Shawshank Re: Dementia Day 481 (1 Year, 116 days): The Devil You Know Versus the Devil You Don't Know

Posted 7/7/21

Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. –Matthew 7:7

How do you make a decision in life based on the title of this piece? Is the devil you know worse or better than the one you don’t? It is harder in so many ways than most people think, depending on just how well we know the devil we know. I just want to briefly discuss Covid-19 and nursing home closures today, with this in mind…. (Cricket sounds begin freely as everyone…all zero of them… interested in this topic, scream)

Here is the devil we know:

(BioMed Central Ltd) In the U.S., approximately one-quarter of community-dwelling older adults are considered to be socially isolated, and 43% of them report feeling lonely [2]. The COVID-19 pandemic is increasing the number of older adults who are socially isolated including both community-dwelling older adults and nursing home residents, as many countries have issued stay-at-home orders and banned visits for nursing home residents.

(CDC Source) Although it’s hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk. Recent studies found that:

Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.¹
Social isolation was associated with about a 50% percent increased risk of dementia.¹
Poor social relationships (characterized by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.¹
Loneliness was associated with higher rates of depression, anxiety, and suicide.
Loneliness among heart failure patients was associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.¹

(NIH Source) Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.
(WebMD Article): Douglas Nemecek, MD, Cigna’s chief medical officer for behavioral health, said the findings of the study suggest that the problem has reached “epidemic” proportions, rivaling the risks posed by tobacco and the nation’s ever-expanding waistline. “Loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity,” he said in releasing the report.

Summary: We know the devil of isolation…we just don’t believe it to the level where it matters to us. It is very interesting to me how we trust science, sometimes, when it fits an agenda/one’s politics, but are quick to discard it as fake news if one of two conditions is observed: the wrong person or group sides with an argument or it directly and specifically harms us.

Case study: Nursing homes. Nursing homes, by and large, were the home to a HUGE number of wonderful folks who died of Covid-19. The numbers are staggering… The response was partially correct. They locked down their facilities (except in NYC and some other high profile blunders) and, once vaccines came out, they vaccinated the dickens out of the residents. Tests were and are passed out like peanuts at a baseball game! Most facilities have 90+% vaccination rates for residents, from the anecdotes and reports I have seen.

However, less than 50% staff vaccination rates among employees of these facilities is the norm. Missouri, the state which houses mom, my uncle, and the Sweet 17, is 3rd worst in staff vaccine rate at about 43%. In Missouri, there are fewer nursing home staff vaccinated than the age 18-64 population as a whole (43.16 versus 48.9 percent, respectively). Out of our collective mouths we say the following:

The vaccine is safe
You should get vaccinated or you have to mask up and meet the devil we do know…see above…
If you don’t use precautions, you will die of Covid
Staff is required to vaccinate for the flu and a host of other things. Vaccines are safe.
Since the 3 different Covid vaccines are not fully FDA approved, we will not require staff to get them
We are short-handed, so we will NOT make anyone vaccinate. We can’t afford to lose staff…unless them dying of Covid is “losing them”, but I digress.
Unless there us full, unrestricted FDA approval, we consider the vaccine too risky, financially, to require.
The Aducanumab dementia treatment, which costs around the same price as a Tesla SUV, fully loaded, per year, is only provisionally-approved as well. (Sorry…I had to throw this in…). Medicaid and Medicare will likely buy everyone a Tesla-worth every year because, on this, we believe in the science.
Oh…and even if the resident AND the visitor are fully vaccinated and the visitor drives in a Tesla, they cannot visit except through a window or on a Zoom and never (gasp) be able to give a stinking hug! The staff, who will not get vaccinated, must be protected with no exclusions from these vaccinated folks, even as they live their life completely normal after work, shopping at Wal-Mart, bellying up to bar, and going to concerts like the rest of us… all the while getting tested until their nose is reamed out like an ear gauge. Sounds legit…like following the science, eh?

I am very frustrated. Can you tell? I believe in, and would fight for, the right of choice whether to vaccinate or not to vaccinate. I have a great friend and co-worker who nearly died of a vaccine. Not some “friend of a friend of a friend”. Not a “vaccine almost killed me (but was co-morbid with something else that was the actual cause)” person. Not a nincompoop…actually one of the most brilliant people I know. And it happened. So, I am NOT unsympathetic. I know multiple who have died of Covid. However, it is a devil you know versus a devil you don’t know scenario here for nursing home staff. I, despite the fact that I think everyone should vaccinate, wouldn’t require an employee…but I would move them elsewhere as needed.

The biggie, to me, for the sake of this discussion, is this: I simply cannot see why a nursing home, who works with the most vulnerable population, restricts visits. We know isolation kills. It is a fact. We know the vaccine is very effective. The only variable is the staff…and they are free to take a bath in Covid-juice 15 minutes after they leave work if they choose, but my vaccination is worthless to keep the virus from leaping from me to them. Why vaccinate all of the residents with so little faith? Oh…lawsuits. The lawsuit devil you do know (getting sued for not vaccinating them) is scarier than the one they don’t. Grrrrrr.

I respect nursing home administrators. I really do. They have been heroes and made many, many, many life-saving decisions in this pandemic. The ones I know are hard-working, strong, and caring folks. I am not mad at them. I am just frustrated by this decision, often made at a corporate level. And I cannot fix it. And I hate losing the last weeks…

#EndALZ

Update: I got to visit mom, outside in the shaded heat, for my 20 minutes yesterday for the first time in nearly 2 months. We have been blocked more than we have been allowed…and it has been devastating. She was largely unresponsive, but woke up a few times with us for 30-45 seconds, then back to slumbersville. She seems happy and not in pain. Her face has a bad coloring to it…almost looked like staph or similar. It dries out a lot and, without us being there to prompt, who knows how often it is addressed. I really wish we could work out a plan to bring her home. All of this being said, it sure was nice to see her from 6 feet away. 🙁

A bonus conversation, since I know many are going to trash me over this piece with bad info:

But their hands are tied…it is illegal to require vaccines! Read this link and tell me that you still believe this excuse: LINK

Here are the key paragraphs:

K.1. Under the ADA, Title VII, and other federal employment nondiscrimination laws, may an employer require all employees physically entering the workplace to be vaccinated for COVID-19? (5/28/21)

The federal EEO laws do not prevent an employer from requiring all employees physically entering the workplace to be vaccinated for COVID-19, subject to the reasonable accommodation provisions of Title VII and the ADA and other EEO considerations discussed below. These principles apply if an employee gets the vaccine in the community or from the employer.

In some circumstances, Title VII and the ADA require an employer to provide reasonable accommodations for employees who, because of a disability or a sincerely held religious belief, practice, or observance, do not get vaccinated for COVID-19, unless providing an accommodation would pose an undue hardship on the operation of the employer’s business. The analysis for undue hardship depends on whether the accommodation is for a disability (including pregnancy-related conditions that constitute a disability) (see K.6) or for religion (see K.12).

And the Shawshank continues………