Damage from COVID-19 could trigger a long-delayed transformation of nursing home care

The dying resident wanted Adeline Ramos to sit and hold her hand in her final moments. But Ramos, a certified nursing assistant at a nursing home in Rhode Island, couldn’t do it. In other rooms, more than 20 other occupants lay in their refuse, waiting for food or screaming for help.

“How do you choose between someone who dies and someone who spends hours in a dirty bed?” Ramos asked Medicare and Medicaid Services administrator Chiquita Brooks-Lasur during a virtual roundtable this month.

Ramos described it as one of her worst days at work.

Complaints from nursing home employees echo throughout the industry, voiced by workers, vendors and residents, about staffing, funding and oversight issues.

“All these stakeholders agree that there are problems, but I don’t think they have agreed on solutions,” said David Grabowski, a Harvard Medical School professor who serves on the National Academy of Sciences, Engineering, and Medicine’s Quality Committee. care in nursing homes.

For years, patient advocates have complained about the way the nursing home industry operates. However, only gradual changes were achieved. Many point to the industry’s resistance to changing the status quo, or that the flaws in the system are so great that they are difficult and expensive to fix.

“These are not new problems. There are a number of longstanding issues in nursing homes,” said Robin Grant, Director of Public Policy and Consumer Advocacy for Quality Long Term Care.

COVID-19 Effect

But experts hope it’s time for change, brought on by a brutal pandemic. More than 150,000 nursing home residents and more than 2,300 workers have died from COVID-19 since the outbreak began two years ago. according to CMS.

“COVID has lifted the veil and allowed all of us to see dysfunction. It doesn’t work for anyone,” Grabowski said. “COVID has been very devastating for nursing homes, for the residents who live there, their family members and for those who work in these conditions. I really think this is an opportunity to rethink some important political issues.”

About 1.3 million people live in nursing homes in the US, most of them seniors, and the country’s population continues to age. The number of Americans over 65 is projected to increase by nearly 18 million between 2020 and 2030. according to a Population Reference The Bureau analysis from Census data. The need to develop better ways to care for the elderly is becoming ever more pressing.

“We made promises to improve nursing home care, but those promises have not been kept. We hope that the commitments and promises made throughout the pandemic for quality care in nursing homes will become promises kept,” Betty Ferrell, chair of the National Academies Committee, wrote in the preface to his 600-page report, published this month, in which outlined a vision for modernizing the nursing home industry.

The Blue Ribbon Group’s report calls for fixing an “ineffective” and “unsustainable” system by changing how nursing homes provide, monitor and fund care. The report is the first of its kind in 35 years; The issues it highlights are not new.

The American Health Association and the National Living Assistance Center, which represents more than 14,000 agencies, said service providers are keen to learn from the pandemic and agree that more needs to be done to improve long-term care. But the industry cannot support “unfunded mandates,” the trade group stressed.

“Critics will always point to service providers as the scapegoat, but the reality is that politicians have failed to properly prioritize and support the social safety net,” the AHCA/NCAL report says. statement. “To make real improvements, we need policy makers to prioritize investing in this chronically underfunded health sector.”

Presidential push

President Joe Biden has plans to change nursing home care that are broadly in line with recommendations from National Academy experts. Biden announced a list of more than 20 new policies, including minimum staffing requirements and tougher enforcement of federal safety and quality standards, during his State of the Union address in February.

The Centers for Medicare and Medicaid services plan to be operational soon by issuing staffing ratio rules throughout the year, and intend to begin lifting temporary pandemic-related exceptions to the quality rules in the near future.

During a discussion with workers like Ramos, Brooks-Lasur compared the current political environment to the late 2000s, when the Affordable Care Act became law after the Great Recession. According to Brooks-Lasur, radical changes are possible.

“Because of the COVID-19 pandemic, there is a different level of understanding of what it means for our country when we don’t have proper healthcare, when we don’t have adequate services to deal with the pandemic and how much we need to do to make sure we address these issues as a country,” Brooks-Lasur said. “That’s why the president is giving me so much attention to making sure we’re doing the best we can.”

Industry issues

At the same time, the pandemic has hit the nursing home industry. Businesses already operating on marginal margins face even greater financial hardship, and labor shortages are rampant. These conditions, combined with long-standing objections to new rules and costs, are leaving the industry skeptical that the time has come to disrupt the long-term care sector.

The National Academy report may provide an opportunity for collaborative efforts to improve long-term care, said Lisa Sanders, director of media relations for LeadingAge, an association of nonprofit aging service providers. “Everyone has to play their part,” she said.

“There’s a sort of tendency to say nursing homes aren’t doing their job,” Sanders said. “But finger-pointing isn’t going to help anyone right now.”

The types of policies included in Biden’s proposals and the National Academy report had been discussed previously, including minimum staffing requirements and more transparency on nursing home ownership, but were not implemented, Grant said.

“Frankly, it’s because the nursing home industry has been against it,” Grant said. A renewed effort could gain momentum, she said, due to changing public opinion and increased political attention.

“For the first time, nursing homes and nursing home residents are part of the daily news,” Grant said. “What happened to the residents of nursing homes during the pandemic caused such a sense of outrage and horror. I think it opened a lot of people’s eyes to the problems that were going on.”

According to Dr. Mike Wasserman, geriatrician and former president of the California Long Term Care Medicine Association, a professional organization for long-term care workers, political will and collaboration between government agencies and stakeholders is critical to making change happen.

“All of these parties should enter the room, lock the door, and don’t let anyone out until they come up with something everyone agrees on,” Wasserman said.