A little over a year ago, we did a blog on the dangers of bedbugs for the senior population. In this blog, we want to revisit that blog and update it with new information including the fact that this problem is far from going away.
Just last month, Orkin, a pest control company, released its list of the top cities for bedbug infestations in the country. It made the news and once again, the talk show circuit where it became the fodder of jokes for the hosts. But let’s make this clear, there is nothing funny about bedbugs, especially for seniors.
According to Dr. Tim Husen, an entomologist for Orkin, bed bugs is a problem that continues to grow. “The number of bed bug infestations in the United States is still rising, they continue to invade our homes and businesses on a regular basis because they are not seasonal pests, and only need blood to survive,” he says.
Let’s look at the top fifteen bedbug cities as listed by Orkin:
But, let’s get a little closer to home. Here is a story about a senior couple from Central Fall, Rhode Island.
Giselle and her boyfriend James, both near 70 years old, struggled for years
on an SSI income and in poor health. Giselle has been diagnosed with COPD from nearly fifty years of smoking nearly a pack of cigarettes a day. James, who has his own issues with crack addiction, complained to the local health center of open sores on his legs.
Their small apartment consisted of three rooms and a small bathroom. The bedroom consists of a mattress on the floor, sometimes covered with a sheet spotted with blood, but more often just an open mattress – also spotted with blood.
“This is all we have,” said Giselle. “I’m afraid to go to sleep because I can feel these things crawling on me. They bite, they sting and I scratch until I bleed. I started drinking so I didn’t have to feel the bites and could fall asleep. Even that doesn’t work anymore.”
The bedbugs she speaks about have left large welts on her legs and even affected her skin color, leaving large dark colored spots all over her legs. She also pointed to the blood spots on the walls, where according to her, “I smashed them bastards as hard as I could, but for everyone I killed, it seemed there were three more, it never stops.”
For James, things became a little more serious when he was diagnosed with an infection from the bites.
“I had these sores that just didn’t heal. I would scratch and scratch and bleed all over the place. When I went to the senior center, one of the social workers there saw the blood coming through my sock and called me to her office. I told her what was happening and she sent me to the emergency room. They gave me medicine and salve to put on my leg, but I ask myself, what’s the point when the bugs are still where I lay my head,” said James.
So why the continued growth in the bedbug problem? Weren’t they eliminated decades ago? According to entomologists, that was indeed the case. But with the banning of the chemical DDT, which was credited with eliminating the parasite, the numbers began to rise again in the 1990s.
First appearing in the “gateway” cities of Miami, New York, San Francisco and Los Angeles, bedbugs began to appear in large numbers once again. By the late 1990s, these cities experienced extreme infestations, first in motels and rooming houses and then expanding into the densely populated inner-city housing developments. From there, they began to show up in premium hotels, hospitals, and nursing homes. Today, these insects have reached levels of infestation never before seen in any culture.
Social scientists and entomologists have several theories for this resurgence including mass immigration, less use of pesticides and even the bedbug’s development of a resistance to the current crop of pesticides being used to control them. Whatever the cause, bed bugs are now found in nearly every setting from homeless shelters to five-star hotels and present a major health hazard for everyone but especially for America’s seniors.
The bedbug itself varies in size, and in color, from a red-brown to a light brown.
Adult bed bugs are 1/4 inch, or about the width of a pencil and they move quickly. Bed bugs are active at night and have been shown to be able to travel over 100 feet in a night but tend to live within 8 feet of where people sleep.
When checking an area for bedbugs, bedsheets and mattresses often have small spots which resemble human blood. Although human blood may be present from the scratching of the skin due to the bedbug’s bite, the small spots are actually the fecal material of the parasites.
They also can be detected by smell. They secrete odors with the smell characteristics of over-ripe raspberries, almonds or the herbs coriander and cilantro. Pest control companies in larger cities have trained dogs to detect these smells when trying to pinpoint large infestations. Remarkably, the animals are said to have a 97.5% accuracy rate in tracking down the bugs.
Bed bugs feed by biting the skin of its host for a blood meal. After feeding, they can increase in size by nearly half and double in weight. Living nearly a year, these insects can lie dormant for months without a meal while awaiting the next victim to come along.
These insects are also quite prolific as the female bedbug has the ability to lay 200-500 eggs within two months of birth. The females lay eggs in the seams of mattresses, box springs, bed frames, headboards, dresser tables, inside cracks or crevices, behind wallpaper, or any other clutter or objects around a bed. The eggs appear tiny, white and are hard to see without a magnifying glass.
The bite of a bedbug can cause many health symptoms including skin rashes, pruritic papules, and nodules associated with allergic reactions. Research has also found that bed bugs carry multiple bacterium, viruses, protozoa and parasitic worms. The bedbug has also been found to harbor Hepatitis B and even HIV within their digestive tracts for several days however these pathogens have not been detected in their feces and there exists no hard evidence of any transmission of these viruses due to the insect’s bite.
Those who experienced frequent bites may also develop physiological changes including disturbances of the lymphatic system and in some cases, enlargement of the spleen. Extended exposure for both small children and the elderly can result in major blood loss and anemia.
Many we have spoken with about this issue were surprised to learn that cleanliness is not a preventative against these insects. These bugs can find their way into the cleanest home on the pants or socks of a person who could pick them up while riding a bus, cab or even waiting in a doctor’s office.
Most people never feel the bite of a bed bug, which can take as long as 10 minutes per occurrence. To make matters worse, a variety of studies indicate that not every person has the same reaction to bed bug bites. For some, the bite wound occurs quickly. Some people will experience itching within a few days. Some people may not begin to itch until two weeks later. Some people will not suffer any itching or subsequent swelling which is one of the reasons that bed bugs are able to spread like wild-fire.
Studies have shown that elderly people often do not react to the bite of bed
bugs. There is no clear answer as to why this is the case but it is suspected that medications that seniors take, such as corticosteroids, may suppress their body's response to allergens making their immune systems less responsive than someone younger.
Although a bed bug bite may not directly kill an elderly person, a case in Pennsylvania in 2017 raised awareness of the threat bedbugs pose to the elderly.
A 96-year-old Hanover, Pennsylvania woman named Mary Stoner died in February of that year from sepsis, a blood infection caused by untreated wounds. Her caretaker, Deborah Butler, was charged with manslaughter in Ms. Stoner’s death.
Butler once ran a licensed home care facility where Stoner lived that subsequently went out of business. When this happened, Butler took over the care of Stoner and another woman in her home. Within months, Stoner’s family noticed that her health was rapidly declining and took her to an emergency room for treatment. While there, ER doctors found numerous sores on her skin, a bad rash covering about half of her body, and a skin infection that was determined to be caused by bed bug bites.
She was discharged a week later, according to the local newspaper the York Dispatch, and readmitted with pneumonia and eventually died. She had been in Butler’s care for more than ten years prior to her death.
What exactly makes seniors especially vulnerable to bedbug infestations? Here are a few things to consider:
Studies show that as many as one-third of people show no reaction to the bite of the bug even when repeatedly bitten. This number is much higher among seniors making it much easier for the infestation to occur therefore a lack of bite trauma is not an indication that bedbugs do not exist. And for some seniors, even though they see these bugs at night, they become apathetic given a lack of any physical signs.
Apathy may not be the reason for all cases of ignoring the presence of these parasites. When some enter old age, they become less caring about their appearance and tend to ignore cuts, scrapes and skin lesions. They simply stop caring. So, if you have an elderly family member, check them on a regular basis.
On the opposite side of the spectrum, some seniors are quite embarrassed by knowing there are bedbugs in their living situation. When the bite marks appear, the become quite concerned about what people will think of them. Unfortunately, there does exist a stigma that bedbugs only happen to dirty people and dirty homes. If you notice that an elderly loved one has welts on their skin, look into this.
While bedbugs don't solely occur in those homes that are dirty, there is a connection between clutter and bedbugs. These creatures have a much easier time infesting a home that is cluttered especially if the items are around a couch or a bed. People who have lived a full life often have accumulations of personal items that can make them susceptible to bedbug infestations.
Some elderly fear disclosing a bedbug infestation concerned that they may be found unable to care for themselves and moved into a senior care facility, losing their independence.
Temperatures also play a role in bedbug infestations. The elderly often keep their homes warmer than younger people and these high temperatures speed up bed bug life cycles and can result in higher bed bug populations. Higher temperatures also increase the potency of insecticides, causing them to break down faster and reducing the length of time they remain effective.
This is a seven minute video on knowing the symptoms of bedbug exposure and how to find them once you think they may be present in your home or facility.
Earlier in this blog, I mentioned that bedbugs have been found in all facilities including hospitals, nursing homes, and senior centers. I want to stress that the cleanest facility is subject to bed bugs despite the overwhelming precautions they take against them. The staff at these facilities have no idea what the next ambulance may be bringing to them.
As a director of several treatment programs on the Southcoast of Massachusetts and at a hospital program in Boston, bedbugs found their way in despite an abundance of precautions we took.
In one program, I found bedbugs in mattresses and wooden headboards. At a
cost of tens of thousands of dollars, all bedding was replaced as well as carpeting, cabinets and bedside furniture. The building was also treated by a professional company. After moving the residents back in, they were being bitten again within weeks. After evacuating the building, a closer inspection found that these creatures had found their way behind wooden wall panels and when these panels were removed, tens of thousands of bugs were found.
Eventually, the entire building was treated and no additional problems were reported.
Meanwhile, at a hospital in Boston, we had a very strict bedbug protocol was in place. All patients entering the facility were placed in a hospital gown immediately and received a close medical evaluation. All clothing was removed and immediately placed into plastic bags for treatment. Despite these precautions, bedbugs still found their way into the building and upon investigation in one case, it was found that a patient who came in with a portable oxygen machine brought the parasites with her inside the device. We also found bedbugs inside the spines of books, in purses and behind photos in frames that sat by a bed or couch.
But it’s not just medical facilities and senior care providers who experience these problems. In fact, some of the most secure locations in the country have had their own battles with bedbugs. Here are a few examples;
According to the Attleboro Sun Chronicle, the Attleboro, Massachusetts District Court was evacuated and later closed so workers could fumigate the building for bedbugs and lice. The building was initially evacuated after a person believed to be infected with bedbugs and lice was arrested over the weekend and appeared for arraignment in the first-floor criminal session, prompting fears of a bedbug outbreak.
In Providence, Rhode Island, the Providence Journal reported that the Garrahy Judicial Complex was treated after bed bugs were detected in the building, State Court Administrator Joe Baxter confirmed. Baxter said a pest inspection company last week treated areas that were reported to have had bed bugs, and that a "very small amount" were found on the fifth floor, where Family Court is located.
According to the New York Daily News, a bug bed-infested courthouse in South Carolina was evacuated after the insects were found there for the second time in just over two weeks. The bedbugs were widespread throughout the building, York County Clerk of Court David Hamilton said, according to a local newspaper. Specially-trained dogs were used and they found evidence of bedbugs in both courtrooms of the criminal court building and in offices on both floors.
An Oklahoma newspaper reported that a courthouse in that state was forced to shutter its doors when bedbugs were found on a lawyer's jacket. Rogers County Sheriff Scott Walton told KJRH-TV that the unidentified lawyer came up to a third-floor courtroom with bugs falling out of his clothing. "I was told the individual that had them also shook his jacket over the prosecutors' files," he told the television station.
I want to reassure families that the overwhelming majority of hospitals, nursing homes, assisted living residences, senior centers, and senior housing programs are clean, sanitary and meet or exceed state requirements. Sadly, their control over the bedbug issue is limited as visitors, new patients and even vendors can bring them in at any time. So, if you hear that a bedbug problem has been found, don’t judge the facility based on this, evaluate them based upon their response to the problem.
In cases where you find bedbugs in the home, it is recommended that you hire a professional pest control firm to address the issue. They know where to look and what to look for and will use approved pesticide to treat the location. Infected items like mattresses or upholstered furniture must be discarded or treated.
Above all, do not try to treat bedbugs yourself. Seniors are more likely to have medical problems such as COPD that make them more susceptible to the effects of insecticides. Those with breathing problems are more affected by airborne irritants and the additives used in pesticide products.
We hope this blog provides some insight into the issue of bedbugs and seniors. If you are a senior, be aware of bites or signs of infections on parts of your body. If you have a loved one in care and are concerned about signs you are seeing, speak up and let the floor staff or the administration know and in the overwhelming majority of the cases, they will respond quickly and professionally to correct the situation.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.