Turning nursing homes around won’t be easy

We need to re-imagine options for long-term living

A sign outside Cambridge Rehabilitation and Nursing Center in Cambridge. (Photo by Shira Schoenberg)

by Richard T Moore

THE HIGH RATES of COVID-19 infections and deaths among residents of skilled nursing facilities, nursing homes, and rest homes in Massachusetts and the nation laid bare the urgent need for significant improvements in infection prevention.  If, after the coronavirus pandemic subsides, there is even a market for nursing home beds, lawmakers and state regulators need to overhaul the standards for licensure and inspection of such facilities.

According to the American Association of Retired People, “more than 16,000 nursing home residents and staff have died from COVID-19, representing roughly a quarter of the nation’s known coronavirus deaths. While dire, this figure is an undercount, experts warn, because not all states are publicly reporting data yet. In some states, more than half of coronavirus deaths have come in nursing homes.”

In Massachusetts, 62 percent of coronavirus deaths have come in nursing homes.

Reimbursements to long-term care providers were inadequate even before COVID-19.  Even the most dedicated workers are unlikely to invest time and energy in infection prevention if they are not able to earn a living wage, if testing is insufficient, and if workers are not provided with essential PPE – masks, gowns, gloves, face shields, etc.

This funding issue must be addressed if we are to be prepared for whatever comes next.  However, given the growing number of for-profit and out-of-state owners of nursing homes, any distribution of public funds must have requirements to direct at least 85 percent of revenues to front-line direct care and maintenance staff and prohibitions on use of any such funds to senior management or investors.

In my years as a health care legislator, I never met a senior citizen who wanted to go to a nursing home.  With the trail of death flowing from nursing homes during the COVID-19 pandemic, will any senior, or their family, willingly choose this future for themselves or their loved one?

Compare the rate of COVID-19-related nursing home deaths in the United States to the rate in Hong Kong – a much shorter distance to the suspected source of the pandemic than Boston or Worcester.

According to an article in The Guardian, Hong Kong has recorded zero deaths in care homes from COVID-19 by employing strict infection control measures that were ignored in the United Kingd0m, where the death toll in English and Welsh care homes reached almost 15,000.

Massachusetts, and probably most other states, need to re-imagine the options available for long-term living and the best use of taxpayer funding to benefit nursing home-eligible residents and for attracting the most caring, competent staff.

The Department of Geriatric Medicine at the University of Massachusetts Medical School needs to be directed and funded sufficiently to make caring for seniors more attractive for new professionals.  UMass Boston’s Gerontology Institute and Center for Social and Demographic Research on Aging should be funded sufficiently to support a comprehensive study of aging in Massachusetts.  Finally, the Executive Office of Health and Human Services needs to prioritize infection prevention in long-term care, including hiring enough trained inspectors to enforce the most rigorous regulatory environment regarding infection prevention.

There are powerful financial and political interests who will resist these changes, but we owe it to the many precious seniors who died, and certainly to those who remain, to fix the system of long-term care.

Richard T. Moore is a former member of the Massachusetts Senate, and served as the first Senate chair of the Legislature’s Committee on Health Care Financing.  He was the lead Senate negotiator for the landmark Massachusetts Health Care Reform Law 2006 and the Health Care Cost Containment Law of 2012.

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Turning nursing homes around won’t be easy