The Erosion of Trust in nursing Homes and public Health

Trust is top of mind these days, whether it be in the news or in our daily lives. We recently heard a nursing home infection preventionist share their experience that many staff did not believe in the value of the COVID-19 vaccine. Sadly, this is not unusual these days.

Ironically, when the question of vaccine mandates for nursing home staff was frist proposed in the winter of 2020-21, we were personally against mandates for one simple reason: Trust.

Trust is something that must be earned. One cannot mandate trust. Requiring individuals to do anything without their approval, understanding and support does not engender feelings of trust.

It is human nature to question authority. Children will naturally rebel when told to do something “becuase it’s good for them.” Most adults, present company included, are no different.

There is solid evidence-based literature affirming that a consensus leadership style among nursing home administrators and directors of nursing is associated with lower staff turnover and higher quality of care. This contrasted with both authoritarian and shareholder leadership styles.

Authoritarian leadership does not engender trust, whether it be in a healthcare institution or in government. Shareholder leadership,with its common perception that direction comes “from corporate,” also fails to generate trust.

The COVID-19 pandemic left more than 250,000 nursing home residents dead in its wake. The virus responsible was initially called a “novel” coronavirus. The novelty of this deadly virus challenged the scientific and public health communities, leading to rapidly changing guidance.

Unprecedented doubts

The politicization of the pandemic response led to a decrease in the trust that the American people have in the Centers for Disease Control and Prevention, public health organizations, and, most regrettably, science in general.

We’ve worked in nursing homes for nearly four decades. The camaraderie among staff who share our common focus for delivering compassionate care is second to none.

We believe that most nursing home staff trust one another. In fact, in our experience, most nursing home residents trust the compassionate staff providing their care. We believe that nursing homes and the CDC have a lot in common regarding the issue of trust.

Some have suggested that the CDC needs to earn back the trust of the American people. While we understand this sentiment, we also take issue with it. We have known many people who work for the CDC. Historically, thay have been true public servants who care deeply about public health.

In March of 2020, the CDC put forth a Morbidity & Mortality Weekly Report describing the findings of the COVID-19 outbreak at a nursing home in Kirkland, WA. (https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e1.htm) The report, like all MMWR reports, was based on science and was presented objectively. That report guided an evidence-based response by me and many colleagues in the field of geriatrics and long-term care medicine.