“Free at last!” That’s what it felt like. The small waiting room at the Kaiser Permanente Mapunapuna Medical Office was jammed with us old folks sitting, standing, all waiting in line to keep our appointments for that first Covid-19 shot.  

For the staff it was all hands on deck, an assembly line totally different from a normal day at the clinic. I got my shot from a high-level administrator who assured me she still remembered how from her former nursing days.

We were first to be eligible because we were so vulnerable, what with those terrible statistics about old people succumbing in nursing homes. Getting first crack at Pfizer or Moderna made us feel special in the way Mister Rogers told children, “You’re special.” 

The deservedly chosen people. How sweet. Reward and respect for people in need.

It didn’t turn out that way for everyone. Specialness and vulnerability turned out to be a trap for people living in nursing homes.

Nursing home deaths from Covid-19 went beyond simple death rates. It was eldercide.

Two eldercides, actually. One at that time, and another that threatens to be part of the next pandemic.

Nursing home Covid death rates were more than a hundred times greater than death rates outside. Among those over 65, death rates were 23 times higher in nursing homes than for those of the same age living elsewhere.

But there is something even worse than just nursing home deaths. It’s how they died.

Endangered On A Mass Scale

By “eldercide” I don’t mean a thug bludgeoning an elderly woman for her purse or a tormented family member helping her mother’s suicide.

Eldercide, as, as Margaret Morganroth Gullette describes in her recent book “American Eldercide: How It Happened, How to Prevent it,”  is “the abandonment of this concentrated and confined group of older adults to exposure and death, on a mass scale, by those responsible for their welfare.”

It involves, she said, “a widespread violation of law and statute, residents’ rights, citizen rights, and human rights.”

Mistreatment of trapped, isolated people. Abandoning them.

It happened in so many nursing homes throughout the country. Higher-quality nursing homes did better, but a 2022 report by the National Academies of Science, Engineering and Medicine concluded that, overall, U.S. nursing home care is “ineffective, inefficient, inequitable, fragmented, and unsustainable.”

Nursing homes were Covid cubicles and incubators. People there died of Covid because they got horrendously bad care or no care at all. Sometimes they were strongly encouraged and even coerced to sign “do not resuscitate” orders.

Staffing ratios were much too low, below government standards. As Covid worsened, governments lessened rather than tightened enforcement.

The people living in these places often had no masks and no personal protection. They were isolated from the outside but not from one another. Those with Covid were not safely separated from those who were not.

Now, I want you to take a moment and think about two things. First, recall the common image of that time: frail old people, depleted, wasting away, on their last legs, dying of Covid. 

“How awful. Those poor things. I can’t bear it. So sad.”

“Vulnerability” is the default explanation, the one we commonly turn to. It’s just a short step from seeing old people as vulnerable to seeing them as frail.

Now, consider what Gullette means when she says that the nursing home residents “were not vulnerable, as much as endangered.”

I doubt that you have any trouble drawing up the first image. The media certainly helped with that. But the second, about endangerment, is harder to imagine. 

It’s common to think about us old people hurrying down to Kaiser Mapunapuna as vulnerable. You poor souls, so many of your kind dying. That thinking is solely about the medical, the biological.

Calling something “endangerment,” on the other hand, removes the focus on the old person’s weaknesses and puts it on what others are doing to cause harm. 

“Vulnerability” is the default explanation, the one we commonly turn to. It’s just a short step from seeing old people as vulnerable to seeing them as frail.

“The frail elderly.” That’s become a term of art.

“Elderly” became “frail elderly,” which became a total merging of the two, as in ”fraileldery,” all one word — a homogeneous lump of debilitated people. If you were elderly, you were frail.

So, God bless you and keep you though soon you will be gone — the bottom of the arc, the end of your time. So sad, but that’s life. What can you do?

Maybe personal protection devices don’t enter the room, but a sense of futility sure does.

An Odd Kind Of Neglect

Through her interviews with nursing home residents, Gullette shows how inaccurate and disempowering that view is. In fact, people in nursing homes are very different from one another. Some are indeed frail, but many of them, even with the issues that brought them to the facility, are quite independent and resilient.

Eldercide lumped old folks together as a homogeneous mass of end-of-lifers, a focus on death rather than life.

We put people in nursing homes that were terribly run and unprotected, then claimed they died because they were so frail and vulnerable.

This was an odd kind of neglect, on the surface a benign neglect suffused with pity but also with a dose of “well, that’s life” with a bit of coerciveness thrown into the mix.

When Mister Rogers said “special,” he was speaking to kids. There is, as Gullette points out, no way that these elderly beneficiaries/victims would have been treated like this if they had been children rather than oldsters. In that case, it would have been futility be damned.

There’s a lot of talk about the lessons this country has learned from the pandemic and what we can do better next time. It’s mostly just talk.

It’s very clear that this country is nowhere near prepared for the next one — say, bird flu.

The way the U.S. health care system is organized and funded, nursing homes and the like are typically privately owned, often for profit, with the government regulating them.

That model failed in the Covid pandemic because all too many nursing home operators had only the bottom line in mind while state and federal governments simply did not regulate or inspect. 

That needs to change, which requires a very different and more proactive stance by the government — a huge job, especially considering how depleted and disorganized U.S. public health is.

For now, Gullette says, “The government’s failure to protect them should strike fear in the hearts of everyone who hopes to grow old.”

Other cultural views about aging, which Covid both reflected and enabled, are challenging because in our imagination these views are so much associated with kindness and caring.

“How can we be doing so bad if we care so much?”

The media’s coverage of Covid reinforced these cultural notions about aging.

So did doctors, many of whom have had no training in working with the elderly.

“Frail elderly” is a distancing term.  It’s a way to distinguish and isolate them from us while diminishing them as just a bunch of pitiful end-of-lifers.

The term generates a sense of futility, as it did with old people and Covid. We are alive and well. They are frail and if not at death’s door at least hobbling down the hall to the entrance.

Lives living versus lives ending. She’s already lived her life versus she is still living her life.

For that happy group of old-timers at Mapunapuna, the pandemic taught us to be thankful we were not living in nursing homes.

It also should teach us to be aware and assertive, because so many treat us as if we do.