Nursing homes or abandoned castles: COVID-19 in Italy

In May 2020, during the first wave of COVID-19, we described Italian retirement homes (particularly in northern Italy) as besieged castles.¹ These homes were in difficult times with no visitors allowed and a very high number of deaths, but overall they remained strong and capable of maintaining standards of care. As of December, 2020, during the second wave, the situation has changed completely. We could now describe Italian nursing homes as abandoned castles, where the virus has entered and settled; causing very serious damage. By whom were they abandoned?

First, by the governments, both regional and national. In Italy, a large amount of money was distributed to different types of private enterprise but none was dedicated to helping the survival of residences for older people, burdened by very high losses due to missed revenues and increased costs. Additionally, the government repeatedly declared that retirement homes do not belong to the public service network.²

Second, residences for older people were ignored by many citizens, who, instead of defending these facilities in their regions, accused them of bad governance, inadequate treatment of residents, and poor management characterised by slow reaction times and insufficient defensive measures.³

Third, they have been abandoned by staff, particularly nurses, with some moving to public hospitals, where the salary is much higher. Residence homes find it hard to recruit replacements because there is a chronic shortage of qualified health-care workers in Italy. Unfortunately, the staff who have remained at work in the residence homes show fatigue, disappointment, and demotivation. They feel abandoned. Yet they still remain strong, often in a heroic way.⁴

Finally, the residence homes have also been abandoned by medical culture (eg, universities and research institutions), which is often in the media regarding various useful or banal developments. However, topics relating to the thousands of older people who live there and their stories of pain, disease, and lack of self-sufficiency, or to their need for adequate clinical care, are neglected.⁵

Defence of this older population falls to representatives of nursing home organisations, who try to make themselves heard but whose voices find neither attentive ears nor sensitive hearts. Unfortunately, we must conclude that the besieged castle image with strong internal resilience was better than this vision of castles on the verge of being completely abandoned.