Battleship Row
On December 7, 1941 eight battleships were neatly moored next to Ford Island as a part of the US Navy’s fleet in Pearl Harbor. Captains, petty officers, and seamen of the USS Arizona, Oklahoma, West Virginia, California, Nevada, Tennessee, Maryland, and Pennsylvania likely enjoyed their morning routine before the bombs started to fall.
I was reminded of Battleship Row when I heard current Surgeon General Jerome Adams state early last week, “This is going to be our Pearl Harbor moment, our 9/11 moment, only it’s not going to be localized, it’s going to be happening all over the country and I want America to understand that.”
Comparisons between wartime actions and peacetime efforts are often overdone. Football players are described as warriors — though not expected to pledge the “last full measure of devotion,” as is required of those in our military. Business teams who talk of battling “in the trenches,” likely cannot fathom the sounds or smells of the Somme Offensive where bullets swarmed over soldiers’ heads like bees while a mess of bodies rotted in the spiderwebs of wire on the trench tops.
Yet, I cannot help but hear the comments by our surgeon general and compare it to what is happening in nursing homes across the country and think — Nursing homes are COVID-19’s Battleship Row: full of vulnerable people, completely unaware of what’s coming, and at the very front-lines of a nation’s first wave into a long and difficult battle.
Like the bombs falling from the sky — COVID-19 caught most nursing homes flat-footed. Both Pearl Harbor and COVID-19 demonstrated similar reasons behind the lack of preparation: governing institutions responsible for intelligence and oversight had failed and counter measures (think anti-aircraft guns and deployable airplanes in Pearl Harbor and wide testing and PPE for nursing homes) were not accessible, available, or ready. Likely the greatest contributor to failed responses of the unexpected was simply that something of that magnitude had never happened. Neither the nursing home industry nor the navy had ever dealt with such a dramatic onslaught. Despite the best efforts of sailors on Battleship Row and the healthcare workers of the nation’s nursing homes, massive casualties became the predicable byproduct of an all-encompassing attack.
Unfortunately, it is the differences, not the similarities of the responses, that give me the most pause and anxiety for those in our nursing homes today.
First, a question: Can you imagine people critiquing the sailors, firemen, and civilians that slept, ate, and worked on Battleship Row over their response while it was happening? How ludicrous would it be if reporters from the Honolulu Star-Bulletin sent out telegrams to those around the country judging the sailors on their technique, policies, and process as they pulled mangled bodies from the oil-soaked water? Unfortunately, that is what is happening right now in most of the nursing home coverage throughout the country. Simply type “Nursing Homes,” into your News Feed and you will find numerous stories about how nursing homes are hot-spots for COVID-19, how the staff and management of nursing homes are overwhelmed, and how politicians of all stripes (some who could not tell you the difference between Medicaid and Medicare) want “something to be done,” about nursing homes in their county/city/state. It’s as if people are blaming the sailors aboard Battleship Row for the attack on Pearl Harbor because they slept in the barracks!
Yes, like every industry, we have our problems. We are understaffed — primarily because we are paid about 20% as much as hospitals are paid to care for the same patient once they are transferred via ambulance to our centers. We have inconsistent infection control protocols, agreed — but we’ve also had inconsistent regulatory guidance between three separate administrations on what is and what isn’t “Effective Infection Control.” In some ways we’ve earned our poor reputation as the media highlight and the general public reads only about the atrocities that have been committed throughout the industry’s history by bad actors acting from within over the last 60+ years. But in many respects, we are not your grandma’s nursing home. Many of us are staffed with qualified administrative and clinical personnel that have undergone years of training and gained crucial experience. Thousands of us have invested heavily in our physical space, rehabilitative teams, dietary offerings and activities to ensure those within our walls are cared for with dignity, respect and compassion. Like the Navy in 1941, we recognize now that we still have a long way to go.
And go we will, one foot in front of the other. For another crucial way this attack has differentiated itself from Pearl Harbor is how long and intense the attack has been. On January 29th, 2020 a registered nurse from Life Care Center of Kirkland made a call regarding a patient with low blood oxygen levels and difficulty breathing. We all know now how quickly the virus spread in that nursing home devastating patients, staff and family members alike. While I cannot comment on the individual facility’s response, I can comment on my feelings while reading about LifeCare Center late into the evening one month later. I thought aghast, “That could easily be one of my centers.” It was their story and a month lead time that forced our company to make the difficult decision to close our doors to visitors even before it was mandated that we do so. It was their story that forced us to create a screening tool with temperature checks for any staff to enter, urged us to order PPE from any place we could find, and convinced us to deploy telemedicine fully into each of our centers.
Unfortunately, here we are almost 3 months later, with no real end in sight. PPE is still hard (sometimes impossible) to come by, testing is still scattershot, and the regulators and government teams who are doing their best to help us, are often themselves overrun. Tens of thousands of nursing home employees have worked every day and every night, doing everything within their power to fight against an unseen enemy described as “the perfect killing machine” for our vulnerable populations. They’re tired, they’re worn, they’re mostly faceless with very few to cheer them as they go into work and fewer to fly in from other states to relieve them of their duties. Yet our incredible people will go on, clock in, and care for millions of who, unlike those on a cruise or battleship, can never dock and never get off.
Amidst the despair of the present, one hears from the past echoes of the hope. Following the attack on Pearl Harbor, the Navy immediately began to repair the Battleships. While some (like the Arizona and the Oklahoma) never returned to battle, each of the other 6 had some part to play in the great World War to defeat those that had threatened the World’s peace and order. Like those ships on Battleship Row, nursing homes will be critical to defeating COVID-19. Damaged, torpedoed, and sunk right now — they will emerge stronger, smarter, and more efficient than they’ve once been — with experienced captains, administrators, lieutenants, directors of nursing, officers, nurses, sailors and CNA’s to guide the way.