patients and staff, the oppressive burden of the additional paperwork, testing, operating under lock-down conditions, and exaggerated climate of fear, makes almost impossible the already stressful environment of health care providers in the nursing homes.
These factors are driving the huge exodus of heath care providers just when they are most needed.
5. Patients who are possibly terminal from the viral disease require a very high level of care, including doctors, nurses, aides, and equipment in-house that is necessary to care properly for these complex and perhaps dying patients. This sort of critical care cannot be left on the backs of nursing homes, whose purpose, staffing, and finance are not designed to provide such care.
Hospitals are the proper health care venue for deadly virally infected patients, not nursing homes. Truly critical patients must be evacuated from nursing home settings into hospitals to stay until they recover or pass away. Hospitals have already set aside wings for people with the viral disease. They must set up programs whereby family members can be brought in to see their loved ones, and be with them to comfort them during their difficult, and possibly last days of life.
6. The pitiful reimbursement rates for CNAs in Mississippi is an absolute scandal. It is scarcely above minimum wage, which imprints upon the CNA that she is really not very important and not very well appreciated.
Other states don’t have this problem. Some states provide starting pay at $14.00 an hour. We are not serious about retaining trained health care workers if we won’t pay them a living wage.
7. Churches and religious groups need to get together to train and make available chaplains, who can go to these nursing homes regularly and minister to the spiritual needs of the patients and the workers there.
8. Perhaps nursing homes could hold monthly memorial services for those who have died, displaying their photographs, with all the staff and patients gathering. This would greatly help in dissipating the feelings of guilt, shame, and sorrow of the workers, who knew these people so well after years of caring for them.
In conclusion, there is little sound scientific evidence to support the view that lock-downs and mask wearing help stop the spread of respiratory viral infections, including COVID-19. Instead, this virus is going to spread until some sort of herd immunity level is reached, then it will disappear, as has happened with prior epidemics.
Meanwhile, we must stop violating our patients’ rights, exhibiting such unnecessary cruelty against them, just because some bureaucrat government agency wants to exercise power to force people to behave in ways that are unnecessary, foolish, non-productive, and without good, solid scientific evidence to support them.
If those who are in authority do not take prompt measures to attend to this situation, our nursing homes will sink back to the level of the old county poor houses – black holes where people go to die, with very little care, and little interest by health care professionals to play any part in.
John Hey, MD, AGSF