When the House Ways and Means Committee held its recent hearing examining the COVID-19 nursing home crisis, the takeaways were clear: skilled nursing facilities are understaffed, the frontline workers who are showing up are overworked and concerned for their and their loved ones lives, families are frustrated with the lack of access to their elders, and the residents themselves are suffering from loneliness and isolation.
We need to do a better job of caring for the most vulnerable among us, namely the elderly and compromised who live in communal settings. Here are six concrete steps that need to be taken immediately:
First and foremost, nursing homes need continued priority access to personal protection equipment and increased access to quicker testing and processing. Nursing homes must be able to easily identify resident and staff cases to ensure the safety of everyone. Additionally, the industry cannot begin to ease restrictions on visitation or communal activities, vital to the quality of life of residents, until they have enough PPE and reliably fast results.
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Even as the rest of the economy opens up, nursing homes cannot return to normal until they can promptly identify outbreaks. While nursing homes are now a priority for testing, the turnaround time for lab results remains critically slow for a meaningful response. Once the staff has enough PPE, we may be able to provide PPE for family members to visit.
Second, more funding from the Provider Relief Fund should be made available to the eldercare community. While Health and Human Services has distributed $4.9 billion in funding to nursing homes — a great start — the senior living industry stands to lose tens of billions of dollars due to this crisis. The average nursing home operates at a loss or at razor-thin profit margins (-0.3 percent on average in 2018) and in the COVID-world, both supply and labor costs continue to increase steadily.
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There is still $65 billion available and residents desperately need the additional support. Congress should also consider allocating more money to the relief fund in the next phase of stimulus legislation. Nothing is more important for nursing home residents’ safety than ensuring the financial stability and viability of these frontline facilities, many of which may go bankrupt if they do not receive help.
Third, we need to take heed of this moment and restructure our health care system so that, in the words of Harvard’s Dr. David Grabowski, who testified at the hearing, Medicaid will “begin to pay a higher rate commensurate with the costs of delivering high-quality long-term care to frail older adults.” As it stands, Medicaid is the primary payer for nursing homes — but it only covers 70 to 80 percent of the actual cost of care.
Research by Grabowski shows that nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates and more health-related deficiencies. These homes are also disproportionately located in the poorest counties and are more likely to serve minority communities. Additional support would immediately increase care for these underserved populations and would also ensure that these facilities would be better equipped in the event of a future pandemic.
Senior living communities did not cause the coronavirus crisis, but they are bearing the brunt of it.
Fourth, while the committee testimony showed that the Medicare system, unlike Medicaid, is a generous payer, Medicare only covers the cost of rehab in nursing homes for up to 100 days. Medicare has promised to extend that time period to account for COVID-19, but to date, they have not released any formal application process or procedures for residents requiring care. Congress must step in immediately and automatically extend those treatments for the duration of this emergency.
Fifth, there should be bipartisan effort to pass the Advancing Connectivity during the Coronavirus to Ensure Support for Seniors (ACCESS) Act. This legislation will increase nursing home facilities’ access to telehealth services and other technologies that allow virtual visits during the public health emergency.
Finally, nursing homes, assisted living centers and senior living communities should be given immunity from coronavirus liability. Given the scarcity of resources and the perpetually changing laws and guidance at the state and federal levels, the industry needs protection from lawsuits.
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Nursing homes should be granted civil liability protection for alleged damages related to the virus, as long as they provided services in good faith and could prove that they were acting in a manner consistent with federal or state guidelines.
While this last measure is sure to be controversial, the numbers prove that nursing home outbreaks have very little to do with the facilities themselves. Even facilities with the highest ratings, zero infection control citations in the past, and experienced staff are not immune to COVID-19.
Senior living communities did not cause the coronavirus crisis, but they are bearing the brunt of it. The numbers continue to spike across the country and nearly half of COVID-19 related deaths have been linked to elder care facilities.
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The staff and residents at nursing homes are innocent victims who follow regulations and are doing their best to stay alive under terribly difficult conditions. The least we can do is recognize the tremendous job that these communities are doing, both as critical backstops and frontline defenders against the virus’ spread.
We must provide more adequate testing and additional resources for nursing home facilities and ensure increased care for our elders. If we do not want these communities to fail, we cannot fail them.
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