Nursing homes are susceptible to epidemics of pneumonia due to the close contact between the residents of the facility and the nurses. In many nursing homesthe occupants are kept side by side in large wards and lay bedridden continuously. Nurses must constantly tend to each resident by turning them over to prevent bed sores and to empty their bed pans. Each time a patient is handled the steel rails on their bed must be lowered and then put back up again after the service is over. These rails are just one of the potential surfaces for bacteria to be spread. If a patient touches or grasps a rail of their bed after coughing into their hand, then the rail can become contaminated with pneumococcus or other bacteria. A nurse can then transfer that bacteria to another patient by touching the rail and then touching the rails of other patients. In this way it is common for pneumonia to spread within a nursing home and kill many patients within a short period.

Workers in nursing homes often describe group die offs as sympathetic. In other words, when one patient dies, others lose heart from the death and give up the will to live as well. In some cases, that may indeed happen. However, in many cases patients in nursing homes are barely aware of their neighbors and lay gaunt and skeletal in their beds oblivious to the world around them. For these patients it is hard to imagine them dying sympathetically because they have no apparent emotional connections either to their neighbors or to anything else. When these patients die in large numbers, often the explanation is the simple one: bacteria colonies are being transmitted from patient to patient by handling procedures that are inadequately sanitary.