The COVID-19 pandemic had a disproportionate impact on nursing home residents. Early in the pandemic, nursing homes accounted for more than 40% of all COVID-19 deaths in the US. That statistic may be understated because the National Healthcare Safety Network did not require nursing homes to report deaths from COVID-19 until the pandemic was well underway.
The virus spread quickly in the confined populations of nursing homes. Since people with serious health conditions are more vulnerable to the COVID-19 virus, nursing home residents were at greater risk of infection than healthier seniors who were able to shelter in place.
A report by the US Department of Health and Human Services (HHS) found that more than 1,300 nursing homes had an infection rate of 75% or more during the spring and fall COVID-19 surges in 2020. According to HHS, “nursing homes in this country were not prepared for the sweeping health emergency that COVID-19 created, nor were they able to stem the devastation once it was evident that nursing homes were especially vulnerable.”
The death rate fell sharply after COVID-19 vaccines were distributed in nursing homes. As unvaccinated Americans began to account for most COVID-19 deaths, the percentage of all deaths attributable to nursing home patients declined to about 21%. Data nevertheless suggests that the death rate in nursing homes was “more 23 times larger than the death rate” for seniors who lived outside of nursing homes.
We all hope that the pandemic was a once-in-a-lifetime event and that nursing homes learned lessons about infection control that will protect patients against another viral spread of disease. The pandemic nevertheless raised concerns that may discourage the adult children of older parents from considering nursing home care to meet their parents’ needs.
Aversion to Nursing Homes
The pandemic contributed to a public perception that nursing homes are failing to provide quality care. A Gallup poll in July 2023 found that 42% of respondents gave a grade of D or F to nursing home care.
The pandemic caused a reduction of nursing home staff that continues to have an impact on quality of care. Staffing levels since the pandemic have only partially recovered, in part because the industry is facing a shortage of qualified workers. The industry’s difficulty filling positions caused the Centers for Medicare & Medicaid Services (CMS) to propose lower standards for the number of nurse aides and registered nurses that nursing homes must employ.
The president of an association of nonprofit providers of aging services argues that nursing homes suffer from a negative image that is not entirely warranted. Surveys by her association suggest that people who receive aging services have a more positive view of the quality of care than the general public.
The association’s surveys cover all “aging services,” not just nursing homes, and may not provide a fair perspective of how patients perceive nursing home care. On a more positive note, those surveys also show that the public has a high regard for care professionals. Most people understand that caregivers perform essential work under difficult circumstances, often for inadequate pay.
The Road to Improvement
The association president blames the “demonization” of nursing homes on a negative bias toward aging and contends that understaffing results from “outdated funding models and under-investment in the nursing home infrastructure.” More specifically, a nationwide shortage of certified nursing assistants may be the result of the nation’s failure to invest in caregivers.
While the shortage predated the pandemic, the risks of acquiring an infection while working in a nursing home caused many CNAs to quit their jobs. Inadequate pay prompted many others to take jobs in other industries. The post-pandemic recovery of those positions has been slow, as the supply of new CNAs has not kept up with rising demand for their services.
Increasing pay would incentivize more people to obtain CNA training. The Urban Institute reports that entry-level workers with no healthcare training earn a lower starting wage than workers who have obtained a CNA certification. Increasing pay would reduce profits, however, and might make it impossible for some nursing homes to operate.
A few states increased the minimum wage applicable to nursing home staff wages during the pandemic, sometimes with public assistance to soften the burden of paying higher wages. Improving benefits and making it easier for CNAs to ascend a career ladder to supervisory or management positions might also attract more workers to nursing home staff positions.
The Urban Institute notes that some cities and states are offering tuition assistance for CNA training, the payment of stipends to students who enroll in training programs, and support services (such as mentoring and childcare) for students who need them. Ultimately, however, increasing Medicare and Medicaid reimbursement rates will probably be necessary to assure that nursing homes can afford to hire and retain adequate staff. Until the staffing shortage is solved, negative perceptions of nursing home care are likely to persist.