Chris Farrell
Contributor
May 15, 2020,10:56am EDT
The COVID-19
pandemic has been devastating to America’s most vulnerable elders, in long-term
care facilities. The New York Times calculates that staff and residents at
nursing homes and other long-term care developments account for more than a
third of coronavirus-related deaths in the United States.
In some states, the
toll is higher. Residents in Minnesota long-term care facilities represent less
than 1% of the population yet comprise about 80% of COVID-19 deaths in the
state.
(Read all of Next Avenue’s
COVID-19 coverage geared toward keeping older
generations informed, safe and prepared.)
“The elderly are
the most susceptible to high risk, bad outcomes,” says Robyn Stone, senior vice
president at Leading Age, an organization that advocates for nonprofit aging
service providers.
If ever there was a
time to reform policies, practices and financing for long-term care facilities
— especially nursing homes — this is it.
Nursing Homes: The
Epicenter of COVID-19
Nursing homes have
been the tragic epicenter of COVID-19. There, residents are often frail, coping
with multiple medical conditions, living in crowded buildings, making them
highly susceptible to the coronavirus. Low-wage caregivers typically work at
multiple nursing homes, hiking their odds of exposure to the virus.
“This crisis has
hopefully made it clear to the general public and public officials that we have
routinely underfunded long-term care for poor elders.”
Yet the trauma from
the pandemic extends beyond nursing homes to the wider ecosystem of senior
living and senior care.
COVID-19 starkly
and cruelly reveals what the elder care community has long warned: America’s
long-term care system is badly frayed, poorly financed and vastly inadequate to
meet the needs and ensure a good quality of life for America’s growing
population of older adults — especially lower-income elders.
“This crisis has
hopefully made it clear to the general public and public officials that we have
routinely underfunded long-term care for poor elders,” says Robert Kramer,
founder and president of Nexus Insights, a COVID-19 inspired advisory firm for
rethinking aging. “I think this has brought out into the open a lot of public
attitudes and public policy that sees people over a certain age as expendable.”
Why the Elder Care
System Is So Troubled
One reason America’s
elder care system is so troubled: its ecosystem is sprawling and complex.
On the payments
side of the equation, Medicare covers few long-term care costs (although
private Medicare
Advantage plans often offer some services). Medicaid, the
federal/state program that pays for long-term care services, requires
impoverishment to qualify. Most Medicaid money pays for institutional care
(think nursing homes), rather than in-home care. Assisted living, continuing
care communities and similar facilities have a private-pay system; some
well-off residents and families tap into long-term care insurance policies to
pay for services.
Middle-income
families have often found their earnings and savings inadequate to meet the
steep costs of long-term care even before the pandemic further reduced
household finances. The annual cost of a private room in a nursing home
(national median) is over $100,000 a year, according to the latest Genworth Cost of
Care Survey. Only about 10% of Americans 65 and older have long-term
care insurance.
Most older adults
prefer aging in their homes with family support, but that isn’t always a
practical or desirable choice.
A Pandemic Effect:
Worsening Economics for Long-Term Care
Due to the
pandemic, the economics of long-term care will worsen.
For one thing, some
families have become reluctant to put aging parents into congregate living
facilities, fearful of the higher health risks from COVID-19 and worried that
parents will be quarantined alone there.
For another, the
price tag for living in a long-term care facility will go up. Expenses are on
the rise with managements scrounging for Personal Protection Equipment (PPE),
coronavirus tests, cleaning supplies and staff.
Take the experience
of Brookdale Senior Living, which operates over 800 communities nationwide.
Management in a recent earnings call said it had spent $10 million in the first
quarter on its COVID-19 response.
How to Fix Things
There is some
recognition of the problem, though.
For example,
Senators Bob Casey (D-Pa.) and Sheldon Whitehouse (D-R.I.) have offered a bill
to provide $20 billion to help states, nursing homes and intermediate-care
facilities (usually small, group homes) contain COVID-19. Leading Age has
called on Congress to allocate $100 billion in its next relief package to
support aging services. And the House of Representatives Democrats' new
coronavirus relief bill, The HEROES Act, would let Medicare health care
providers receive compensation for the additional COVID-19 costs they’re
incurring. HEROES is an opening marker in a debate about the next relief fund
and at least some relief may make it to President Trump’s signature.
“There will not
come a time when we will return to the old normal.”
Yet many of the
expenses associated with battling the coronavirus will become critical costs of
doing business in a post-pandemic environment. What’s more, paying for higher
long-term care expenses will be tough for financially drained households and
tax-starved governments.
The bottom line?
Business as usual for long-term care facilities isn’t an option.
“There will come a
time when we’ll see the pandemic in the rearview mirror,” says Kramer. “There
will not come a time when we will return to the old normal.”
The clear and
present danger is that numerous senior living and senior care operators go out
of business and that policymakers reduce their support even more.
That said, the
unprecedented disruption also opens up the tantalizing opportunity for society and
policymakers to address the kind of reforms that would improve the living
standards and lifestyle of an aging population, most notably the large ranks of
lower-and middle-income elderly Americans.
“This has shaken
things up enough that reform could happen,” muses Stone. “I think that the
Phoenix rises from the ashes,” she adds, laughing.
A Look Into the Future
of Long-Term Care Facilities
What might reform
look like?
Congregate living
won’t disappear as an option, but the settings will likely be redesigned with
physical and mental health considerations in a post-pandemic society.
Two of the changes
experts expect: no more shared rooms and reconfigured living spaces for comfort
during periodic shelter-in-place moments. Private balconies or small private
patios, for instance, would let residents safely get outdoors during
quarantines.
Also likely: The
health care system will increasingly blend into senior care communities, from
increased use of telemedicine (rather than in-person doctor’s appointments) to
infectious disease control systems.
“There are changes
we can make to make them [long-term care facilities] safer,” says Sara
Marberry, a health care design knowledge expert and marketing consultant.
“There are a lot of technology and products for infectious control in health
care already; it will now permeate all kinds of senior living, including
independent living.”
Long-term care
analysts also think congregate living managements will — finally — devote
bigger budgets to training their professional staff and personal care workers.
That way, the workers will be trained to be more knowledgeable about how best
to keep infections at bay.
“We have learned
from this that we need highly trained people, particularly real infection
control and a whole system of care,” says Stone.
Investments in
technology will be essential. As telehealth and telemedicine become routine
coming out of the crisis, they’ll both require good broadband access and
devices in long-term care facilities.
How to Pay For It All
How to pay for
better design, workforce training and technology? There is no shortage of good
blueprints, including policy models developed by the Long-Term Care Financing
Collaborative and the Bipartisan Policy Center. Another place to look:
Washington State’s universal public long-term care insurance benefit for
residents which became law last year. Countries like Germany and Japan offer
approaches to emulate, too.
There’s no
exaggeration in saying that the choices we make about how we treat our elders
gets to the core of society’s values. In recent weeks, too many callous remarks
have dismissed older adults and their pandemic-related risks of death as sad,
but nothing to get worked up over.
But rather than
framing the care of elders through the lens of dependency, think about how much
they add to society.
“I hope we’ll
generate a really good vision of older adults in our society,” says Kramer.
“What they contribute to our society. Not a dependency model.”
The question now
is, will we take advantage of the pandemic-induced upheaval in long-term care
to create a better life for an aging population?
That’s a challenge
worth embracing
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