By Dick Hall-Sizemore
The pandemic has presented a challenge to at least a couple of the basic tenets of conservatism.
The first of these challenges is to the basic negative attitude toward regulations. Conservatives abhor regulations. In anticipation of objections from Jim Bacon and Steve Haner, among others, that such a statement is too broad and that conservatives object to only “bad” or “unnecessary” regulations, let me say that I agree there are some regulations that are bad. However, the conservative rhetoric has not differentiated between “good” and “bad” regulations. Over the past 40 years or so, whenever conservatives talked about regulations, the phrase “job-killing” was almost always used. “Regulation” has become synonymous with “job-killing”.
Sometimes, conservatives do not bother with attaching the label “job-killing” to their attack on regulations; they just condemn regulations altogether. A Heritage Foundation article titled, “How Regulation is Destroying American Jobs,” did not distinguish between “good” and “bad” regulations; instead, the author declared that “regulation deserves much of the blame” for job creation grinding to a halt. Closer to home, Matt Fariss, R-Rustburg, in an op-ed published last week, bragged that Republicans had “reduced regulations.” Note that he made no distinction in the kind of regulations reduced. The strong implication, therefore, is that regulations, per se, need to be reduced.
Nursing homes have been a major source of discussion on this blog and in the national news over the past few months. Regular readers of this blog are familiar with a dialog that Jim Sherlock and I have been having. Jim argues that the Virginia Department of Health staffing regulations for nursing homes are too weak and the Commonwealth should adopt the requirements of the federal Centers for Medicare and Medicaid Services (CMS). My contention is that the federal standards, even if any better than Virginia’s (which is debatable), are not strong. A 2001 study and report by a consultant to CMS reached the same conclusion that the nursing home staffing standards were inadequate. (The standards in effect in 2020 are largely unchanged from those in effect in 2001.) Not content with staffing standards that are too low, the current administration in Washington relaxed nursing home requirements even more in recent years.
Then the pandemic hit. Lots of patients in nursing homes got very sick and many died. The howls went up from all over — “Why isn’t the government doing something?” There were complaints on this blog that the nursing homes were understaffed. Of course, they were, but that did not make them out of compliance with those federal and state regulations Those understaffing levels earned them low scores on the CMS rating scale, but not violation notices. Nevertheless, the Republican Party charged that Governor Northam was creating “death homes” out of nursing homes. Never mind that one of its members, Del. Farriss, was bragging that the Republican Party had reduced regulations.
Conclusion: Conservatives are against regulations until they are for them.
Another bedrock belief of conservatives is in the superiority of the private sector over the public sector. I know this from personal experience. Responding to a comment of mine in a meeting attended by numerous state officials and staff, one of Governor Allen’s zealots, chairing the meeting, reprimanded me point-blank, declaring, “Anything the government does, private enterprise can do it better and cheaper.” Period. Next topic. Needless to say, I bit my tongue for the remainder of the meeting.
That axiom has not held up well in Virginia during the pandemic. The following state agencies operate congregate facilities analogous to nursing homes:
- Dept. of Corrections— 42 prisons, which include numerous facilities in which inmates are housed in dormitory units that include about 75 beds. Of the approximately 28,000 inmates being held, chronic medical conditions are common, especially diabetes and hypertension. One of its facilities houses 300-400 geriatric inmates, many of them classified as needing assisted living services and some needing skilled nursing services. In the whole prison system, 11 inmates have died from COVID-19. In the facility that houses geriatric and assisted living inmates , there was one death from COVID-19. (The agency’s COVID-19 webpage is here.)
- Dept. of Behavioral Health and Developmental Services — 11 residential facilities for adults with mental health and developmental services needs. One of these facilities, Piedmont Geriatric Hospital near Burkeville, is a 123-bed psychiatric hospital that serves persons over the age of 65. As of July 1, there had been no COVID-19 related deaths in DBHDS facilities. (The agency’s COVID-19 data is here.)
- Dept. of Veterans Services — Two residential care centers for veterans. The Sitter & Barfoot Veterans Care Center in Richmond, has 175 residents who need skilled nursing or Alzheimer’s/ dementia services. The Virginia Veterans Care Center in Roanoke provides assisted living, skilled nursing, intermediate nursing, Alzheirmers/dementia, or hospice services for 188 residents. The agency does not post COVID-19 data on-line, but senior staff have told me there have been no deaths related to COVID-19.
In summary, in the state-operated residential facilities housing approximately 30,000 individuals, many of whom are especially vulnerable to COVID-19 , there have been 11 deaths related to the disease. Only one of those deaths was in a facility specifically designated for older persons. None of the agencies have reported any staff deaths resulting from COVID-19.
In contrast to the state-operated facilities, there have been 1,149 deaths, according to the Dept. of Health, in the privately-run nursing and assisted living homes. At least 60 of those who died were residents of one nursing home. Data on COVID-19 deaths of any nursing or assisted living home staff members is not available.
Conclusion: Representatives of privately-owned and operated nursing homes should meet with their state counterparts to determine what the government-operated facilities did right and what could be replicated by the private sector.
One last note. The mother of a friend of my wife and me was transferred about a year ago from a private nursing home in Henrico to the Piedmont Geriatric Hospital operated by the state. The transfer was necessary because of the lady’s “behavioral problems,” which the nursing home could not, or did not want to, deal with. Our friend has had nothing but praise for the care her mother is receiving at Piedmont. Her only regret is that she cannot visit her mother as often because Piedmont is an hour’s drive from Richmond and she works on weekends, in addition to her full-time job during the week. When her mother was in Henrico, she could pop in for short visits several times a week. Nonetheless, I would bet that she is very glad that her mother is in the state facility rather than in a privately-operated one.
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