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 “It’s very lonesome and stressful,” she says.

For many Americans, ending up in one of the country’s 15,000 nursing homes is seen as a worst-case scenario of lost freedom and faculties. Many will wind up in one anyway, at least for a time.

Southern Pines nursing home resident Shirley Campbell visits with her daughter, Margie Price, and son-in-law, Ken, through a glass door in Warner Robins, Ga., on Friday, June 26, 2020. (AP Photo/John Bazemore) MINZY Mess with My Chickens and You Will Meet The Crazy Chicken Lady Shirt

Homes were no stranger to bad press when the virus began sweeping through and the pandemic only exacerbated negativity, with rampant problems with infection control coming into plain view. At least 55,000 residents and staff of U.S. Long-term care facilities have died of COVID-19, a disproportionately high figure. It represents about 40% of the total U.S. Virus deaths.

To move past this, to guard safety while acknowledging the rights of residents and their families and the toll of isolation, testing is key. With staff constantly coming and going — a key source of the virus in nursing homes — the Centers for Medicare and Medicaid Services, which regulates the facilities, has called for weekly testing of employees. It is just a recommendation, though, and like most things in American health care, it’s viewed through a lens of money.

Southern Pines, like seven in 10 U.S. Nursing homes, is a for-profit enterprise. About 90% of its residents have their care paid by Medicaid, for which the home receives about $186 a day. Shorter-term rehabilitation stays paid by Medicare can deliver a daily rate several times that.

Each staffer at Southern Pines underwent testing for COVID-19 in April, but barring a government mandate there is no plan to require tests at regular intervals. The cost is too high.

“You start doing the math,” says Stefano.

As a girl, Stefano visited nursing homes with her Girl Scout troop and Sunday school class and didn’t step foot in one again until answering that newspaper ad. Over the years, she’s run nursing homes’ housekeeping and laundry and kitchens, coordinated admissions and, in her most lasting role, led them as an administrator.

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