• American Eldercide
• Margaret Morganroth Gullette (bio)

Transporting a sick nursing-home patient to the hospital in Austin, Texas (John Moore/Getty Images)

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Contrary to what many believe, the tens of thousands of deaths of those living in long-term care (LTC) were no inevitable biological catastrophe. Their grieving, angry family members know better: they know the conditions that prematurely deprived their loved ones of the remainder of their lives. By December, just as vaccine distribution started, nearly 110,000 residents and over 1,000 staffers had died. The extra deaths among our elders constitute an appalling number of the diverse 1.4 million Americans who were living in nursing homes before the pandemic. Many people have also died in assisted living facilities, middle-class residences not currently inspected by the Centers for Medicare and Medicaid Services. Until other deaths soared toward 500,000 over the winter, the deaths in nursing and veterans’ facilities alone accounted for almost 40 percent of all the U.S. dead. If we can’t explain why these care homes failed the people they were responsible for, we cannot prevent the next pandemic.

We may need to be reminded that people who choose congregate living in nursing and veteran’s homes include men and women of all races and ethnicities. Some are quite healthy or staying in rehab only temporarily. Other residents are chronically ill, disabled, frail, or living with some level of cognitive impairment. They may have little in common except their powerlessness to avert their fate. All of them should be able to look forward to living nicely, perhaps with some assistance—receiving help with activities of daily life such as showering and taking medications—as well as good meals, exercise classes, access to the outdoors, pleasant and helpful aides, conversation at mealtimes, and visits from loved ones. Many would have lived long lives in their new homes. All this was denied to those who sickened and died.

We don’t know enough stories of the nursing home survivors from their own mouths—their anguish at being neglected, anxiety as they listened to the news of mounting deaths among people like them, compassion for friends who were taken to hospitals and did not return, or stubborn determination to survive. While journalists have interviewed family members and [End Page 113] administrators, few have spoken to residents to find out how they felt and what they observed. Aides were overworked, unprepared, and lacked protective equipment. Nurses were overextended. In one harrowing case at the Soldier’s Home in Holyoke, Massachusetts, where union officials had long warned about conditions, staff were instructed by the home’s leadership to merge two dementia units, cramming residents with COVID-19 into wards with residents who were uninfected. At least seventy-six residents died. All across the country, if an aide held an old hand and spoke words of love from the family members whom residents could not see, that was the best death available.

The fact of the matter is this: No resident, however poor, feeble, or impaired, needed to die of COVID-19. Nor did those who work taking care of them. We don’t need to look far for proof. In a small, nonprofit, Baptist-run nursing home in Baltimore, Maryland, whose low-income residents were people of color, many with chronic conditions, not one person had even become infected as late as June 18, 2020. Everyone was protected by best practices, instituted early and with the greatest good will. Derrick DeWitt Sr., a reverend and the CFO of the nursing home, brought in personal protective equipment, more TVs for entertainment and social distancing, hired an extra activities coordinator, and provided food for employees so that they wouldn’t have to leave to buy lunch. They already had a full-time infection-control nurse on staff before the pandemic.

Similar procedures led to lower mortality rates in other residences. A study of New York State LTC facilities showed that 30 percent fewer residents died in unionized than in nonunionized facilities. There were fewer infections. There were better masks and eye shields. Unionization often means better pay and infection...

• 美国杀虫剂
• 玛格丽特·摩根罗斯（Margaret Morganroth Gullette）（生物）

将患病的养老院患者运送到德克萨斯州奥斯汀市的医院（约翰·摩尔/盖蒂图片社）

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与许多人的看法相反，长期护理（LTC）中成千上万的死亡并非不可避免的生物灾难。他们悲伤而愤怒的家庭成员知道得更多：他们知道过早地剥夺了亲人生命的条件。到12月，疫苗开始分发之时，将近11万居民和1000多名工作人员丧生。在大流行之前，住在我们养老院的140万美国人中，我们老年人中的额外死亡人数令人震惊。许多人还死于辅助生活设施中，这是目前医疗保险和医疗补助服务中心尚未检查的中产阶级住宅。在整个冬季其他死亡人数飙升至500,000之前，仅护理和退伍军人设施中的死亡就占美国死亡总数的近40％。如果我们无法解释为什么这些养老院使他们所负责的人失败，我们就无法阻止下一次大流行。

可能需要提醒我们，选择在疗养院和退伍军人家庭中聚集的人包括各个种族和种族的男人和女人。有些人很健康，或者只是暂时康复。其他居民患有慢性病，残疾，虚弱或生活在一定程度的认知障碍中。除了无能为力避免命运的能力外，他们可能没有什么共同点。所有这些人都应该能够期待美好的生活，也许需要一些帮助-接受日常活动的帮助，例如淋浴和吃药-以及美食，运动课，户外活动，愉快而乐于助人的助手，就餐时的交谈以及亲人的来访。许多人将在新家中长寿。所有这些都被生病和死亡的人所否认。

我们没有从自己的嘴里听到足够的关于养老院幸存者的故事-他们对被忽视，在他们听到像他们这样的人中越来越多的死亡消息，对被送往医院但没有返回的朋友的同情心的焦虑感到焦虑，或or强求生的决心。记者采访了家庭成员和[结束页113]管理人员中，很少有人与居民交谈以了解他们的感受和观察结果。助手们工作过度，准备不足并且缺乏防护设备。护士人满为患。在马萨诸塞州霍利奥克的士兵之家的一个令人痛苦的案例中，工会官员长期以来一直在警告情况，工会领导指示工作人员将两个痴呆症单位合并，将COVID-19的居民挤入病房与未感染的居民一起。至少有76位居民死亡。在全国范围内，如果一名助手牵着老手，向居民看不见的家人说出爱的话，那将是最好的死亡案例。

事实是这样的：没有居民要死于COVID-19，而无论其贫穷，虚弱或受损。工作的人也没有照顾他们。我们不需要寻找证据。在马里兰州巴尔的摩市由浸信会运营的一家小型非营利性养老院中，低收入居民是有色人种，其中许多人患有慢性病，直到2020年6月18日，甚至没有人被感染。每个人都受到了保护最佳实践，尽早制定，并怀着最大的诚意。敬老院院长兼首席财务官德里克·德威特（Derrick DeWitt Sr.）带来了个人防护设备，更多的娱乐和社交疏散电视，并聘请了额外的活动协调员，并为员工提供了食物，这样他们就不必离开买午餐。大流行之前，他们已经有一名专职的感染控制护士。

相似的程序导致其他住所的死亡率降低。对纽约州LTC设施的研究表明，有工会的居民比没有工会的设施少了30％。感染较少。有更好的口罩和眼罩。工会化往往意味着更高的报酬和感染力...