Nursing homes and other long-term care facilities are playing a sad, familiar, and disturbing role in the U.S. health system’s teetering on the verge of collapse in too many parts of the country due to the coronavirus pandemic.

The owners and operators of the care facilities for the aged, sick, and injured insist they have done as well as they could have under unusual, calamitous conditions. But after taking in billions of dollars of emergency taxpayer assistance, they apparently have not moved with the needed alacrity to deal with their previous problems or to assist in positive ways with the crisis now slamming the health care system.

Just a reminder that the U.S. health system has its own “supply chain” nightmare. Hospitals offer intensive care, and their beds and other treatment spaces are among the system’s most costly, and, in the pandemic, in the highest demand.

But hospitals — with deadly consequences for patients — cannot get the relief they require to free up beds, typically by getting patients well and stable enough for transfer to another level of less resource-intensive care in long-term care institutions, including skilled nursing facilities, and, of course, nursing homes.

These “pressure valve” institutions only recently ended their lockdowns and returned to a blithe normality, much welcomed by isolated, lonely residents and their loved ones. Still, they mostly are not taking on more of the elderly, sick, and injured. These had been a major revenue source for long-term care facilities and their unwillingness to take in more residents and patients is causing hospitals to be overwhelmed.

The pandemic also exposed huge problems in long-term care, including with their regulation, infection control, as well as in their keeping adequate staff to deal with the vulnerable needing 24/7 attention. Did the facilities deal with these health menaces as vaccines eased some of the pressures on them?

Nursing home owners and operators have moaned about how their overworked, under paid, poorly trained, and neglected staff — notably the aides who provide a major part of residents’ front-line care — departed in droves. The facilities, which kept their nurse staffing at bare minimums, also have struggled with vacancies of these better educated, better trained, and high-demand health workers.

Did long-term care institutions, as other major employers have, respond to their employment challenges by listening to their own people and providing appropriate economic answers — including wage increases, bonuses, educational and other advancement opportunities? Did owners and operators recognize, at long last, that taking care of the vulnerable is tough work, as National Guard personnel have found as they act as great Samaritans in assisting health workers at overrun sites.

Nah. In fact, institutions cried poor us, kept their low wages and made their hard-working staff ripe targets to be recruited away by the likes of Amazon (which, according to published reports, is hardly a nirvana-like place to work …)

Owners and operators also continued to imperil their prime customers — their residents — by dragging their feet in persuading their health workers to get vaccinated against the coronavirus, including in recent times with protective booster shots. Nursing homes and other long-term care facilities bellyached that forcing shots on their already downtrodden, angry, and suspicious workforce — geez, how did they get that way — would only increase their staffing exodus.

By the way, the facilities also plodded in getting boosters for their highest-risk residents, even as the Delta variant, much less Omicron strain infections increased in sites already savaged by the pandemic. The institutions’ residents, throughout many of the months of the virus’ spree, made up a third of the hundreds of thousands of disease deaths and infections. Did owners and operators fail to learn already the value of vaccinations and at what cost in a highly infectious winter coronavirus surge?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care centers.

Critics — correctly — ripped the Trump Administration for its lax, failed oversight of these facilities during the pandemic. But the Biden folks and Congress have not held the institutions’ owners and operators to account as needed, much less to conduct the deep, public dig into the failures that caused so many elderly, ailing, and injured long-term care residents to die or suffer greatly due to the pandemic.

The lack of this reckoning, notably what happened to billions in rescue funds for the facilities, haunts us in the latest coronavirus surge. Is our blindness to the plight of the vulnerable fostering unacceptable, reported increases in elder abuse, too? We have much work to do to ensure that our most vulnerable get safe, decent, dignified, and affordable care 24/7 as they need and deserve it. We can protect the whole health care system, especially overwhelmed hospitals, by dealing with long-term care problems. We can’t just leave residents and their families in the quandary of deciding whether their only recourse for justice is through lawsuits in the civil justice system. That’s one remedy. We have much work to do for a fast-graying nation that has significant issues looming no longer but smacking us in the face.