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$300 loan.
A picture of a surgical mask, thermometer, and pills

Just when I thought I’d come up with every reason I needed to stay out of a nursing home, public-health experts have delivered another one: superbugs.

Reporting in the New York Times, Matt Richtel and Andrew Jacobs describe the infiltration of a particularly virulent drug-resistant fungus into the nation’s skilled nursing facilities over the past four years. The germ, Candida auris, has struck nearly 800 patients, half of whom died within 90 days. It is so contagious that many nursing homes will not accept patients carrying it, but enough of them do that the trend has caught the attention of the Centers for Disease Control and Prevention (CDC).

“They are the dark underbelly of drug-resistant infection,” said Tom Chiller, MD, chief of the CDC’s fungal division.

But C. auris isn’t the only superbug making its way through our healthcare system. A team of researchers in June published the results of a study showing that 65 percent of nursing home residents in Southern California carried a drug-resistant germ; in long-term acute-care hospitals, that number jumped to 80 percent.

“They are cauldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” explained Betsy McCaughey of the New York–based nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

The nursing-home industry, of course, responds to reform measures in much the same way C. auris responds to a short course of antibiotics, which is to say, not very well at all. And healthcare economics make it even less likely that we’ll see significant changes in the near future. As long as Medicare pays skilled nursing homes more to care for high-risk patients than less vulnerable folks, these facilities will continue to welcome them into their often understaffed and poorly equipped rooms.

Though the Center for Medicare and Medicaid Services contends that the majority of the nation’s skilled nursing homes are providing quality care, Richtel and Jacobs note that about 1,400 of these facilities were cited for poor staffing in 2018.

“It is impossible for them to do a good job with the way their staffing is,” said Mary Hayden, MD, a Rush Medical College professor who studies the rise of drug-resistant bugs in healthcare settings. “The way they’re set up, they can’t do it.”

All these issues will surely create some fraught decision-making if grim reality intrudes on my determination to live out the end of my days in my own home. I’m encouraged by the gradual emergence of home healthcare options, but there’s no way of knowing what kind of shape I’m going to be in tomorrow — or 20 years from tomorrow.

That’s why the real decision-making happens every day, when I opt for a healthy breakfast or a bike ride across the river to the office or a zazen session on my mat. There are plenty of reasons to avoid the nursing home in my dotage, but it’s the things I do now that may make any late-life argument unnecessary.

Thoughts to share?

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