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Solving the Nursing Home Crisis after COVID-19

The crisis that hit nursing homes during the coronavirus pandemic isn’t a new problem. But solving the crisis will require new solutions.

Even before COVID-19 came along, U.S nursing homes “were like tinderboxes, ready to go up in flames with just a spark,” wrote Rachel M. Werner, Allison K. Hoffman, and Norma B. Coe in a late-May edition of The New England Journal of Medicine. “The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy.”

The crisis that hit nursing homes during the pandemic isn’t a new problem, maintain the authors. The crisis actually began in the 1960s when Medicare and Medicaid adopted a medicalized model of care and prioritized the use of licensed providers and institutions. That move elevated the care provided by nursing homes, leaving family caregivers invisible and unsupported. To make matter worse, the financing system driven by Medicare and Medicaid didn’t cover all the costs of long-term care.

Nursing homes have seen decreasing occupancy for decades, due to cost-cutting measures that reduced post-acute short stays and moved more care to the home. Given their shrinking census, many nursing homes had little cushion to respond to the pandemic. In the coming months, many will struggle financially, and some will close.

“COVID-19 has exposed the cracks in our tenuous system of providing and funding long-term care, and there are no easy fixes,” the authors write. “But we believe we are well past due for comprehensive policies that take the care of aging Americans seriously and fund it accordingly and in a wider range of settings.”

Their recommendation include allocating federal funds—up to $15 billion—to save nursing homes over the short term, and then transforming how we pay for and provide long-term care by:

  • Investing more Medicaid funds to support care in all settings, including homes.
  • Creating safe, affordable residential options that provide care in small, self-contained, family-style houses with a small number of residents.
  • Implementing more comprehensive funding through existing social insurance programs or stand-alone universal long-term care insurance for the entire population.

“More funding alone is not the answer,” the authors conclude. “Nor is more regulation a sufficient response. Rather, we need a combination of funding, regulation, and a new strategy that fully supports a range of institutional and noninstitutional care.”

Read the full article.