Nursing homes have probably been the absolute last choice of where to go for any impaired elder in need of some care. The average age of a nursing home resident is 86. Many folks are there because they have no other option. About 60% of the 1.4 million residents receive Medicaid as their only payment source for living there.
All kinds of professionals and stakeholders are in agreement that the nursing home industry is broken. This is not new news. As a 19 year old nursing student, decades ago, I worked in nursing homes and I saw what was going wrong firsthand. From what is observable now, things have only gotten worse in the decades since. Most glaringly, failure of nursing homes to adequately address the pandemic led to approximately 133,000 deaths from Covid. We can only speculate that if these facilities had adequate protective equipment (masks, gloves and gowns) that some of these deaths were avoidable. We can also speculate that if their administrators and staff had adequate education about infection prevention, that Covid-related outcomes would have been much better. Have we learned anything from this?
Beautiful plans are in place to make nursing homes less hospital-like and more friendly. Great minds have devised reform policies for everything from staff-resident ratios to construction of facilities that feel more like homes than outdated, cold, unfriendly structures they usually are. And what will become of those lofty goals?
My guess: not much. It will all depend a great deal on Congress authorizing funding for such reforms. From here, it does not appear that taking care of our frail and dependent elders is a broad legislative mandate. The residents in these homes are not the target voters of those who attain legislative power. Nor are their families, many the spouses and adult children of their frail elders, some of whom are impaired to some extent themselves. We simply don’t see nursing home residents’ families marching in the streets demanding that their elected representatives in Congress do something about
the broken system.
In 2022, President Biden announced in his State of the Union address that his administration planned to set higher standards for nursing homes. The plan included setting minimum staffing standards in them. What’s wrong with that idea? Barely any of these homes are adequately staffed and they have trouble attracting workers. If they pay workers more, that will cut into the profits of the private equity firms that own many of them. By 2018, private equity firms had invested $100 billion in for-profit nursing homes. And of course, one must find workers willing to do the hard and often messy work. We have a nationwide labor shortage and this sector is no exception.
Another prong of the plan: find ways to reduce shared rooms in nursing homes. These are the only kind of rooms Medicare (for short term stays only) and Medicaid (long term stays) pay for. Do you think that the motivation of our Federal legislators is to spend more money on Medicare benefits or expand Medicaid benefits? I say, fat chance. Many seem bent on reducing government spending, not increasing it.
All the lofty goals of reforming nursing homes are well thought out, and worth the time of those involved to create a vastly better vision for what nursing homes should be. And, unfortunately, it does not look like the dysfunctional legislative body we have now is going to bring any of those worthy plans to fruition. They are far more likely, sad to say, to just let things be as they’ve been for the past 70 years.
Anyone who has a loved one who must go to or live in a nursing home would probably agree that it is unsatisfactory to have them there. If you want change, you need to bring this to the repeated attention of your elected representatives and to ask directly for the much-needed changes.
Your allies include: Leadingage a national coalition of age-focused nonprofit organizations, and service providers, and Moving Forward Coalition, a group of nursing home providers and others, working to create action plans to improve nursing home care. Additional state-based organizations have vigorously advocated for legislative change for years. It all boils down to the question of how to get the Federal funding to make these essential changes a reality.