A crisis in quality care: Nursing homes offer ineffectual response to the ill and dying

May 7, 2020 12:29 am


By Everett Ressler

The globally reported health emergency in the Accordius Health long term care facility in Harrisonburg remains a situation for which immediate action is still needed.  The situation there uncovers a “crisis in quality care”, an issue deserving greater priority in response to the Covid-19 pandemic.  

Accordius Health is a privately owned, long-term care center in Harrisonburg with a capacity of 117 nursing beds.  Most or all residents have contracted, or are assumed to have, the COVID-19 virus. As of this writing, most of the residents are reportedly ill, some acutely, and at least 22 residents have died, many in their beds (some have been taken to the local hospital).  Many staff contracted the virus and became ill; others quit.  The institution struggles even more to meet the needs of this situation. This combination of factors has created a crisis in the quality of care.

Sufficient staffing has not been mobilized to ensure quality care and treatment.

While it does not excuse institutional culpability, it is perhaps understandable that the swiftness and severity of unfolding events temporarily overwhelmed the nursing home; the same is happening in other institutions and possibly in families caring for ill loved ones.  What deserves consideration is the lack of rapid support from local, state and federal systems to effectively counter the dire situation of care in an overwhelmed situation.

Every emergency response is dependent on heroic action – action taken to benefit others even in the face of personal risk.  But heroic action without effective public supportive systems is not enough.  

Why is the corporation that runs Accordius Health unable to mobilize sufficient help?  The state health department sent in Medical Reserve Corp volunteers, a helpful but insufficient action.  Why haven’t city authorities and state systems been able to ensure that good quality care is mobilized?  Why haven’t the medical services been able to ensure that all who are sick are provided the best medical care possible and hospitalization when needed?  Why haven’t the federal systems moved quickly to solve a life and death situation? Why isn’t the public speaking out at the lack of response that results in mothers and fathers suffering or dying in awful conditions? 

Is it because we have not given sufficient attention to the issue of quality care?  Is the lack of rapid corrective support linked to the nature of the corporation paid to provide the service?  What role does the economic situation of the residents play in decisions regarding hospitalization and care?  To what extend does use of gag orders by such institutions prevent staff and volunteers from speaking out about conditions? 

Five immediate actions are needed:

  • The Accordius nursing home should be declared and treated as an emergency to mobilize the extraordinary efforts required. 
  • Quality care and treatment of the needy ill and dying should be made a top priority of public services.  Conversely,  gaps obstructing the achievement of quality care and treatment should be made a key determinate in the nature of support provided by local, state and the federal authorities. 
  • The caregivers and medical staff within the nursing home should be given adequate personal protection materials, and remuneration commensurate with the risks and duties.
  • The issue of gag orders in private and public services that limit public knowledge in these dark places should be rolled back; or “whistle blower” protections strengthened. 
  • An analysis should be undertaken of how and why the public systems have so failed to provide a timely corrective response when quality care was most needed. 

Poor care and excellent quality care are to be found both in expensive institutional care situations and in institutions of last resort.  If the quality of care is the primary indicator to stimulate action, then supplies and equipment needs will also be met.  But if supplies and equipment are the criteria on which response is judged, quality of care can be the casualty.  

This tragic situation shines an unflinching light on unsavory attributes of our health and governance systems.  We are better than this.  Our public systems should be expected to uphold the value and dignity of each human life and compassion in the time of need, evidenced in good quality care and treatment, including for the sick and elderly, people in institutions, care workers and the poor, and for you and me.  

Everett Ressler, a longtime chief with UNICEF, is a practitioner, educator, and researcher in the humanitarian field, with specialization in early warning, preparedness and response in emergency situations. His career includes supporting efforts in major emergencies internationally, putting in place early warning and preparedness systems globally with UNICEF, and co-authoring a foundational study on the care and protection of unaccompanied children in emergencies. He worked with UNICEF, the Asian Disaster Preparedness Center, Norwegian Save the Children, and the KonTerra Group, in Europe, Asia, Africa and the US. He is currently Executive Director of HDPI, Inc, a global network of people working on humanitarian concerns manged from Harrisonburg.


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