Chronic issues in Michigan’s long-term care facilities were deepened in 2020 by the pandemic.
Public health measures often had the unintended consequence of forcing residents into isolation and loneliness. National studies show those conditions can have negative health impacts on older adults, and in some cases bring on an earlier death.
Michigan facilities responded by setting up window visits and video calls, often to the relief of family members. But those solutions — one cumbersome, the other tech-heavy — weren't feasible for all residents.
Salli Pung, the state's long-term care ombudsman, says some facilities found creative ways to keep their residents engaged.
"We’ve heard things like hallway karaoke, you know where the staff will just kind of break out in a song and get residents to sing along," she said. "I think it’s that spontaneity that people need, you know, something that’s exciting and different and engaging."
Pung says she’s heard from many families that their loved ones would rather risk infection than endure more lockdown.
Last fall, the Michigan Department of Health and Human Services allowed first outdoor, then indoor visits in long-term care facilities under the right circumstances, though in most cases those visits halted as infection rates rose and temperatures dropped.
2020 exposed the plight of staff in these facilities as well. Many stayed home because of sickness or fear of infection, while others stretched themselves thin.
Industry experts say even before the pandemic, the state of Michigan hadn't done enough to make frontline jobs in long-term care facilities attractive.
"Those frontline workers who are providing that hands-on care that we refer to as nurse aides or direct caregivers, they’re critical, and yet we pay them the same wage that we might a high school student who’s, you know, preparing fast food in a restaurant,” said Pung.
A nursing home task force recommended on August 31 that Michigan provide more career development opportunities for nurse aides. Assessing the national situation in nursing homes, a report from AARP calls on state and federal policymakers to “ensure that staff have health insurance, paid sick leave, and competitive wages so they do not need to work in multiple facilities to make ends meet.”
MDHHS and LARA have acted on some of the task force’s recommendations. For example, MDHHS is working the Michigan Public Health Institute and a crisis-intervention call center in Kalamazoo to develop a “specific mental health engagement strategy” for staff in long-term care facilities, according to the department.
As for the recommendation to establish a formal career ladder for nurse aides, MDHHS and LARA "have identified that it likely requires legislative changes to expand the nurse aide training program,” and therefore “falls outside of the scope of the current COVID-19 pandemic response.”
As of December 31, MDHHS was reporting 4,650 resident deaths and 61 staff deaths from COVID-19 in long-term care facilities. Without all facilities reporting, that's likely an undercount.