Originally published on Solidarisch gegen Corona
With its social distancing measures, the German government is pursuing two goals in the Covid-19 pandemic. Firstly, it wants to to drastically slow down the infection rate (‘flatten the curve’) so as not to overload the healthcare system, and secondly, it wants to protect so-called ‘risk groups’ from infection.
In view of the current situation in elderly care homes and nursing homes, we have to conclude that government policy has failed in this second objective. Care facilities for the elderly have become a pandemic hotspot in this country. One third of all the people in Germany who have died due to Covid-19 were residents of elderly care and nursing homes. The misconduct of individual facilities isn’t to blame – this disaster has structural causes.
The following text from a member of the Cologne Alliance for More Healthcare Personnel addresses these causes and concludes that it is primarily the workers in the care of the elderly themselves who could change the situation. The Alliance has therefore launched a poster campaign to express solidarity with nursing staff and to support them in their efforts to defend themselves against the bad conditions.
There were clearly visible warning signals for the disaster. After the experiences in Italy and Spain it was foreseeable what would happen here too. Wherever people live in close proximity to each other, whether in prisons, hospitals, care homes, collective accommodation for refugees detention centres or on aircraft carriers, the virus can spread quickly and distance regulations cannot be observed. As the disease is often particularly fatal in older people, this has a catastrophic effect in nursing homes. And it is precisely here that the state’s precautions in the context of the Corona measures were purely cosmetic, without even the slightest questioning of the profit- and cost-saving oriented management of these facilities. A ban on any visits was hectically imposed in care homes, which led to the residents becoming even more psychosomatically susceptible to any illness through the almost fatal isolation. Another result was that the chaotic activities of the home managers became even more shielded from the public eye.
In fact, this also weakened the ability of nursing home employees to point out grievances and exert pressure. Sociologists have been wondering for years why there is not more resistance to the lousy working conditions in the nursing sector despite the strong demand for nursing staff on the labour market. “Nurses are too nice for rebellion”, was the headline of a report in the Süddeutsche Zeitung on the 11th of November 2017 about a research project on the representation of interests in nursing care for the elderly. Due to the isolation of the homes, working under the conditions of a ‘no go area’ is unlikely to induce the courage to rebel – and the clapping of the educated middle classes on balconies every evening seems to signal to the celebrated “heroes” that they should do their duty for the fatherland without contradiction. Would people still be clapping if they were on sick leave or on strike?
Yet their rebellion would be the only thing that could prevent the imminent catastrophe. Warnings were given early on, without being heeded. On the 20th of March, Rolf Höfert, the head of the German Nursing Association, warned in a Spiegel interview: “This could cause a wildfire”. The first case of mass death in a nursing home to hit the headlines in Germany was in Würzburg. Care homes are insufficiently equipped with PPE and the staffing levels are far too low. Höfert refers to a study by the University of Bremen, which concludes that there is a shortage of at least 150,000 nursing staff in care and retirement homes. In recent years, undercutting the minimum staffing levels has become part of the system, especially since a ruling by the Federal Social Court in Kassel in 2012 gives nursing home operators a fairly free hand: the nursing care insurance can cut the nursing homes’ funding only if it can be proven that the required staffing level is intentionally not being met (or unintentionally below eight percent of the required level for a certain period of time). Proving this is obviously difficult. Nursing care insurers saw this as a carte blanche for nursing home operators to save eight percent of their personnel costs – a considerable amount of money, which increases profits. A new legal regulation was demanded in order to close this loophole and was supposed to be introduced by June 2020. It goes without saying that this will now be put on hold for the time being.
In the case of the Corona pandemic, nursing staff being systematically overworked is particularly fatal. Studies from China and South Korea show that the risk of infection among nursing staff and hospital doctors increases dramatically after six hours of work. After this time, concentration decreases and in the hectic rush, masks slip or the simplest hygiene regulations are overlooked. As in every situation of alienated wage labour, every day and every minute you are faced with the decision to either adhere strictly to the safety regulations or to achieve your prescribed work target – working both fast and safe is impossible. The hierarchical structure of work forces you again and again to cut back on safety. And at the same time you have to hide this carefully from the homes’ management, the supervisors or even your own colleagues to avoid the risk of being given a disciplinary warning or dismissal, even though it is the pressure to meet targets enforced by the nursing home hierarchy that forces you to do so. Workers’ actions, like ‘work to rule’, are based on this general contradiction of capitalist wage labor – and these actions can be very effective. But like a real strike, it too presupposes collective action; it only has an impact if it is practised by many at the same time and if individuals can be protected from disciplinary measures. These kinds of actions are an open power struggle for control over the work process, which at the same time is always a process of exploitation.
This power struggle would have to start now in order to stop the looming catastrophe in care homes – because the state acts counterproductively on all levels and would not be able to prevent the catastrophe with its apparatus (health authorities). From a purely medical point of view, an immediate reduction of the daily working time to six hours would be necessary – with full wage compensation, of course, to ensure compliance and to prevent voluntary overtime due to financial worries. Instead, the government decreed an emergency regulation that allows working hours to be extended to 12 hours. This seems plausible at first because there is a shortage of nursing staff and the situation in home and outpatient care is particularly dramatic because of the mass exodus of Eastern European nursing staff. But in reality there is a huge potential of trained care workers available in society. The few empirical studies on the fluctuation of skilled nursing staff show that the vast majority of them give up their profession just a few years after training because of the poor working conditions. If wages were raised to a corresponding gross monthly salary of four, five or six thousand euros similar to other skilled workers’ wages, there would be no shortage of personnel. The political decision to extend working hours is therefore only a decision to hold onto the capitalist, profit-oriented production of service of care for the elderly, but not a response to an absolute shortage.
The same applies to the question of the lack of Corona tests in care homes for nursing staff and residents. In the public debate, which focuses solely on virological and technical issues, the fact that cost calculations are still at the centre of decision-making is constantly being ignored. Whether and how testing is carried out cannot be explained by what would be useful to contain the pandemic. It is naive to think that we are suddenly living in a social order based solely on use values, while even the smallest things are turned into cost issues, i.e. the economic value of things. Even the financing of the ridiculous 1.500 € bonus that nursing staff are supposed to get in July (!), is still being fought over between the different cost bearers. Even for many on the left, the huge sums of money that the state is suddenly paying out as Corona-related financial aid seem to cloud the view to such an extent that the capitalist form is overlooked, which the state is still trying to secure.
Corona tests cost a lot of money – there are various figures, but they are likely to cost around 150-250 € per test. In Germany, there are about 15,000 nursing homes in which about 820,000 people are cared for (as of the end of 2018), by about 730,000 nursing staff, 85 percent of whom are women; since 1999 their number has risen by about 75 percent, which shows how strongly this sector is booming and has become an interesting capital investment. So in order to test everyone in the nursing homes just once, 1,560,000 people would have to be tested, which would cost € 320 million at, say, € 200 per test. As the virologist Hendrik Streeck has already suggested in an interview with the FAZ on April 1, it would make sense to test nursing staff and residents every four days. In view of the average incubation period of 5-6 days, as stated by the Robert Koch Institute, this seems reasonable in order to detect infections before symptoms appear. And Streeck refutes the objection that available testing capacities are insufficient by proposing group testing, which has long been practiced in transfusion medicine. It might be possible to reduce the costs, but if we stick to the €200 just to estimate the dimensions, comprehensive testing in nursing homes every four days per month would cost €320 million times 7.6, i.e. almost €2.4 billion per month! Even with only 7-day tests, it would still cost €1.35 billion. In a capitalist society the question arises: Are these old people, who “will die soon anyway” (according to the Green politician Boris Palmer), really worth it to us? Just by way of comparison: the one-off premium of € 1,500 offered for nursing staff would, according to calculations by the Institut der deutschen Wirtschaft (IW), amount to a total of € 1.14 billion for nursing care for the elderly alone – and this figure has led to a stubborn wrangling among the potential cost bearers. The financing of really effective and systematic tests in nursing homes is therefore completely up in the air – it will not come from the homes themselves, nor from the health or nursing care insurance companies. Meanwhile, the media are suddenly wondering why the available testing capacities are not being used.
It is good to see that in the last few days some daily newspapers have been researching the situation in care homes and reporting on the scandalous conditions, but it is naive to blame the conditions solely on organisational shortcomings and mismanagement. They have a system. The current situation is the systemic outcome of the care of the elderly in a capitalist class society. The state reacted to increasingly threatening class conflicts in an industrial society that is highly sensitive to disruption by providing social security for people in old age and illness. The ‘twilight years’ promised with pensions and nursing care are supposed to keep people in the daily treadmill of wage labour in good spirits. During the great pension reform of 1957, the ’pension was very aptly described by a social politician as a “perseverance premium”. The function of elderly care homes is therefore not simply to give the old, sick or people with dementia some more happiness in life for humanitarian reasons. Rather their care should make it clear to those exploited in wage labour now why it is worthwhile to endure the daily agony of alienated work. In contrast to the times of pauperism in early capitalism, modern capitalism does not simply let the people who are no longer usable starve or die of their diseases, but cares for them. This is expensive, but as a signal to those still working today it is also extremely productive and prevents rebellions. For working people are those who could rebel and resist, or who could lose the desire to work, if they see their own future in the dying of the old today. People who are cared for in homes are hardly able to defend themselves. It is a wider social issue, questioning the promises made in the four-colour glossy advertisement brochures of the nursing home operators and contrasting them with the real conditions in those institutions. In this way, living and dying in these homes is part of the general class struggle in this society. And just as class antagonism can only be kept under control by numerous forms of division according to gender, age, ethnicity, citizenship, etc., so too is the separation and exclusion of so-called “people in need of care” in isolating social units (nursing homes) an element of the reproduction of class relations.
Stubborn Corona virus deniers still repeatedly refer to earlier flu epidemics, which didn’t lead to public panic and the closure of entire branches of industry. We, in turn, can ask why, for example, the millions of deaths caused by the ‘Spanish flu’ in 1918/1919 had disappeared from historical memory for a long time, or why the flu waves of 1957 and 1968 with tens of thousands of deaths in West Germany were hardly mentioned in the media back then: “Just twelve years after the end of the Second World War, attitudes towards death and illness were different from those of today. The flare-up of tuberculosis, typhoid, dysentery and cholera still claimed thousands of victims in Germany at the end of the 1950s. And compared to what the country had gone through in the years of war and the early post-war period, the flu was then not so significant for many contemporaries and for the press.” (FAZ 04/22/0220)
So it is also an achievement of the class struggle that people today no longer allow themselves to be easily sacrificed on the battlefields of war or now to ‘economy’ (a euphemism for profit and capital valorisation, on which our whole existence is made dependent); that a higher esteem for the individual makes the fulfilment of one’s duty to higher beings like God, emperor or fatherland pale into insignificance.
But at the same time, in recent years society has been saturated by a neoliberal competitive thinking, which in case of doubt, always drives towards solutions at the expense of others: If, after 2015, it was the ‘refugees’, today it is ‘the old’. As Shimon Stein and Moshe Zimmermann warn in the Tagesspiegel, ‘risk groups’ are gradually turning into ‘unproductive eaters’ (“Ballastexistenzen”). The new verdict on euthanasia in the Netherlands shows how real the danger of this development has become – people like Boris Palmer are now speaking out, and are thus well received in parts of society.
It is in this area of tension that the conflict about, in within, care homes will be dealt with in the coming months or years. The most important role can be played by the nursing staff in the homes, who know best what needs to be done and who want to protect the people they care for, but who are systematically prevented from doing so – including through repression, bullying or dismissal.
The mobilization of nursing staff is even more difficult in nursing homes than in hospitals, because the countless homes are widely scattered throughout the city and the surrounding area. The ‘Cologne Alliance for More Healthcare Personnel’ therefore launched a campaign on the 1st of May under the slogan: “Preventing the Corona Catastrophe in the Nursing Homes”. With a poster, the nursing staff can be supported and encouraged on the one hand, and on the other, the residents can be protected from the threat of isolation by demanding tests and protective clothing for visitors. A web form is provided on the poster, with which workers can anonymously point out grievances, repression or conflicts in their homes – a helping hand for them to take basic steps of action themselves. This call for whistle-blowing is intended to warn and intimidate home managers and supervisory staff at the same time. There are almost a hundred nursing homes in the Cologne city area and a similar number in the surrounding area. The aim is to put up these posters in front of all the homes and at nearby public transport stops if possible, so that nursing workers can be reached. A movement in care homes will only come about if a social movement from below makes it clear that it is observing what is happening behind closed doors and is prepared to take action on the spot in the event of conflicts. Neither the state with its health authorities, nor the trade unions or any other institution are in a position today to react adequately to the worsening situation in care homes. By making it quite clear in practical terms that only the people who work and live there can know what to do, we are using a small but important example to show what a society shaped and controlled from below – beyond capitalism – could look like.