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A Broken Elder-Care System Crumbles Further Amid COVID-19

Nursing homes are the source of more than 40% of North Carolina’s reported COVID-19 deaths so far. These facilities house some of our most vulnerable community members, many of whom need personal care — things like help going to the bathroom or brushing teeth. As of Tuesday, the data from the North Carolina Department of Health and Human Services shows that 48 nursing homes and 20 residential care facilities (which include adult and family care homes) have outbreaks

Host Frank Stasio talks to Lisa Leatherwood, an administrator at the facility Silver Bluff Village  in Haywood County, about how she and her staff are working to protect their residents. So far, that facility has no confirmed cases of COVID-19. Stasio also talks to Thomas Goldsmith, a longtime journalist and reporter for North Carolina Health News who covers aging. Goldsmith shares his investigation into staffing at facilities that have seen outbreaks and details the statewide landscape of elder care facilities in North Carolina.

We also hear from Donna Denton, an 89-year-old assisted living resident in Raleigh; Eileen Hume, a Charlotte-based occupational therapist who specializes in elder care; and Darlene Chee, a family nurse practitioner working in palliative care in western North Carolina.

Interview Highlights

Chee on what makes detecting COVID-19 symptoms more difficult in dementia patients:

It's hard for a patient to say that they're feeling short of breath. It's hard for a patient to tell you they have a fever. And people of advanced age don't tend to mount fevers. So there's this kind of perfect storm of pretty difficult aspects.

Nursing home residents in the hallway, sitting outside their rooms.
Credit Courtesy of Lisa Leatherwood
Silver Bluff Village residents play hallway bingo, a way to socially distance while still being together.

Leatherwood on what makes COVID-19 harder to prepare for than other respiratory diseases:

I think the difference is we're not used to the length of time that someone could be without symptoms. So normally with flu within a day or two, you know the person's sick. You isolate them. You isolate everybody they've had contact with. But we're looking at a two-week period, and then some people may never have symptoms. And so the problem is, by the time you realize you've got a problem, it may have spread much more than a normal outbreak of flu, norovirus or whatever that we're used to preparing for.

Leatherwood on the difficulty staffing nursing homes:

I would love to be able to pay $15 or $20 an hour, but the money's just not there. - Lisa Leatherwood

It is a labor intensive business. And it's very difficult because we're all pulling from the same group of staff available: the nursing assistant registry. You have to be on that to be able to work as a nursing assistant in North Carolina, and the numbers are flat. So every year, there's more jobs created, but there's not more nursing assistants on that registry to pull from. So we ended up actually going to Puerto Rico to bring some staff in to try to supplement.

Goldsmith on the needs of the elderly:

We're talking about what older people want. Well, first of all, older people are just like you and me. And what they want is just what you and I would want. They want to feel the sun on their face. They want to have really good food, like they've eaten all their lives and often prepared for themselves. They want to have people to talk to and things to do. And so many of those elements are just not really provided at the level that you or I would want, were we there in the facility.

I think we have a problem in the entire country where the average person might not know — and certainly leadership doesn't necessarily understand — the quality of life of an elderly patient. - Darlene Chee


Amanda Magnus is the executive producer of Embodied, a weekly radio show and podcast about sex, relationships and health. She has also worked on other WUNC shows including Tested and CREEP.
Longtime NPR correspondent Frank Stasio was named permanent host of The State of Things in June 2006. A native of Buffalo, Frank has been in radio since the age of 19. He began his public radio career at WOI in Ames, Iowa, where he was a magazine show anchor and the station's News Director.
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