As vaccinations increase and COVID-19 infection rates in nursing homes plummet, it’s easy to forget just how bad things got in many of them and how ill-equipped many were in the the early months of the pandemic to provide humane and effective care.

The following excerpt is from our March Reflections essay, “Right Under Our Noses: Nursing Homes and COVID-19,” which was written by a California nursing professor who volunteered to join a California Medical Assistance Team. The mission of her team was to bring aid to a skilled nursing facility where the coronavirus was rapidly infecting both patients and staff, a facility with little PPE available and many staff members refusing to come to work out of fear of infection.

The conditions I saw were shocking, even to an experienced nurse. I saw soggy diapers on the floor at the heads of many beds on most mornings. One day a bedbound patient needed the bedpan. I searched every closet and drawer but there were no supplies. I filled a basin with warm water and cut up a PPE gown to make washcloths to clean the patient. On the second day of my deployment I realized that many of the patients were dehydrated. They had no access to water. A patient with dementia was sipping juice from a cup. I glanced in the cup and saw floating fly carcasses.

On the next block, behind closed doors.

The author makes the powerful point that intense suffering often happens behind closed doors, right under our noses. While not every facility had conditions so dire—and we should be clear that desperate and overburdened staff were not to blame for the breakdown in care resulting from systemic neglect and individual management decisions—a similar story played out in many settings and resulted in untold deaths.

The media has shown COVID-19 patients in clean hospital settings, not in the conditions I witnessed—conditions hidden from view only blocks from the homes of a very wealthy community. In the last two weeks of May 2020 I saw, firsthand, the inequality of the U.S. health care system.

The author describes her efforts to help formulate a plan to improve conditions, and her sense of the ethical quandary she faced in knowing it couldn’t possibly be enough. Most powerfully, she calls for a harder look in the coming months and years at how such care was allowed to happen, as well as the underlying inequalities that have been more fully exposed by these events.