Aging Americans have a wide variety of living options. The right choice is usually determined by a combination of need and affordability. Maximizing independence is the goal of most seniors. Whether that means staying in a family home, downsizing, or moving to a retirement community is a decision that healthy seniors will need to weigh.
When a senior needs daily care, living with family members is one option. Moving to an assisted-living facility is another. When the family member needs constant care, a nursing home might be the best (or only) option.
Nursing homes faced serious challenges during the pandemic. Keeping a contagious virus out of a confined population is no easy task. Some nursing homes undertook that challenge more successfully than others.
The Pandemic’s Impact on Nursing Homes
According to the Kaiser Family Foundation, more than 34,000 long-term care facilities have reported at least one known case of COVID-19. The 1.4 million reported cases in long-term care facilities represent about 5% of total cases. Unfortunately, the 175,000 pandemic-related deaths in long-term care facilities represent more than a third of the total death rate from COVID-19.
Whether those statistics are accurately reported is a question of growing concern. News stories that nursing home deaths have been underreported in New York and Indiana are a source of unease for families who wonder just how safe nursing homes really are.
Fortunately, COVID-19 vaccinations are now reaching most long-term care facilities. They appear to be making a difference. New cases and deaths in nursing homes have declined sharply since vaccination distribution began. The New York Times reports that new cases among nursing home residents fell by more than 80% from late December to early February, almost twice the rate of decline seen in the general population. When fatalities in the general population were spiking, they decreased in nursing homes by more than 65%.
The good news is that the pandemic’s impact on nursing homes is turning a corner. The bad news is that concerns about the future of nursing home health care have not been entirely resolved.
Based on interviews with nursing home researchers, advocates, industry representatives and staff members, NBC News reports that America’s failure to invest more money in caregiving is the underlying problem in America’s system of long-term care.
The nursing home industry is suffering a financial fallout from the pandemic. Nursing home leaders say the industry “is doing all it can with limited resources — and that the real solution to better care would be more public money through Medicaid, which makes up the bulk of long-term care funding.”
A large chunk of Medicaid funding, however, comes from state governments. States are feeling their own financial pinch because of the pandemic. Whether states that face a budget crisis — or states that make helping the vulnerable a low priority as a matter of principle — can or will commit resources to caregiving is doubtful.
NBC reports that the “biggest obstacle to any sweeping change” is the difficulty of “convincing lawmakers and the public to make long-term care a priority.” People who are young and healthy don’t want to think about what will happen, either to themselves or their parents, if they suffer infirmities as they age. And if voters who haven’t reached their senior years aren’t focused on a problem, neither are the politicians who represent them.
The Failure to Value Caregiving
Caregivers in long-term care facilities help residents with the activities of daily living — eating, bathing, getting dressed. The work isn’t glamorous, but it is vital. Yet it isn’t unusual for an aide in a nursing home to earn only $12 to $13 an hour.
Staff shortages are common in nursing home, in part because demanding low-wage jobs are subject to high turnover. Staff shortages compromise the quality of care and reduce the opportunity for isolated residents to engage in social interaction.
Low wages result from classifying aides as unskilled workers. Robyn Stone, senior vice president of research for an organization that represents nonprofit nursing homes, told NBC that aides — the people who help residents live — are far from unskilled. Their pay should reflect their value.
Changing the System
Medicare generally won’t cover long-term stays in a nursing home. That coverage failure isn’t an oversight, but an intentional policy decision designed to control the cost of Medicare. Yet the Medicare budget is artificially constrained by a decision to place a cap on payroll taxes. Median-income workers pay the tax on their entire income, while high-income workers pay the tax on a lower percentage of their income. An act of political courage to tax all workers equally, or at least to raise the cap substantially, would make it possible for Medicare to pay for services that it now fails to cover.
Most nursing home coverage is paid by Medicaid, a program that is available only to people of limited means. Patients generally need to spend down their assets, deliberately impoverishing themselves, to qualify for Medicaid coverage of a nursing home stay. Nursing homes complain, however, that Medicaid reimbursement rates are far too low to pay for quality care.
Most industrialized countries cover long-term elder care as a public benefit, assuring that everyone who needs care receives it. For all its resources, the United States lags far behind Japan and Western European nations. Perhaps the public’s focus on the nursing home during the pandemic will convince people to pressure their elected representatives to devote public resources to the care of America’s aging population.