America is in the middle of an affordable housing crisis. According to FreddieMac, the US has a shortage of 2.5 to 3.3 million homes. Why don’t we build more homes? Because these homes are needed by families with the lowest income. Where it makes economic sense for a developer to build a new home, it makes sense to build the most expensive home the market will bear. That’s why big American cities have an affordable housing crisis.

Consider San Francisco. The cost of rent has skyrocketed, leaving thousands homeless. SF… a modern American city… have families living in tents and the streets of the city. Teachers… full-time, unionized, city workers… cannot afford housing. A study by Trulia found that less than 1% of teachers in San Francisco can afford housing in the city. And SF teachers are some of the highest-paid teachers in America!

Housing is undeniably a crisis in 2020 America. But it’s not the only crisis. Healthcare… cost, quality, and distribution… is a cluster of crises. If you were to draw a graph, with a line for healthcare and a line for housing, where they meet is America’s biggest cluster… ahhh …. crisis. This is where American’s live in nursing homes and care centers.

Ever since the demise of Willowbrook and the film “One Flew over the Cookoo’s Nest” America has been deeply suspicious of government-run institutional care (more often institutional warehousing). Once Americans understood the degree of mismanagement and indifference in these institutions, we began shutting them down.

While we were effective at tearing old, primitive institutions, we have as yet to fund the type of community-based, humane care services that “de-institutionalists” recommend.  If you can afford it, there are some very nice care facilities, but few can afford them. If your care will be paid for my Medicare alone, the quality is not as good (and some times quite bad). Even so, the wait for ANY  bed may take a decade or more.

And that was before COVID-19. It’s easy to understand how the government can neglect low-income housing. But it’s not entirely their fault. The world has changed and governments are notoriously slow at recognizing change. America is aging. More citizens are over 65 years of age than at any point in our history. And, if you live long enough, you’ve going to develop disabilities.

Miraculous improvements in health care are responsible for our healthier, longer lives. Today’s older Americans routinely break athletic records made by 20-year-olds a few decades earlier. But if you have always been sickly, disabled, or were born with the wrong genes, your health issues could dramatically increase as you age.

Our longer lifespans mean an extra decade of dealing with the limits of old age, more physical limitations as we regularly live into our 90s and beyond, and mental disabilities like Altzheimers. If you began life with a disability like Autism or Down’s syndrome, lie expectancy has doubled or even tripled since the 20th century. But… this was all before COVID-19.

In some facilities the coronavirus was like a living beast, killing 30%, 40%, or even 50% of residents, according to Christopher Laxton (executive director of the Society for Post-Acute and Long-Term Care Medicine). Why the sky-high rates? It will take time to say definitively why residents died and why there was so much variation, but here are the “usual suspects”…

Occupancy: Nursing homes are expensive, yet 1.5 million Americans live in nursing homes. In order to manage costs, two or more residents may cohabitate a single bedroom. It doesn’t take a lot to understand how shared rooms spread infection. When you have 20 or 30 infected patients, what do you do with them? Leave them in the shared room? There are no empty rooms to separate them? You could ask another nursing home to take your infected presidents, but in the middle of a Pandemic do you think that will work? Families are going to want answers to these questions… and where homes have few answers, families will probably move their loved ones to another provider.

Bathrooms: A single or double occupancy may have a shared bathroom. Other residents may share a bathroom with an entire floor, or building. Seniors with dementia or physical disabilities need assistance in the bathroom, exposing nurses and janitorial staff to infectious matter, risking the transmission of a virus through the entire facility. As more residents sicken and die, the staff becomes overwhelmed and they too become infected, leaving too few workers to follow proper cleaning procedures.

Air: We are waiting for research on how readily COVID-19 spreads through the air. Even if COVIDS-19 does not easily airborne, the next pandemic spread this way. Modern heating and cooling system have inexpensive options to filter and sterilize the air. However, many nursing homes are older, and few have focused on modern air purification technology.

Laundry: Every millennial uses their grandparents’ behavior as a baseline for what is bad and outdated. But for argument’s sake, let’s assume our grandmothers ran the laundry in a care facility. Grandma would take your sheets and linens (all-white, always white) and clean them in a toxic combination of boiling hot water, chlorine bleach, and environmentally irresponsible detergents. Next, she would fry everything in a superheated dryer or put them on a clothesline for the sun to irradiate them in UV light. Good for the environment? Hell no! But it kills germs dead! Gentler cleaners, water-saving washers, and energy-saving washers and dryers may save the environment, but they don’t kill COVID-19. Instead, a central laundry can spread infections materials throughout a nursing home.

Visitors: The pandemic and social distancing put an end to family visiting time. But before the lockdown, visitors may introduced COVID-19 into the care facility. Handheld electronic thermal detectors are cheap (under $100) and easy to use. Airports have used advanced thermal scanners that cover a whole room at once. The latest devices have built-in Artificial Intelligence to eliminate false positives (you were standing outside in the sun, or just finished exercising) and focus on individuals most likely to be infected. This technology is almost never used in nursing homes.

Now what? Almost likely, we will see years and years of lawsuits. The very best nursing homes, with the very lowest infection rates, will have few or no lawsuits, and be in even higher demand. Sub-average nursing homes will be at risk of being closed. Just keep in mind that “sub-average” means 50% of all nursing homes.

1.5 million Americans live in nursing homes. Hundreds of thousands of these beds could be shut-down due to lawsuits and new regulations. Will a new generation of expensive, more secure nursing homes be built? Possibly. Will these new homes be affordable for someone with just Medicare? Almost surely… they will not!

There is no question that some homes will shut down for their recent poor performance and new affordable nursing home beds will be almost impossible to find. As the lockdown eases, families are going to want answers about the thousands (possibly tens of thousands) who died in nursing homes.

What about you? Do you have a loved one in a care facility? How well did they work during the Pandemic? Do you want to stay with your provider? Talk to us! Tell us your story!