Sunday, March 7, 2021
NBC News ran this story, America now knows that nursing homes are broken. Does anyone care enough to fix them? . Once COVID starting sweeping through facilities last year, more folks learned about the current model of providing long-term care, and their short-comings. Experts began calling for reform on the way we provide SNF care in the US. But did that call for reform get drowned out by the daily news about the havoc COVID was wreaking on our country?
The NBC News story ran yesterday (thanks to my colleague and dear friend Professor Bauer for sending me the link).
The pandemic turned nursing homes into a death trap for more than 170,000 long-term care residents and staff members who have lost their lives to Covid-19.
But the virus also revealed how America’s system for long-term care is fundamentally broken in ways that will continue to harm vulnerable residents and workers, long after the pandemic has faded away.
The biggest underlying problem? For all the billions of taxpayer dollars that the United States spends on a system meant to care for frail, elderly residents, not enough money is being invested in caregiving itself, according to interviews with more than a dozen nursing home researchers, advocates, industry representatives and staff members.
There are two sides to this issue, as noted in the story, as well as an opportunity for reform, complete with roadblocks to achieving it.
Nursing homes, by their nature, are ideal breeding grounds for Covid-19: Frail, elderly residents live in close quarters, often requiring support from aides to eat, get out of bed, bathe and get dressed.
This hands-on caregiving is the backbone of what a nursing home provides, and the reason that most residents are in long-term care to begin with. But a chronic failure to value this work, and compensate it accordingly, helped accelerate the pandemic’s catastrophic spread, experts said.
Staffing shortages are discussed in the article, along with explaining how those shortages contribute to a greater risk of a COVID outbreak. The work these folks provide is undervalued both in terms of salary as well as the role they play in providing care.
The section of the article on funding is quite illuminating
America’s long-term care system was created as an afterthought, when nursing home coverage for poor, frail Americans was included, without much fanfare, as part of the 1965 law .... A half-century later, the elderly population has ballooned, and life expectancy has shot up, while personal savings have not, leaving millions of aging Americans unable to pay for the care they need. But unlike most major industrialized nations, the U.S. has no universal public system that covers elder care, which means that many patients, as well as nursing homes, are ultimately left to rely on Medicaid.
The trouble with Medicaid — the only federal program that pays for long-term care — is a reimbursement rate that the industry has long complained is too low, about $200 for each day of care, on average. Medicare pays at least twice as much, but it only covers up to 90 days of post-acute care and rehabilitation, typically following a hospital stay.
The article discusses accountability, the use of third-party contractors, quality of care transparency (or a lack thereof) and lobbying efforts. The article looks at proposals to change the industry. I'm assigning it to my students and we will discuss it in class. I recommend it to you.