A Celebration of Indifference to Nursing Home Prison Rules

Nursing homes won't be saved from centrally planned hell of "nursing home prison" by a destruction of entities like the CDC, CMS, etc. - but instead by a mass indifference to their dictates.

Say ‘Hi’ to Patty the Chin-Strap Wearing Nurse!

I didn’t see that. I just see a nurse. What’s the problem here?

Realize that the majority of people working in long-term care - the nurses, are really good people that got into the field because they really care about their patients, as people. Even today with the overwhelming move towards nursing homes as Goffmanesque “total institutions” - or what I’ve called “nursing home prison” - the humanity and caring spirit of nursing staff is something I see every day.

That’s why I propose that what needs to happen next in order to bring back some semblance of normal to nursing homes is not some crazy, pie-in-the-sky scheme to get people in congress to somehow take an interest in nursing homes.

We may be deluding ourselves if we think we can save nursing home residents from their imprisonment by yelling at the people at the Center for Medicare and Medicaid Services (CMS) and the CDC, and then somehow get the proper rule changes pushed through so masks, social distancing, the signs, the plexiglass, etc. - can all go away.

Honestly, what needs to happen is benevolent neglect of the rules.

Let me give you an example. About three weeks ago they brought back group dining (conjugal dining) at my nursing home. Remember me complaining about it here?

Before you get too excited, let me explain to you what it looks like:

Previously - my residents would get together in a large room and we would line them up in long rows of tables, facing each other across each side of the table and with a resident on each side. Residents who could move their wheelchairs independently could roam around the room and gather condiments from the condiment carts, socialize, stop over at other tables, and generally it was a good time:

Not our nursing home, but it is similar to how it used to look. Close in, social, no masks on staff. Social eating!

Now, after many long months of no conjugal dining - residents are back in the dining hall, but there are only single tables available, spaced out across the room, and residents must sit at each end of the table (only two per table) - six feet apart from each other.

Not particularly social. And staff are still masked, as well as, supposedly, residents (at least in between bites… right?).

Did I mention staff are still masked?

Also, our residents have had their first (and not their last) restaurant outing in the community - which was very exciting. But guess what? For the privilege, they are required to “quarantine” to their rooms for seven days after they return from their two hour trip to the local Applebees. That means they are supposed to stay in their rooms and not leave, and remain masked at all times when they are out of the room.

This is where our chin-strap wearing nurse will save us.

Basically - it’s 2023. All of our residents are vaccinated, and multi-boosted. They are also extremely old, and at the ends of their lives. They really don’t have much life left - this is it.

Let’s just say that the nurses in our new, socially-distanced dining hall experience witness another resident, Bob, amble over to the table with Mabel and Georgia, and sit with them and flirt with them for a bit - thereby violating the socially distancing rule.

Mind if I join you two lovely ladies for lunch?

Let’s just say our mask chin-strap wearing nurse doesn’t really enforce that rule, and lets also say that octogeniarian lothario Bob, who really wants to flirt with Mabel (and is friends with Georgia) do his thing.

I’m going to say something extremely controversial - assuming there is no active outbreak of COVID (or flu, or norovirus, or whatever) at my nursing home, and Bob wants to chat with Georgia and Mabel at their table - and I see a nurse isn’t enforcing the social distancing rule - guess what I say?

I’m going to say that I’ll be extremely hard-pressed to call on that nurse to enforce it.

In fact, I may just deliberately turn a blind eye to this “violation” of the COVID protocols, and many others just like it.

Likewise, if Bob goes out to a restaurant with the activities staff and comes back, and he’s not-so-compliant over the next week as per our 7-day quarantine rules (maybe goes outside to look at the birds, hits the vending machine a few times, maybe socializes with the ladies again in the hallway before they have lunch, maybe even nibbles a little of Mabel’s sandwich while she has her lunch before he heads back to his room) who in their right mind should, or would, drop a dime on Bob?

Or tell on the nurse that turned a blind eye?

I don’t think these rules are humane, or right, and eventually they are going to go away simply because they’re absurd and anti-human with our nursing home patients, and everyone knows it. The nurses are going to only loosy-goosey enforce them at best, and doctors like me, even medical directors, are going to likely only give lip-service at best at enforcing these rules. This *will* happen, and this *is* happening.

Eventually, these COVID rules are going to be ignored so much that eventually they are going to get dropped.

In the meantime, I assure you that in the nursing break rooms, none of the nurses wear masks. They don’t spend much time worrying about breakroom capacity limits, and honestly, their administrators stopped caring a long time ago too (but when the site visitors come, masks come back on for sure - as well as for families).¹

But when the families leave and the site visitors gone - the masks start slipping down towards the chin, and the nurses turn a blind eye to those persistently social residents who can’t help but need to see faces and be close to others.

Would I prefer a complete, resounding liberation of my residents from nursing home prison, and a return to the days when my residents could see all faces, come and go out of the building as they pleased (along with their familes) - attend outings like normal people, and not be quarantined and masked?

Yes!!

But I think that’s not realistic, sadly.

Nursing home prison will continue to limp along , but it’s many complex and ever-changing rules will engender less and less respect and eventually the entire edifice will likely develop a lot of holes and take on a lot of water - so much so that eventually something will have to give.

But by then I will have probably retired.

Photo by Pedro Monteiro on Unsplash

1. As an aside, I think that if you go to say, Texas or particularly Florida and visit a skilled nursing facility there - I strongly bet that the enforcement of “COVID protocols,” and “universal masking” is likely far more perfunctory than in the blue state that I live in. If masks are worn, they’re chin straps unless site accreditation visitors (JHACO, LTCI are around). The social distancing signs are probably much more ignored, if not outright scorned - as they should be.