The Nursing Home Closure Debacle – does it help anyone?
It’s news — 600 nursing homes closed so what’s the strategy to fix? Rant on. You may have read a depressing article this morning in the Wall Street Journal about the number of people stuck in hospitals with no place to go because there are no nursing homes to take them – which is the status in the UK’s the National Health System (NHS). That was an embarrassment in the UK – and this is a scandal in the US. It never should not have gotten to this point. So many factors crushed nursing homes — Covid and Private Equity nursing home ownership were big players, followed by government strategy to undermine them. For 14 years, Florida banned new nursing home construction. The federal “Money Follows the Person” was introduced in 2005 to enable seniors to avoid them and receive Medicaid-paid services. Reauthorized repeatedly, it is now authorized through 2027.
Why have nursing homes become so publicly scorned? Surely it is to the detriment of older adults stuck in hospitals (see Massachusetts). Was it the misnamed Five Star rating system that got such a bad reputation that Yelp seemed better at helping families find care? Or was it the senior living industry that seized their business? With deferred move-ins of frailer residents, residents, the for-profit industry changed its offerings, expanding memory care and finding a market near the listed prices charged by nursing homes. Along the way, Medicaid waiver programs appeared in many states to enable alternatives to nursing homes. And finally, there’s the Aging in Place fixation, perpetuated by the media, as well as AARP – just use the checklist and help Mom age in place! Yet Mom needs a lot of care and so the one-worker/one care recipient home care market is booming – and terribly short of workers.
There is another side to the nursing home story – and maybe you have seen it. You may have visited great nursing homes whose staff members care about the job and the residents. You’ve seen the rehab functions performed by many nursing homes reimbursed by Medicare and Medicaid. Pre-Covid, you’ve seen residents of nursing homes share meals with other residents, receive care provided by long-time aides, benefit from visits from community volunteers, or attend religion services provided on Fridays or Sundays. Perhaps the care was delivered through an order of Carmelite nuns, some of whom, along with retired priests, were also residents.
Why are nursing home closures bad news? The comments in the Wall Street Journal article reinforce the post-Covid theme that ‘nursing homes are awful, so who needs them?’ Who exactly? Does that mean families will care for the frailest members at home? Even with full-time jobs or living many states away? Even for an aging family member with significant dementia and a family has limited assets to pay for (if they could find) home care? Even in homes that are inappropriate for people with disabilities and complex conditions? Seriously? Who will reset this apparently political debacle, improving the financial structure, providing better management of nursing homes that struggle with a litany of obstacles AND poor media coverage, but still remain open because, guess what? Seniors and families need them? Rant off.
