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Rethinking How We Approach Long-Term Care In The U.S.

Nursing home residents make a line for the coronavirus disease (COVID-19) vaccine at Harlem Center for Nursing and Rehabilitation, a nursing home facility. (Yuki Iwamura/AP Photo)
Nursing home residents make a line for the coronavirus disease (COVID-19) vaccine at Harlem Center for Nursing and Rehabilitation, a nursing home facility. (Yuki Iwamura/AP Photo)

Nursing homes in crisis. Is it time to rethink how they work? We talk about alternative models for nursing homes and how to build a better long-term care system in the U.S.  


Katie Smith Sloan, CEO of LeadingAge, the association of nonprofit aging services, including nursing homes. (@SmithSloan)

Jack Beatty, On Point news analyst. (@JackBeattyNPR)

Howard Gleckman, senior fellow at Urban-Brookings Tax Policy Center at the Urban Institute. Author of “Caring for Our Parents.” (@howard_gleckman)

Also Featured

Sandy Isham, registered nurse in Kansas who pulled her mother out of a nursing home during the pandemic.

Stephanie Igoe, former administrator at the Hallworth House, a non-profit nursing home in Providence, Rhode Island that closed in August 2020.

Interview Highlights

The American Health Care Association says that nursing homes could lose some 34 billion dollars over the next couple of years. And 10 times as many nursing homes, perhaps as many as 2,000 or almost 2,000, could close this year. Do those numbers make sense to you?

Katie Smith Sloan: ”I would characterize the nursing home sector right now as fragile. You know, nursing homes have been through a war over the last year. Early on in COVID they were ignored by the feds, even though we knew well that older people and those with underlying health conditions were most at risk. Nursing homes lacked PPE, they lacked access to testing, and they had to scrape and scramble to keep their residents and staff safe. And the truth is, when there were high rates of coronavirus in the community, there was COVID in nursing homes. Because staff come and go, three shifts a day.

“So as long as communities were not taking measures to control spread, sadly, nursing homes could not avoid COVID. So we were extremely relieved when CDC prioritized nursing homes for vaccines through the pharmacy partnership program. You know, by mid-March of this year, just a few weeks from now, all homes will have had their third and last clinic, which means that like 80 to 90% of residents will have been vaccinated. And finally, this is an acknowledgment that older lives are not expendable.”

We reached out to the American Health Care Association, an industry group that represents some 14,000 operators. And in the statement they gave back to us, I think a half a dozen times, they said Medicaid has been notoriously underfunding nursing homes for years. Is that part of the problem?  

Katie Smith Sloan: “It’s absolutely part of the problem. We need to invest in paying homes for the cost of care, not some arbitrary and unrelated amount that falls woefully short of what it actually costs to care for people with complex medical conditions. And a lot of the expense that Medicaid covers is staffing. And we need to invest in these jobs. We need to pay our direct care workers a livable wage, and professionalize the work that they do. So it does come back to what we value as a country. And do we value quality care for older adults? And if so, knowing that Medicaid is the primary payer, we need to invest more in our Medicaid programs.”

So should it be the primary payer?

Katie Smith Sloan: “Families impoverish themselves and spend down in order to be able to access long-term care through the Medicaid program. From our perspective … we need to completely rethink how we pay for long-term care in this country. So families’ pocketbooks don’t become the deductible for Medicaid, which they are now.

“We need to think about long-term care, not as just nursing home care, but long-term care includes home health care. It includes hospice. It includes assisted living. It includes the full panoply of services and supports. Because everybody’s aging journey is different, everybody needs different services at different times. But ultimately, over half the older population will need to access some form of long-term care. So we need to think about the system of long-term care and how we are going to support it so people can get the best services they need wherever they call home.”

From The Reading List

Wall Street Journal: “Covid Spurs Families to Shun Nursing Homes, a Shift That Appears Long Lasting” — “The pandemic is reshaping the way Americans care for their elderly, prompting family decisions to avoid nursing homes and keep loved ones in their own homes for rehabilitation and other care.”

The 19th: “Most nursing homes say they won’t be able to stay open another year due to pandemic costs” — “The United States recorded its first COVID-19 death in February 2020 as the virus swept through a Washington nursing home. Within one year, the country has reported more than 136,000 coronavirus deaths linked to long-term care facilities — more than one-third of all coronavirus deaths in the country. Now, the nursing home industry faces a financial crisis.”

New York Times: “Nursing Homes, Once Hotspots, Far Outpace U.S. in Covid Declines” — “Throughout the pandemic, there has been perhaps nowhere more dangerous than a nursing home. The coronavirus has raced through some 31,000 long-term care facilities in the United States, killing more than 163,000 residents and employees and accounting for more than a third of all virus deaths since the late spring.”

Tampa Bay Times: “How to fix the nursing home crisis, now and after the pandemic” — “The COVID-19 pandemic has caused tens of thousands of deaths and more than three million infections, with predictions of many more to come. Nursing home residents have been among the most affected by the pandemic.”

This article was originally published on WBUR.org.

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