What the pandemic teaches us about nursing home care

Current regulatory structures and payment models jeopardize care for individuals unable to live in the community.

More than 2,000 nursing homes in the US have reported COVID-19 cases within their facilities, often accompanied by heart-wrenching rates of death. Combatting the avalanche of death posed by the novel coronavirus in nursing homes requires concerted effort to align several conflicting priorities that have afflicted nursing homes for years. COVID-19 puts into full view the regulatory structures and payment models that jeopardize care for long term care residents and those receiving post-acute care. 

A nurse with gloved hands puts an IV in the arm of an elderly patient

Caring for COVID-19 patients after hospital discharge in a nursing home, alongside those who reside in a nursing home for long-term care, brings into stark relief the spatial and staffing challenges that this setting poses. While the care needs of both groups overlap significantly, patients recovering from COVID-19 infections bring with them the possibility of spreading the virus to a large number of vulnerable long-long term care residents as well as a shared workforce. Once COVID-19 enters a nursing home, stopping the spread of the virus proves challenging and deadly.

Post-acute care following hospitalization has increased over the past decade. Hospital incentives to decrease inpatient length of stay coupled with Medicare funding for post-acute care services resulted in increased utilization of nursing homes as a discharge destination. Post-acute care represents an important line of business for nursing homes. Without post-acute care admissions, many nursing homes face financial uncertainty.

While accepting post-acute care patients recovering from COVID-19 presents clear risks to nursing home residents and the nursing home workforce, the financial consequences of not admitting individuals for post-acute care during this pandemic are also clear, and complicate the protection of residents and staff. Balancing the competing priorities of patient safety and financial stability often favors the latter. While the financial demise of nursing homes would further reduce the limited care options for older and low income adults who are unable to live in community settings, the risks of caring for COVID-19 patients should not be overlooked.

This article is by Ashley Z. Ritter. Read more at Penn LDI.