Residents and their loved ones may have reached a major turning point with nursing homes and other long-term care facilities, agonizing as to whether the institutions really can provide safe, hygienic, and welcoming places for the vulnerable — or whether other, tough options must be considered.
Who can forget that that 132,000 elderly, injured, and seriously ill residents died of the coronavirus during the many months of the pandemic, and almost 1.4 million infections were recorded in 38,000 long-term care facilities? The institutions — even as the pandemic’s terrible toll keeps rising — still account for a third of all U.S. deaths due to the disease.
The facilities’ covid-related deaths have plummeted by 91% since December, especially as public health officials campaigned to get residents and staff vaccinated, the New York Times reported (see chart above, based on federal data). But public confidence in long-term care facilities also has plunged, as reflected in admissions and occupancy:
“The 14,000 skilled nursing facilities in the United States now have on average a vacancy rate of slightly more than 25%, according to figures from the National Investment Center for Seniors Housing & Care.”
Long-term care facilities have received billions in federal pandemic rescue aid. They still are struggling to return to their previous levels, not only because of shortfalls of willing residents but also in keeping up with their increased post-pandemic spending and staffing needs.
The New York Times interviewed distraught families who have struggled during the pandemic with stress, guilt, anguish, and great inconvenience while worrying what to do with frail, aged, despondent, and confused friends and relatives desperately needing intensive 24/7 care.
Families, the newspaper reported, have learned they can manage situations they thought they could not, keeping loved ones at home, rather than institutionalizing them. The fear, frustration, and toil they experienced has been huge, especially because programs like Medicaid and Medicare can be less than helpful in supporting home care.
Indeed, as long, lonely, nursing home lockdowns proved debilitating for residents, friends and families found, for example, long waiting lists for home care aides and support programs, the New York Times reported. Costs of home care also can be daunting, though it is worth remembering that the annual cost of a nursing home single averages more than $100,000. The institutional choice also looks grimmer than ever to residents and their loved ones:
“Even before the pandemic began 14 months ago, nursing homes had become the source for rampant, antibiotic-resistant infections. The facilities also faced systemic problems like high turnover among nursing home staff and the gaming of the federal government’s rating system, which made it hard for families to judge the quality of homes. For years, federal health officials and some insurers have tried to encourage more stay-at-home care, and the pandemic has created a sense of urgency. ‘It’s really changed the paradigm on how older adults want to live,’ said Dr. Sarita Mohanty, the chief executive of the SCAN Foundation, a nonprofit group focused on issues facing older adults. The vast majority of those adults would prefer to stay at home as they age, she said. ‘What’s happened is a welcome sort of market correction for nursing homes,’ said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform in San Francisco. Some families, he said, ‘ended up agreeing to a nursing home without giving it a lot of deliberation.’ But after trying home care during the pandemic, many families found keeping an older relative at home was a viable alternative, he said.”
The newspaper also reported that there are new federal proposals to boost home care:
“The Biden administration has proposed spending $400 billion to address some of the gaps in long-term care by providing more funding under Medicaid for these alternatives, but prospects for President Biden’s $2 trillion package are unclear.”
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 abuse and neglect in nursing homes and other long-term care facilities. It is a painful but positive step to see so many members of the public think hard about the giant challenges of our graying nation in providing long-term care.
The facilities’ operating model is arguably dysfunctional. And it does not appear that their owners and operators are racing to deal with their significant issues, though at least some progressive investors are pushing them to improve. As facilities reopen, and more information flows about what happened in them, disclosures are forcing residents and their loved ones to make tough decisions, for example, whether to seek justice with lawsuits in the civil system. And it seems growing numbers of plaintiffs are pursuing this option.
We cannot lose sight of the deadly lessons the pandemic has provided us, notably about nursing homes and other long-term care facilities. This is what Liz Barlowe, the former president of the Aging Life Care Association, a nonprofit representing senior care professionals, told the New York Times:
“[S]he says she has sensed a shift in views on long-term care among families, even as some of the worst of the experiences in nursing homes fade. The crisis laid bare how poorly equipped many facilities were to handle a pandemic, she said. It also underscored that the industry needs to make fundamental changes to restore the confidence of the country. ‘The damage is done,’ Ms. Barlowe said. ‘Now we all know it can happen. We need to be looking at system change.’”
We have much work to do to not just restore to a previous normality the nation’s nursing homes and long-term care facilities but to improve them vastly.