Review: "What Happened in Room 10", by Katie Engelhart, California Sunday Magazine, August, 2020 with all due respect to the compassionate careworkers at all levels and to those who have died living and working in nursing homes during the pandemic.
The COVID-19 virus has revealed the failure of our US healthcare system, especially the care of older and disabled people needing residential care in nursing homes and other long term care facilities. We are eight months into the pandemic and have no centralized strategy guiding facilities in their response to the virus. Advocates for residents of nursing homes, including Geriatricians, non-profit program administrators, academic Gerontologists and Health Policy “experts” have been actively trying to influence the Federal response to the nursing home crisis by convening panels, committees, task forces, and writing recommendations, white papers and Op-Ed pieces to examine practical responses that are needed such as testing of residents and staff, infection control training, and adequate PPE supply.
Meanwhile lobbyists for the nursing home industry have succeeded in getting legal immunity in several states for the time period surrounding and during the pandemic. Even before the pandemic, the lobby requested and received easing of regulations and fines from the Centers for Medicare and Medicaid (CMS). This immunity and easing of regulations is in addition to the fact that the top-ten nursing home companies had already split themselves into real estate and operations limited liability corporations, making it much more difficult for residents’ families to successfully sue for negligence. 43% of COVID-related deaths in the United States have been in nursing homes. In spite of the task forces and calls for reform, the response has been about protecting the owner and investors, not about protecting residents and staff.
While immediate reforms to improve conditions of care are necessary, a radical critique of the mainstream response to the nursing home crisis is necessary because none of these responses address what the COVID virus revealed about the systemic failure of the healthcare system that is increasingly run for profit rather than need.
One mainstream response is particularly interesting in that it appears to be a radical critique but falls into reformism, a good example of how the neoliberal system attempts to control the discussion of this crisis.
In March, 2020, the first widespread COVID outbreak in a nursing home occurred in a Kirkland, Washington facility owned by the large nursing home chain, LifeCare Centers, based in Tennessee. A lengthy expose called "What happened in Room Ten", was published in the August, 2020 issue of California Sunday magazine and was praised and shared widely among the professional and academic Gerontology and Geriatrician community on social media. To better understand and critique this article, a little background for both the publisher and the writer, Katie Engelhart, is helpful.
California Sunday was established in 2014 as an insert with Sunday editions of the LA Times, NYTimes, Sacramento Bee, San Francisco Chronicle, and San Diego Union- Tribune. In 2018, California Sunday was acquired by the Emerson Collective, a “social change” organization founded by Laurene Powell Jobs, widow and heir of Steve Jobs, and now a billionaire. Emerson Collective is also the majority owner of the Atlantic magazine.
Katie Engelhart is a 2018 “Eric and Wendy Schmidt Fellow” at New America, a “think and action tank dedicated to renewing the promise of America, bringing us closer to our nation’s highest ideals”... an “incubator for policy experts and public intellectuals” for a “renewed America” (from their website). New America’s board members include Eric Schmidt, former Google CEO and currently chair of the US Department of Defense, Defense Innovation Advisory board, Robert Soros, son of billionaire investor and philanthropist George Soros, and others. Both Emerson Collective and New America represent powerful, billionaire-directed organizations guiding the discourse of young, ambitious journalists like Ms. Engelhart who are willing to promote the neoliberal agenda of market-oriented reforms, privatization and austerity by not questioning the existing neoliberal capitalist system she is writing about.
However, the pandemic has nakedly revealed the failure of the US Government and the private institutions that it depends on to address the spread of COVID in nursing homes. Ms. Engelhart had no choice but to describe in some detail the failure of the nursing home industry to deal with the pandemic. The Kirkland nursing home, from it’s outbreak in February, 2020 to the stabilization of the facility in April, had forty-six COVID-related deaths.
But Ms. Engelhart’s article does not begin with an exemplary presentation of the systemic failure of the government and the privately run facilities that led to the forty-six deaths at Kirkland’s LifeCare facility, but rather cutely, with the stories of two residents, Helen and Twilla and their daughters: slick, vibrating, interpolating artwork sentimentalizes life and loss in the facility, drawing us into the experience of the two residents and away from the forty-six residents and staff that have died. Helen has a world map above her bed “so that [the poorly paid] nurses could point to the countries where they were from” and talk about their former lives in their countries of origin. So the foreign labor that the facility relies on and underpays makes Helen’s life there more interesting.
At this point, Engelhart turns to the negatives: the spread of the virus in the facility, the staff shortages due to illness, including the facility’s medical doctor who was eventually replaced by hard-working LifeCare nurse, Chelsea, who volunteers to take a job there, comparing the job to her combat medic husband’s lengthy deployments, thinking “it would be her turn to go to war”. More residents get sick and Chelsea does do heroic work to try to manage the crisis. Twilla has succumbed to the virus and now Helen seems to be getting sick. At this point, the action stops and Ms. Engelhart abruptly switches to a brief history of the nursing home industry. We learn about how the nursing home industry grew from small, independent, for-profit and often poorly run rest homes, to it’s current domination by corporate ownership that has succeeded in reaping huge profits in a $100 billion dollar Medicaid-subsidized industry. We also learn that state and federal regulations and lawsuits for negligence are hard to enforce when equity firms buy up 75% of nursing homes and restructure them to incorporate related third parties that siphon off profits by billing the nursing homes themselves. Engelhart turns to the expert, Ernest Tosh, a plaintiff lawyer, to learn that LifeCare has followed these restructuring “trends” of the nursing home industry, that LifeCare nursing homes are quite profitable and that the industry’s lobbyists are seeking higher Medicaid reimbursement rates due to “financial distress”.
One would expect Ms. Engelhart to then go on to place the specific predaceous practices and failures of LifeCare within the general predatory practices and failures of the for-profit health care system. Instead, we abruptly return, with a slickly illustrated brushstroke across the page to Helen, lying in bed reflecting on the death of her roommate Twilla, and to hero-nurse Chelsea’s ongoing challenges, moving away from systemic failure and toward personal courage and tragedy -- toward neoliberalism’s comfort zone: identity politics.
Our last image in Ms. Engelhart’s article is that of resident, Helen, isolated from her daughter as they continue visits limited to waving at each other through the window. The writer leaves us with this thought:
“This part of the story (isolation) is bigger than nursing homes -- bigger, even, than medicine --and maybe most clearly encapsulated in that refrain from the earliest days of the outbreak: It only affects old people. Decades from now, will we be haunted by that “only”?.”
The appeal is toward sympathy for the elderly, who deserve our respect since we will all be old one day. That is the problem! Forget about nursing homes and apparently broken systems. They are what they are and we might as well just get used to it. Katie Engelhart has now come full circle in reducing a dismissed social problem, that she has exposed, to “ageism” that can be combatted individually by Ayn Rand-type heroic individuals: Helen, the rugged individualist from Minnesota who survives the virus at age 98; her demented roommate, Twilla, who doesn’t, but whose selfish daughter hires a selfish lawyer to sue the nursing home corporation for its negligence for big bucks; an emergency medical response team (hired by the State Department and based in Dubai according to my background search) and coordinated by nurse warrior, Chelsea, who ends up testifying in defense of the nursing home corporation when they appealed the fines for their failings.
By the article’s end, we have forgotten the 46 people who have died and the fact that nothing systemic has fundamentally changed to prevent another COVID outbreak in Kirkland or anywhere else. Our attention is now on a political ideology that values the competitive individual over the social and the profit of the corporate person over the needs of society.
This article and others like it must be read with extreme caution. They only serve to preserve the status quo, which has been exposed by the COVID-19 pandemic as unable and unwilling to address the social, economic, ecological and other crises it has itself created.
To sum up, while ageism is a legitimate cultural issue, it should not be used to avoid confronting the failing capitalist system that it is embedded in. Geriatric medicine, academic Gerontology, Aging Studies, and programs focussed on health disparities, relating patterns of death and disease to the political, economic and social structures of society, can help by breaking out of the limitations of capitalist discourse and outline steps towards socialized medicine and a nationalized system of nursing home care.
Neoliberal media will not permit this discussion.
https://story.californiasunday.com/covid-life-care-center-kirkland-washington
