Still thinking about nursing homes and Covid-19.

Covid-19 has exposed the confusion in our culture between being old and fit – with many more years left in you and being elderly and frail and near death.

Before Covid-19, the ordinary flu would wipe out a surprisingly large number of elderly people each winter. No-one thought about it very much and we didn’t stop people with colds from entering nursing homes.

It’s been natural to let disease take its course. Few would argue against this – or at least few would have in the past.

But then a dramatic disease like Covid-19 comes along. In Australia, of the 102 people who’ve died, 86 have been over the age of 70. Unsurprising. But there’s lots of assumptions in saying their deaths were inevitable. Many of those who died were fit and well. When many of their stories are told, they are of people who had a lot to live for, were engaged and alert.

And then something else clunks along beside this. Experiences all over the world have shown that collectively, we think just because people are elderly and reside in a nursing home, it’s okay for them to be ‘locked down’, with those who are covid-19 positive, even if they themselves are negative.

The coffee table conversation about this falls into two groups. Some people are deeply disturbed by the proposition of this mix. But a large number of people haven’t even thought about it and don’t see anything odd about it.

But how would it be to be a healthy, alert over 80-year-old who requires care because of, say, an incapacity to walk, who enjoys a good game of chess and wine with dinner and to then realise that most people – especially those who don’t know you – see nothing wrong with you living in a place with people who are Covid-19 positive?

This scenario was considered acceptable in Australia at the beginning of the crisis, when it looked as though our ICU units would be overwhelmed and there would be a shortage of the ventilators needed to save lives infected with Covid-19. In that case, nursing home patients were to be excluded from hospital care, by tacit social agreement.

What happened in Australia played out differently to expectations. There were plenty of ventilators available in emergency hospitals. Yes, and high quality equipment was brought in to nursing homes with infections, as were high quality staff.

But how does it feel, what’s the psychological effect of knowing that the rest of the community found it acceptable that both the well and the unwell should be housed in the same environment, simply because all the people there are elderly?  

The point here is that everyone is different and the choices should be considered in line with other factors, not age.

Debbie Neuhauser Pepin, a US death literacy advocate posted a recent article on her LinkedIn site which graphically illustrates the dilemma. The article “No intubation, seniors fearful of Covid-19 are changing their living wills” by Judith Graham appeared in Kaiser Health News. Kaiser is a major American health care provider.

This article shows different ways of looking at ventilation – from the point of view of someone who doesn’t want it and from someone who does.

This is not about advance care directives, when people are sick. This is the time period before. When everyone is in lockdown and waiting for the next case.

This still needs some explanation. So the questions linger.

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