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The U.S. Government Pandemic-Proofs Nursing Homes

Authored by Carla Hu

Art by Angela Yuan


Think for a minute. Where might you be living at the age of 65 or older? For many Americans, that answer will be senior assisted living communities, also known as nursing homes. In 2017, a CDC survey revealed the U.S. has 1.3 million nursing home residents. More than a third of these individuals suffer from dementia and require 24/7 care from skilled registered nurses (RNs) [1, 2]. Nursing homes are a key part of long-term healthcare in the U.S., but debates on quality of care and cost have become increasingly prevalent among families and medical professionals. 67% of nursing home residents, many of whom are racial and ethnic minorities, live in Medicaid-funded homes, which often suffer from lower ratings and staffing shortages compared to privately-funded nursing homes [3, 4]. A study on Connecticut nursing homes during the pandemic found private nursing homes with higher RN staffing could better control the spread of disease by 22% fewer cases and 26% fewer deaths compared to homes funded by Medicaid or had larger ethnic minority residents [4]. As a result of these pandemic-related studies, the U.S. government has recently taken action to improve elderly care facilities as these long term deficiencies in the health care system have come to the forefront.


During the State of the Union Address, the Biden administration introduced new nursing home policies as post-pandemic measures meant to protect elderly individuals and increase nursing home regulations through The Centers for Medicare & Medicaid Services (CMS). The CMS is a federal agency that oversees nursing homes through state surveyors who inspect for deficiencies and give citations when regulations are not met. In 2015, seven percent of facilities had no deficiencies, whereas per facility, there is an average of 8.60 deficiencies [5]. The most common deficiencies included quality of care, infection control, and food sanitation, all of which reveal a concerning need for improvements, especially post-pandemic [5]. One of the proposals offers that the CMS will set a federal floor for staffing levels, known as the 24/7 RN rule [6]. This policy side-stepped the staffing debate in nursing homes by allowing facilities to continue enforcing the “sufficient” staffing policy of 2.45 hours of nursing care per resident daily [6, 7]. According to a 2001 CMS funded study, 4.1 hours was found to be adequate staffing, which is far above the current requirements [7]. Much of the proposal is “pandemic-proofing,” which include increasing the accountability of nursing homes and penalties for low rated nursing homes, requiring infection control specialists in facilities, and furthering policies to regulate nursing home management [6]. These policies may prevent current abuses in management and poor conditions in low rated nursing homes, but for facilities with just “adequate” conditions, elderly care still suffers from deficiencies in quality of care and individualized attention.


According to several studies, the key issues the US government should be “pandemic proofing” against should be done by developing variations of specialized care and health conditions among nursing home residents [6]. About half of nursing home residents do not stay long-term, but the individuals who do should consider staying at centers with programs dedicated to their specific medical condition, rather than placing the specialized work on nurse aides who often struggle to find time to provide adequate care [2, 7]. Residents with dementia or memory conditions may find memory centers specifically designed to meet the needs of such patients as a better fit for long-term health [8]. The U.S. government overlooks the potential in these specialized programs as opportunities to help ease the rising number of nursing home residents, failing to see the value of individualized healthcare. A study found that long-term residents who have complex medical conditions such as multiple comorbidities should consider smaller facilities with fewer beds and higher quality care [8]. Green Houses, or small nursing homes, are long-term care facilities that provide small homes with outdoor space and numerous rooms, rather than traditional nursing home complexes [8]. A study on small nursing homes compared to CMS data found that Green Houses had infection rates of 2.92 cases per 100 residents, while traditional nursing homes with less than 50 beds and more than 50 beds were, respectively, 5.48 and 27.0 [9]. These facilities may also reduce hospital admissions, lower use of medications, and offer a higher quality of life to the residents [9]. Currently, this model is unrealistic for nursing homes to undertake without any external funding, but it reveals a viable nontraditional living option [8]. 


Simply put, we should value the new post-pandemic measures set by the U.S. government, but we should also be aware that decreasing the understaffed and crowded nursing home facilities to smaller or more specialized programs could potentially lead to permanently safer conditions, in addition to more individualized care [10]. These ideas would create a mutually beneficial environment where patients receive more attention for their specific health conditions and staff are able to connect and care for patients on a more personalized level. The U.S. government has begun to introduce changes to nursing homes, but we must continue down this path to address further lackings in elderly healthcare in order to guarantee adequate and safe living conditions for our future.


References

1. Sengupta M, Lendon JP, Caffrey C, Melekin A, Singh P. Post-acute and long-term care providers and services users in the United States, 2017–2018. National Center for Health Statistics. Vital Health Stat 3(47). 2022. DOI: https://dx.doi.org/10.15620/cdc:115346.

2. Harris-Kojetin, L., M. Sengupta, J. P. Lendon, V. Rome, R. Valverde, and C. Caffrey. 2019. Long-term care providers and services users in the United States, 2015–2016. Vital and Health Statistics 3(43). Available at: https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf (accessed September 8, 2020).

3. Harrington, C., H. Carrillo, V. Wellin., and A. Burdin. 2003. Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1996–02. San Francisco: University of California www.nccnhr.org.

4.  Li, Yue, et al. “COVID ‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates.” Journal of the American Geriatrics Society, vol. 68, no. 9, 21 July 2020, theconsumervoice.org/uploads/files/issues/li_JAGS_NHs_and_COVID_final_June_18.pdf, https://doi.org/10.1111/jgs.16689.

5. Harrington, Charlene, and Carrillo. Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 through 2015. 2017. https://files.kff.org/attachment/REPORT-Nursing-Facilities-Staffing-Residents-and-Facility-Deficiencies-2009-2015

6.  The White House. “FACT SHEET: Biden-Harris Administration Takes Steps to Crack down on Nursing Homes That Endanger Resident Safety.” The White House, 1 Sept. 2023, www.whitehouse.gov/briefing-room/statements-releases/2023/09/01/fact-sheet-biden-harris-administration-takes-steps-to-crack-down-on-nursing-homes-that-endanger-resident-safety/.

7. Sedensky, Matt. “US Will Regulate Nursing Home Staffing for First Time, but Proposal Lower than Many Advocates Hoped.” AP News, 1 Sept. 2023, apnews.com/article/biden-nursing-home-staffing-ebd1aad4a8bb13f892b930cae2f3f1cd. Accessed 26 Sept. 2023.

8.  Fulmer, Terry T., et al. “Reimagining Nursing Homes in the Wake of COVID-19.” NAM Perspectives, 21 Sept. 2020, https://doi.org/10.31478/202009a.

9.  Zimmerman, Sheryl, et al. “Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths.” Journal of the American Medical Directors Association, vol. 22, no. 3, Mar. 2021, pp. 489–493, https://doi.org/10.1016/j.jamda.2021.01.069. Accessed 23 Sept. 2021.

10. “Skilled Nursing Facilities Post-COVID-19.” Brickyard Healthcare, 20 May 2022, www.brickyardhc.com/2022/05/skilled-nursing-facilities-the-road-to-recovery-post-covid-19/. Accessed 26 Sept. 2023.

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