How COVID-19 Has Affected Long-Term Care Decisions

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Long-term care facilities are a necessity for many seniors. Assisted-living facilities provide skilled care for seniors who need help getting dressed, bathing, or engaging in other activities of daily living. Seniors who suffer from dementia often need specialized attention that families cannot provide. Nursing homes provide 24-hour healthcare services to seniors who suffer from health conditions that require intense monitoring.

Like most other businesses, long-term care facilities have been challenged by the spread of COVID-19. The residents of nursing homes and assisted-living facilities often suffer from underlying health problems that make them particularly vulnerable to the disease. Residents who live in close proximity to each other and those who have frequent contact with staff members find it difficult to practice social distancing.

The risk of acquiring COVID-19 is less acute in senior-living communities that offer individual units for lease or purchase. Independent living centers have seen only modest outbreaks of COVID-19. Seniors who are active and healthy also face less risk of developing serious symptoms from a COVID-19 infection.

Still, young people who were otherwise in good health have died from COVID-19. Whether they live in a nursing home, an assisted-living facility, a senior-living community, an apartment complex, or a rural farmhouse, people of all ages should protect themselves by staying inside when they can and by practicing social distancing and wearing a mask when they are in public.

Long-Term Care Facility Strategies for Coping with COVID-19

Unfortunately, risk avoidance is more difficult in nursing homes, where patients have frequent contact with staff members. A substantial percentage of COVID-19 deaths have occurred in nursing homes.

Nursing homes may have been unfairly blamed for deaths among patients with comorbidities that enhanced their risk of exposure to a highly contagious disease. Nursing homes that accepted the return of patients who were discharged from hospitals were placed in a difficult situation. Controlling the spread of an infectious disease is problematic when patients who display no symptoms of the disease are nevertheless contagious.

In the first months of the pandemic, testing was not widely available and test results were delayed (a problem that continues in some areas). Nursing homes faced the difficult choice of requiring symptom-free workers to stay home and leaving the facility understaffed or taking the risk that an asymptomatic worker might spread the infection.

Facilities have increasingly responded to the pandemic by following the evolving CDC guidelines for protecting vulnerable populations from COVID-19. Some facilities have done an admirable job of preventing COVID-19 from spreading to their patients. Others have been less successful.

Some facilities have locked down. On a temporary basis, some have chosen not to accept new residents. Others are accepting residents after careful screening, including testing. According to the Centers for Medicare & Medicaid Services, “Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories.”

The Long-Term Care Dilemma

The spread of COVID-19 has created uncertainty for seniors who had planned to move to a long-term care facility or senior-living community. The population of independent living centers and senior-living facilities has grown steadily since 2008. Thanks to COVID-19, occupancy rates have dropped to a 15-year low.

Low occupancy rates, coupled with increased expenses associated with testing and personal protective equipment, have placed a strain on operating budgets. Like other businesses, some long-term care facilities might not survive the burgeoning financial crisis that the pandemic has sparked. Public health agencies have been slow to provide the financial assistance that facilities need to protect their residents.

Facilities that have stopped accepting new residents, either to enforce social distancing or because of staff shortages, have contributed to the declining resident and patient populations. Demand for the facilities has also declined as families consider whether they should delay plans to move a family member and opt instead for homecare.

The decision is difficult. Foregoing the specialized care provided by a long-term care facility may be an unwise choice for a senior whose medical condition is deteriorating. If a preferred facility is not currently accepting patients, families may need to do careful research to find another facility that suits their loved one’s needs.

In other cases, delaying entry into a facility might be an appropriate safeguard against transmission of the coronavirus. These difficult decisions are best made in consultation with the senior’s health care provider and other professionals who are familiar with the senior’s situation.

The Problem of Long-Term Care Insurance

Many seniors, anticipating the potential need for long-term care, purchased long-term care insurance. Some analysts are predicting that seniors will stop paying premiums and abandon those policies to avoid the risk of coronavirus exposure in a nursing home.

Some patients have requested a reduction of premiums so they can maintain their insurance until the pandemic is under control. They argue that by foregoing care for which they are eligible, they are saving the insurer money. Since collecting premiums for benefits that are never paid is an ideal situation for insurers, those requests have not always been met with a favorable response.

Long-term care insurance was easy to find in 2004, when more than 100 companies offered policies. By 2018, only about a dozen insurers offered long-term care policies. Companies often found that the insurance was not profitable, given the potential cost of care for the senior’s remaining lifetime.

According to Manulife, there is some evidence that fewer seniors are making claims for payment of long-term care expenses. That’s a good outcome for insurance companies but a waste of the premiums that seniors paid in the expectation that long-term care facilities would be a viable response to declining health. How long the pandemic lasts may determine whether seniors will opt to save premiums by canceling their policies or will continue their policies with the hope that they can safely move to a long-term care facility if the need arises.


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