In
defense
of
SNFs

May 24, 2020 -- SNFs (skilled nursing facilities, at one of which I work) have been getting a bad rap lately.

Their residents suffer a disproportionate share of Covid-19 deaths. The implication in a recent spate of articles in the press is that these institutions have delivered substandard care or worse, driven by rapacious administrators and capitalistic owners to cut corners and let patients sicken and die.

While such abuses have surely occurred, I maintain that these are a vanishingly small minority and that very nearly all such institutions have performed well, even in the face of daunting odds. What are those odds? They are two:

  1. SNF residents are by definition the most vulnerable demographic: elderly beset by numerous comorbidities, often surviving by the merest thread sustained only by, well, skilled nursing. Throw a deadly virus into this mix and the outcomes are inevitably poor.

  2. The designs of these places are commonly outmoded. If we were to redesign them today (and many have, for example the New York Times: As Death Toll in Nursing Homes Climbs, Calls to Redesign Them Grow) each resident would have a private room. The HVAC/ventilation systems would exhaust to the outdoors instead of recirculating. Shared spaces would support social distancing. The number of residents in a nursing unit ("pod") would be perhaps a half dozen instead of the two or even three dozen common in today's SNFs, most of which were designed many decades ago.
So today the odds are against us. What can we do? Bulldoze and rebuild? Where's the money for that?

In practical terms, let's do what's possible within the constraints of reality, and point fingers only when the malfeasance is real. Which it rarely is. In defense of SNFs, please understand the realities. And go (skilled) nurses!

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