Here at AgingParents.com, we see clients who have a loved one who must go to a nursing home. They’re worried, and with good reason. It’s probably the absolute last choice of where to go for any impaired elder in need of some care. The average age of a nursing home resident is 86. Many folks are there because they have no other option. About 60% of the 1.4 million residents receive Medicaid as their only payment source for living there.
All kinds of professionals and stakeholders are in agreement that the nursing home industry is broken. This is not new news. As a 19-year-old nursing student, decades ago, I worked in nursing homes and I saw what was going wrong firsthand. From what is observable now, things have only gotten worse in the decades since. Most glaringly, failure of nursing homes to adequately address the pandemic led to approximately 133,000 deaths from Covid. We can only speculate that if these facilities had adequate personal protective equipment (masks, gloves and gowns), some of these deaths were preventable. We can also speculate that if their administrators and staff had adequate education about infection prevention, that Covid-related outcomes would have been much better. Now Covid variants are rising once again in some areas. Have we learned anything from this?
Beautiful plans are in place to make nursing homes less hospital-like and more friendly. Great minds have devised reform policies for everything from staff-resident ratios to construction of facilities that feel more like homes than the outdated, cold, unfriendly structures they usually are. And what will become of those lofty goals?
My guess: not much. It will all depend a great deal on Congress authorizing funding for such reforms. From here, it does not appear that taking care of our frail and dependent elders is a legislative mandate. The residents in these homes are not the target voters of those who attain legislative power. Nor are their families, often the spouses and adult children of their frail elders, some of whom are impaired to some extent themselves. We simply don’t see nursing home residents’ families marching in the streets demanding that their elected representatives in Congress do something about the broken system.
In 2022, President Biden announced in his State of the Union address that his administration planned to set higher standards for nursing homes. The plan included setting minimum staffing standards in them. What’s wrong with that idea? Barely any of these homes are adequately staffed and they have trouble attracting workers. If they pay workers more, that will cut into the profits of the private equity firms that own many of them. By 2018, private equity firms had invested $100 billion in for-profit nursing homes. And of course, one must find workers willing to do the hard and often messy work. We have a nationwide labor shortage and this sector is no exception.
Another prong of the plan: find ways to reduce shared rooms in nursing homes. These are the only kind of rooms Medicare (short-term stays only) and Medicaid (long-term stays) pay for. Do you think that the motivation of our federal legislators is to spend more money on Medicare benefits or expand Medicaid benefits? I say, fat chance. Many seem bent on reducing government spending, not increasing it. In the recent House of Representatives historic battle to elect a speaker, there was repeated ranting about too much government spending.
All the lofty goals of reforming nursing homes are well thought out, and worth the time of those involved to create a vastly better vision for what nursing homes should be. And, unfortunately, it does not look like the dysfunctional legislative body we have now is going to bring any of those worthy plans to fruition. They are far more likely, sad to say, to just let things be as they’ve been for the past 70 years—dysfunctional, broken, scary and dangerous.
Anyone who has a loved one who must go to or live in a nursing home would probably agree that it is distressing to have them there. If you want change, you need to bring this to the repeated attention of your elected representatives and to ask directly for the much-needed changes.
Your allies include: Leadingage a national coalition of age-focused nonprofit organizations, and service providers, and Moving Forward Coalition, a group of nursing home providers and others, working to create action plans to improve nursing home care. Additional state-based organizations have vigorously advocated for legislative change for years. It all boils down to the question of how to get the essential federal funding to make these changes a reality.
If you have a family member or friend who must go to a nursing home (also called “rehab”), you need to watch over them daily, at least by phone. Ask the charge nurse to update you about everything that goes on. Learn what the physician has ordered and see if the staff carried it out. Be a watchdog. Your aging loved one’s safety depends on this!
If you feel lost in the system, you can get guidance at AgingParents.com. Practical advice will give you confidence so you can navigate much better in unfamiliar territory. Get an appointment today. Call 866-962-4464
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