Nursing homes or abandoned castles: COVID-19 in Italy
Authors: Marco Trabucchi, Diego de Leo
Journal: The Lancet Psychiatry (2021)

In May 2020, during the first wave of COVID-19, we described Italian retirement homes (particularly in northern Italy) as besieged castles.1Trabucchi M De Leo D Nursing homes or besieged castles: COVID-19 in northern Italy.Lancet Psychiatry. 2020; 7: 387-388Summary Full Text Full Text PDF PubMed Scopus (105) Google Scholar 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.2Orlando N RSA a Brescia, "situazione sotto controllo, ma risorse e organico sono insufficienti".https://brescia.corriere.it/notizie/cronaca/20_novembre_04/rsa-la-situazioneora-sotto-controlloma-risorse-organicosono-insufficienti-d6a72394-1ecd-11eb-9970-42ca5768e0fd.shtmlDate: Nov 4, 2020Date accessed: November 25, 2020Google Scholar 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.3Liverani L Ora basta morti nelle.https://www.santegidio.org/pageID/30468/langID/it/itemID/39908/Ora-basta-coi-morti-nelle-Rsa.htmlDate: Nov 7, 2020Date accessed: November 25, 2020Google Scholar 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.4Visetti G RSA, infermieri in fuga: "é come stare in guerra ma senza più soldati".https://rep.repubblica.it/pwa/generale/2020/11/03/news/rsa_infermieri_in_fuga_e_come_stare_in_guerra_ma_senza_piu_soldati_-272964887/Date: Nov 3, 2020Date accessed: November 25, 2020Google Scholar 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.5Salvalaggio E Nel Veneto è allarme, i contagiati sono oltre 900 e mancano più di 1.500 infermieri.http://www.quotidianosanita.it/veneto/articolo.php?articolo_id=90124Date: Nov 19, 2020Date accessed: November 25, 2020Google Scholar 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. We declare no competing interests. Nursing homes or besieged castles: COVID-19 in northern ItalyThe tragic events in Italy, with more than 10 000 deaths due to novel coronavirus 2019 (COVID-19), are causing pain and demoralisation to a still incredulous and shocked general population. It is particularly distressing that outbreaks of infection have developed rapidly in many nursing homes, where staff have been completely neglected by health authorities and can offer only little protection to many frail and needy older people. Full-Text PDF