ONLINE — Judy Johnson, a nurse at a long-term care facility in New York City, did not pull punches.

“Why were essential workers’ lives put at risk? Why did so many nursing home patients have to die?”

The issue at hand: “Nursing homes were disproportionately affected during the pandemic,” she said. “They were given so much less but were required to do so much more.”

Johnson was a panel member in the Long Term Care Community Coalition’s (LTCCC) October town hall on the future of long-term care.

What was behind the disaster? Both the response to COVID-19 and problems that have been around for decades, panelists said.

“Inadequate staffing and poor infection control,” made worse by the pandemic, said Richard Mollott, executive director of the LTCCC. The nonprofit works to improve the quality of care and improve life and dignity for the elderly and disabled in long-term care.

“Nursing homes are being run by millionaires and even billionaires,” he said, “who are taking a big cut of payments they receive to provide care, and then turn around and say they don’t have the money to hire more staff or to pay a living wage.”

It started before the pandemic, “even decades before,” said Assemblyman Richard Gottfried (D-75), who chairs the Committee on Health. “Short staffing, short staffing of health departments and inspectors of nursing homes, lax attitudes on enforcement, inadequate funding by Medicaid” are all issues, he said.

Lack of PPE is another, said Johnson. Staff who worked endlessly and covered for co-workers who became ill. “The analogy that health care workers are fighting a war is quite true,” she said. But they fought “without ammunition, our PPE, and many of our co-workers made the ultimate sacrifice.”

Gottfried brought up Cuomo’s March 25 order that required hospitals to discharge patients back to the nursing home. To some extent, he said, it made sense: nursing home beds are expensive. (That early in the pandemic, hospitals were expecting to be deluged, and nursing homes could hopefully care for their patients better.)

But, Gottfried said, the Department of Health should have made sure that care could be provided. Subsequent hearings found “significant shortages of PPE and major problems with visiting regulations,” he said.

Also, visiting rules. Visitors “provide care, they provide service, emotional and mental support,” and in some nursing homes, patients who don’t have visitors receive poorer care.

Groups representing the owners of nursing homes, both for-profit and not-for-profit, praised the health department for consulting them, said Gottfried. “The unions representing the workers, the families, the residents... none of them thanked the health department for communicating with them. That spoke volumes.”

Nursing homes care for people with cognitive loss and significant physical illness, said social worker and psychotherapist Cathy Unsino. Top-down management seems like “the safest and most efficient approach.” But “nothing is further from the truth.”

It’s not easy to keep homes viable when Medicaid—which pays for the majority of long-term care—is threatened, she added.

Ultimately, said Johnson during her part of the presentation, “the responsibility rests on the powers that be to ensure that this does not happen again.”

The town hall was also about solutions...

... And there were many suggestions.

From Assemblyman Richard Gottfried:

• Require nursing homes to spend a certain percentage on direct care.
• Watch the increased private ownership of nursing homes. “It’s pretty well-documented that for-profit nursing homes provide much worse care than not-for-profit nursing homes.” He suggested a moratorium on new for-profit homes.
• A safe-staffing bill that would require a certain amount of nurses per patient.
• Repeal changes to Medicaid that could make it harder for patients to qualify for home health care.
• Better fund the ombudsman program that protects patients.

From nurse Judy Johnson:

• Nursing homes must be adequately funded to ensure safe staffing ratios.
• They must commit to higher standards in caring for patients.
• Do not forget preventative care.
• “Affordable health care should be guaranteed to each and every citizen regardless of ability to pay,” Johnson said.

From psychotherapist Cathy Unsino:

• Nursing homes have “a prescriptive, a controlling, a top-down management approach.” Instead, she called for an “interconnected, relational” nursing home culture.
• She also emphasized the importance of seeing residents as human beings, of the stories behind each face. “As they become known, they become more valued as an individual.”