Reforms needed after systemic flaws in nursing homes worsen COVID-19: Read our piece in ABA journal on law and aging
A new piece by CHRT staff, “Reforms needed after systemic flaws in nursing homes worsen COVID-19,” appears in this month’s BIFOCAL, a journal of the American Bar Association Commission on Law and Aging. The article by Marianne Udow-Phillips, founding executive director, and Robyn Rontal, data analytics director, explores the need for systemic change in nursing homes and long-term care facilities.
“The COVID-19 pandemic has disproportionately affected nursing home residents and staff, and illness and fatalities will likely continue to mount until effective treatments and vaccines are available,” write Udow-Phillips and Rontal who note that while less than 1 percent of the population resides in long-term care facilities, residents and workers account for about 40 percent of all COVID-19 deaths in the U.S.
Opportunities for improvement include:
- Regulatory changes to enhance quality and procedural oversight in nursing homes.
- Enhanced information systems and data reporting protocols so states and local officials know where to target resources in crisis situations and for staff, families, and individuals to have more transparency about the risks within particular nursing homes.
- Resource investments, including more personal protective equipment, more guidance on best practices, and enhanced assessment tools for compliance with infection control.
- Physical structure investments to move toward smaller environments with fewer residents, which have been shown to curb the spread of infection.
Moreover, the financing of nursing homes in America needs to be reimagined, write the authors.
“Unlike many other countries, the U.S. has no comprehensive approach to long-term care,” they write. And “because funding comes from a variety of payers, all with different rules around eligibility, quality measures and reimbursement incentives, nursing homes have designed structures that may not be in the best interest of public health.”
The authors recommend a series of financial reforms including:
- Taking advantage of Medicare Advantage Special Needs Plans to boost service coverage.
- Expanding eligibility for proven, effective programs like Programs of all Inclusive Care for the Elderly (PACE).
- Using new approaches to Accountable Care Organizations to better integrate hospital and nursing home care.
- Experimenting with conflict-free “options centers” to provide consumers with more transparent information about he services and programs for which they’re eligible.
- Using innovation waivers for Medicaid long-term care, such as Michigan’s MI Health Link program, to strengthen the long-term care system going forward.
“Seniors want to remain at home and be as independent as possible for as long as possible,” write the authors. “COVID-19 has vividly exposed the cracks in our current system. What we’ve learned can be used to point the way to a future of integrated design changes and a comprehensive public policy framework for long-term care.”