COVID-19 and 2021: Looking into the Crystal Ball

Published in the Pawtucket Times on December 28, 2020

Novel coronavirus (COVID-19) cases continue to surge across the nation.  Yesterday, nearly 18,986,236 Americans have contracted COVID-19 with over 331,930 dying, says the John Hopkins Coronavirus Research Center. Projection models say that deaths may spike to over 500,000 by March 2021.

As 2021 approaches, the Centers for Disease Control and Prevention (CDC) has announced that 1.9 million people throughout the nation have gotten a dose of COVID-19 vaccine.  CDC also warned that a new variant COVID can be more rapidly transmissible than other circulating strains of SARS-COC-2.

Even with the dissemination of a safe and effective COVID-19 next year, many experts say that COVID-19 will around for a long time.  We are now seeing New Year predictions being made about COVID-19’s future impact on the delivery of care to seniors. The New York-based Aloe Care Health, one of the world’s most advanced voice-activated medical alert and communication service for elder care, recently brought seven experts together, to make predictions as to how COVID-19 pandemic will impact the provision of healthcare, insurtech, caregiving services and aging services in the upcoming year.  

Predictions from Health Care Experts

According to a statement released by Aloe Care Health on Dec. 22, these invited experts see a ‘Better Year Ahead.”  Here are some of their insightful predictions: 

Jay H. Sanders, M.D., CEO, The Global Telemedicine Group, member of the Aloe Care Advisory Board, observed: “The best examination room is where the patient lives, not where the doctor works. And, any variant of the following: telemedicine is to healthcare as Amazon is to shopping; as Netflix is to the movie theater, and as on-line banking is to your local bank.” 

“While 2020 turned the world upside down, it also revealed the massive gaps and deficits that exist in caregiving and senior care. I think 2021 will be the ‘Year of the Caregiver’ as companies, the senior care industry, and leading service organizations come to terms with how to best serve these underpaid and undervalued everyday heroes,” stated Amie Clark, Co-Founder and Senior Editor at the Clackamas, Oregon-based The Senior List.  

Donato Tramuto, Author, Chairman and Founder of Health eVillages, noted: “After a year highlighted by the devastating impact of COVID-19, vaccinations and other measures bring us hope to combat the virus in 2021. However, it is also important that we pay attention to the unintended consequences of COVID-19. As we safely social distance to decrease exposure risk, we must find ways to intervene and deal with the social isolation and loneliness caused by the lack of connection. I expect the next decade to bring innovations in business and healthcare to help us rebuild our community of connections and address the loneliness epidemic.” 

“Aging-in-place will continue to gain traction. Remote patient monitoring, personal emergency response technology, and other health matters will be addressed in-home. Health Insurance companies will redouble efforts to advance digital care management, using data to prevent acute health episodes. Covid19 will accelerate the digital adoption of remote patient care and communication. Masks will be required or desired in many public forums for much of 2021. Sadly, social distancing may be here to stay,” predicted Bob Hurley, Executive Advisor in Digital Health, eHealth; member of the Aloe Care Advisory Board. 

“COVID has demonstrated the power of telehealth to support health care workers, the older population and caregivers. It is amazing to see the adoption rate grow amongst all ages and the importance it addresses for the safety and independence of vulnerable populations. I expect innovative concepts to grow and expand in 2021 that will further empower providers and the population as a whole to live healthier and fulfilling lives,” anticipates Vicki Shepard, Health and Aging Expert, co-founder of Woman Business Leaders (WBL): Women Leading Healthcare 

“The last several months have given every one of us a dose of radical empathy for people who are isolated and alone. My profound hope is that this translates into better care for one another, especially older adults, in 2021 and beyond. And as our population ages overall (more than 10,000 of us reach 65 every day), I hope too that we collectively evolve beyond so many limiting, false, and often unconscious preconceptions about aging. This starts with products that are more thoughtfully, more beautifully designed, and extends right through to our everyday interactions.” Says Ray Spoljaric, CEO and Co-Founder, Aloe Care Health  

Finally, Jordan Mittler, Director and Founder of Mittler Senior Technology, adds: “In 2021, older adults will continue to rely on simple technology to interact with friends and family, as well as to function independently. Normalcy will take time to resume, and senior communities need to use home devices to function in society. Online shopping, online healthcare, online banking, and virtual communication will be major components of the lives of elders as we go into 2021.”  Jordan leads an inspiring group of teens teaching elders how to use technology to improve communication and daily activities. 

Predictions from a Rhode Island Physician

Over the months, Michael Fine, M.D., Chief Health Strategist, City of Central Falls, says that the COVID-19 pandemic made seniors to feel isolated and vulnerable. “As people get vaccinated it will let people feel more comfortable about moving around.  But January and February will be very hard month,” he warns. 

As we move into 2021, Fine predicts that “many people will think twice before moving to congregate settings of any sort, and we will live with new and burdensome precautions for a long time.”  He thinks that Rhode Island will lose some of its assisted living facilities and nursing homes due to the ongoing pandemic.  

Next year, Fine recommends that older Rhode Islanders stay close to home until they are vaccinated and use food delivery services where possible.  “The best way to cope is to use the telephone a lot and go out walking as much as possible, and to listen to lots of music and read a lot,” he says.   

“COVID-19 has changed how we live our lives.  Wearing a face mask and social distancing are the new normal. “I think we will go back to life as it was.  But it will take 3 to 5 years,” says Fine.   

Fine, who formerly served as the state’s Director of Health, has some thoughts about combating the COVID-19 surge in the Ocean State.  “My advice continues to be to shut bars and restaurants for indoor dining and to keep schools open, until we drop to below 2 new cases/100,000 population per day.  Everyone who works outside their homes should be tested twice a week, and every employer should make sure that’s happening, and everyone positive should be isolated for 10 days, and all contacts go into quarantine. We need employers to take the lead on this, because government has not been able to get it done,” states Fine.

Spotlight on Government Action

“It is time we all look hard at our political leadership, which has chosen to keep factories, bars and restaurants open, at the cost of hundreds of lives and a robust economy, while the virus is spreading in our communities, hitting people of color hardest.  We need to look at ourselves and our faith communities as well, allowing this to happen instead to speaking up for the sanctity of human life,” says Fine. “Democracy depends on the consent of the governed.  We all went along.  This response represents the most fundamental kind of institutional racism, the kind that puts profit in front of the lives of people of color and the communities in which people of color live,” he adds.

“All level of government failed.  SARS-CoV-2 is a cold virus.  We remain completely unprepared for a truly dangerous virus, which is evolving somewhere around the world, and will hit elders and people of color hardest again,” warns Fine. 

Bill Protects Nursing Home Residents, Providers

Published in the Pawtucket Times on June 1, 2020

This month, U.S. Senator Bob Casey (D-PA) and Senator Sheldon Whitehouse (D-RI) throw a bill in the legislative hopper to slow the spread of novel coronavirus (COVID-19) in nursing homes. It’s a common-sense legislative proposal and needed.

A recently released Kaiser Family Foundation study reported, “COVID-19 has had a disproportionate effect on people who reside or work in long-term care facilities, including the 1.3 million individuals in nursing homes; 800,000 in assisted living facilities; 75,000 in intermediate care facilities; and 3 million people who work in skilled nursing or residential care facilities.”

Combatting COVID-19 in Congregate Settings

With COVID-19 quickly spreading throughout the nation’s nursing homes and intermediate care facilities, Casey and Whitehouse’s legislative proposal, S. 3768, The Nursing Home COVID-19 Protection and Prevention Act, seeks to provide needed resources to facilities to protect frail residents and staff. Residents in these facilities are among the most vulnerable because of their age and underlying medical conditions. According to an analysis conducted by Gregg Girvan for the Foundation for Research on Equal Opportunity, as of May 22, in the 39 states that currently report such figures, 43 percent of all COVID-19 deaths have taken place in nursing homes and assisted living facilities

As more than 20,000 nursing homes residents and workers have died due to COVID-19, according to the latest reports, on May 19, 2020, Casey and Whitehouse introduced S.3768 to help states, nursing homes and intermediate care facilities put the brakes on the spreading of the deadly COVID-19. The legislative proposal, with 14 Democratic cosponsors (including Rhode Island Senator Jack Reed}, would help states implement strategies to reduce the spread of COVID-19 in congregate settings, including through the purchase of personal protective equipment (PPE) and testing and to support nursing home workers with premium pay, overtime and other essential benefits.

S. 3768 was referred to Senate Health, Education, Labor, and Pensions. As of March 30, 2020, a Congressional Budget Office cost estimate or this measure has not been received.

Days after the introduction of 25-page Senate legislative proposal, a House version (H.R. 6972) was introduced by Rep. Ana G. Eshoo (D-CA), cosponsored by Reps. Janice D. Schakowsky (D-IL), Donna E. Shalala (D-FL), Madeleine Dean (D-PA), Seth Moulton (D-MA) and David N. Cicilline (D-RI). The House bill was referred to House Energy and Commerce

“This virus spares no state, no county, no facility. The unprecedented crisis unfolding in our Nation’s nursing homes demands an immediate, extraordinary response. Reports indicate nursing home residents and workers account for roughly 1 in 4 deaths from COVID-19 in the United States,” said Casey, who serves as Ranking Member of the U.S Senate Special Committee on Aging, in a statement announcing the bill’s introduction. “The Nursing Home COVID-19 Protection and Prevention Act would provide $20 billion in emergency funding [for staffing, testing, Personal Protective Equipment, etc.] to devise a sorely needed national, coordinated response to stem the spread of this terrible virus in nursing homes and intermediate care facilities,” notes Casey.

According to Casey, the Senate bill would also require the U.S. Department of Health and Human Services (HHS) to develop guidance on cohorting best practices, including on how to safeguard resident rights. It would also instruct HHS to collect and publish data on COVID-19 cases and deaths in nursing homes and intermediate care facilities, and finally fund surge teams of nurses, aides, and other critical staff to fill in at facilities where multiple residents and staff members have been infected.

“COVID-19 poses an immediate threat to the more than 1.3 million Americans, including more than 7,000 Rhode Islanders, who live in nursing homes,” says Whitehouse, noting that frontline staff across the nation are “doing heroic work under very challenging circumstances.”

“We need to get vastly more personal protective equipment and tests to nursing homes, which care for the patients who are most vulnerable to the coronavirus. Our legislation would also help states fund surge teams, sending additional staff reinforcements to facilities where they are needed to care for patients and prevent infection,” adds Whitehouse.

Before S. 3768 was officially introduced, in early March, Washington, DC-based AARP announced its support for the Senate proposal. “AARP supports the draft of the Nursing Home COVID-19 Protection and Prevention Act that would help protect the health and save the lives of people in nursing homes and other facilities by supporting testing, personal protective equipment, staffing and more,” said Megan O’Reilly, Vice President of Government Affairs for AARP. “The proposal would also improve public transparency and help protect the rights of residents and their families, adds O’Reilly, calling on Congress “to act immediately to stem the loss of life and slow the spread of the virus.”

In the House Chamber, Rhode Island’s Cicilline, a member of the House Democratic Leadership as Chair of the Democratic Policy and Communications Committee, has also pushed for Congressional funding to stop the spread of COVID-19 in nursing homes. The fifth term Congressman has called for additional funding for the Public Health and Social Services Emergency Fund in the next package for congregate care facilities, including nursing homes. He also signed a letter to HHS Secretary Azar and Administrator Verma, of the Centers for Medicare and Medicaid Services (CMS), urging that HHS and the CMS to ensure that a significant portion of the newly allocated $25 billion for testing in the recently passed CARES Act be utilized for testing in nursing homes and other congregate living facilities.

State-wide Efforts to Combat COVID-19 in Nursing Homes

With Governor Gina Raimondo declaring a state of emergency on March 9, 2020, with the COVID-19 arriving in Rhode Island, the deadly pandemic virus spread quickly throughout the state’s nursing homes. At press time, it has been reported that 75 percent of all related COVID-19 deaths are in nursing homes.

According to Joseph Wendelken, Public Information’s Officer for the Rhode Island Department of Health (RIDOH), the state moved quickly to stop the spread of the COVID-19 virus in the community and in nursing homes. He stated: “We curtailed and then prohibited visiting early on, and we have been doing extensive testing in every assisted living facility in the state. We are doing cyclical testing, meaning that we are continually testing all residents in all homes on a rotating basis. We are giving tailored infection control guidance to specific homes, and we are helping them procure additional PPE.”

Adds Wendelken, RIDOH has established two COVID-19 Specialty Nursing Homes [at Oak Hill Center in Pawtucket and Oakland Grove Health Care Center in Woonsocket] to be a COVID-19 Specialty Nursing Home. “These are centralized facilities to accept patients who are being discharged from the hospital and who are COVID-19 positive but no longer require acute-level care. This strategy allows COVID-19 positive patients leaving the hospital to receive specialized rehabilitation and step-down, post-acute care while reserving hospital beds for patients who need acute-level care,” he said.

On Smith Hill, the Rhode Island House Republican Caucus has recently called for members of the House Committee on Oversight to meet to address the increasing COVID-19 death rate in the state’s nursing and assisted living facilities.

Putting Politics Aside…

With less than 156 days until the upcoming 2020 Presidential election, will S. 3768 reach the Senate floor for a vote. Since the beginning of 2019, more than 350 House-passed bills—including hundreds that have bipartisan support—have been buried by Senate Majority Leader Mitch McConnell (R-Kentucky) in his legislative graveyard. With no Republican Senators supporting Casey and Whitehouse’s COVID-19 bill, will it even reach the Senate floor for a vote?

It’s time for McConnell, who has called himself the “grim reaper” of Democratic legislation, to lay down his deadly scythe, making the safety of millions of residents who reside in the nation’s 15,583 skilled nursing facilities a legislative priority. The GOP Senator from Kentucky, who is in a close Senate race with Democratic opponent Amy McGrath, might consider putting politics aside during a raging COVID-19 pandemic sweeping across the nation to work with Senate Democrats to protect frail residents and nursing home staff. Kentucky voters might view protecting residents against COVID a bipartisan issue.