[The government should require that owners give residents private
space — or it should take over the facilities and replace them with
small homes.]
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EVERYONE IN A NURSING HOME DESERVES A SINGLE ROOM  
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Margaret Morganroth Gullette
April 15, 2023
Boston Globe
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_ The government should require that owners give residents private
space — or it should take over the facilities and replace them with
small homes. _

Transporting a sick nursing-home patient to the hospital in Austin,
Texas,

 

This concerns all of us. At the start of the COVID-19 pandemic, in
2020, many residents of nursing facilities died because they were
crowded together in small rooms with other people, with often nothing
more than a plastic shield between the beds. If an aide unknowingly
carried the coronavirus into the cramped space and one resident caught
the highly contagious disease, other roommates could too. They were
all locked in, and their families and friends, social workers, and the
occasional ombudsman were locked out.

Most residents — despite being old and physically vulnerable —
have survived the pandemic. They were resilient. But residents of the
363 nursing facilities in this state are still dying every week from
COVID. They were individually special and well-loved, and their
untimely deaths are deeply mourned.

The pandemic has driven home what a 2022 report from the National
Academies of Science, Engineering, and Medicine highlighted: The
nation’s nursing home system is “ineffective, inefficient,
inequitable, fragmented, and unsustainable
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The best response to the sobering facts of danger and death would be
to deinstitutionalize as many current long-term care residents as
possible, returning them to their communities. That’s what most
people yearn for. Expanding a government program called Money Follows
the Person
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make that possible for more long-term care residents. The program also
lowers costs. But because it is not possible to empty the nation’s
15,000 nursing homes of 1.2 million people, many of whom need care up
to 24 hours a day, what then?

The answer is architectural, medical, and ethical. Each person should
get a private room if they want one — not a room with two beds or a
single bed in a dormitory. Being in their own room keeps vulnerable
individuals safe. It makes residents feel more like human beings of
value. Sweden and Denmark have moved to this higher standard.

In Massachusetts, the Department of Public Health mandated in 2021
that there be no more than two people to a nursing home room. That is
better than before but still leaves the residents unhealthily
confined. The space for a bed, a tiny chest of drawers or locker, a
night table, and a chair is allowed to be as small as 90 square feet.
Two-person rooms provide no privacy. A roommate may snore, cry out in
her sleep, drift into your space, watch TV 12 hours a day, take one of
your few remaining precious possessions.

Only Dickens could do justice to this inhumane minimum. The federal
government requires even less, only 80 square feet per person. A
resident could be lying less than 6 feet of shared air away from the
person in the next bed. Such regulations exist to prevent nursing
facility owners from going even smaller.

Almost all the owners of the facilities in Massachusetts agreed
without a fuss to the two-to-a-room mandate, even though they lose
some Medicaid funding, which is allocated per head. The industry here
now has many empty beds, partly from deaths, partly because potential
clients are fleeing. Thirty-one owners refused to comply with the
mandate and have sued the state to prevent it
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Four, all in the western part of the state, are closing
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than giving their residents more space.

When owners close facilities, the residents are often unable to find
other accommodations. Often the available choices are badly run or
farther from family. Good people in state government or
nongovernmental organizations struggle to find them another placement.

There are two solutions. The state could build “small houses,” as
it will be doing in a $400 million renovation of the infamous Holyoke
Soldiers’ Home
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This approach, which is also known as the Green House model and
admired in many states, cares for 10 to 12 people, each in a single
room. One study, of three-quarters
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other small houses around the country, found that _no one_ in that
sample of centers died in that first terrifying spring and summer of
2020. In small houses, retention of aides improves. Residents’
health improves. Many emergency room visits are prevented; many
illnesses are more safely treated in-house. Small houses offer the
safety and dignity our elders deserve.

If we can achieve this for the veterans in Holyoke, why not for other
vulnerable nursing home residents who need the same kind of skilled or
constant care?

The second solution would be for the state to take over failing
facilities. Many citizens dislike “lemon socialism” — when the
government takes responsibility only for _failing _capitalist
enterprises — but the situation of chaotic multiple closures and a
wealthy pigheaded industry demands radical thinking.

Reformers have been begging for comprehensive improvements for
decades. The state has some powers, but all over the country, the
lobby is strong. Many nursing facilities are part of a
multibillion-dollar industry and must provide high earnings for
shareholders. A conscientious legislator aiming to improve grim
conditions has at her ear an industry lobbyist whispering about
helping her campaign — while he holds the threat of a home’s
closure behind his back like a grenade.

Some of the two dozen bills before the Massachusetts Legislature aim
to raise the minimums of care hours and improve working conditions.
Giving residents more space without providing enough trained and
well-paid aides would still be a guarantee of continuing misery,
morbidity, and mortality.

Under Governor Maura Healey, can the state finally be trusted to serve
the elders in its charge with decency? By running refashioned
facilities humanely and honestly and using guaranteed Medicare and
Medicaid funds, the state could in one stroke save money and improve
conditions.

We should all seek age and disability justice. Given a vast
retirement savings crisis
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ill health [[link removed]], Gen X and
Gen Z may also need a bed someday.

_Margaret Morganroth Gullette, resident scholar in the Women’s
Studies Research Center at Brandeis University, is the author of
“Ending Ageism, or How Not to Shoot Old People.” Her forthcoming
book is “American Eldercide: How It Happened, How to Prevent It.”_

* nursing home care
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* eldercare
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* senior health
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