Long-Term Care is Broken

Ideas and Issues

July 7, 2021

New Orleans    

Yes, the headline in an opinion editorial in Scientific American couldn’t have been clearer in its look at nursing home and similar care in the USA, saying “Long-Term Care is Broken.”  In the shadow of the pandemic, it’s almost impossible to disagree, but what is being done about it is perhaps a bigger question.

The editors have their facts straight.  Less than 1% of the US population resides in long-term care facilities of one type or another.  The pandemic ravished that population counting at least 175,000 deaths by March 2021, a full one-third of the total US mortality from Covid-19.  Workers also found this one of the most dangerous – and fatal – jobs during the pandemic for an hourly rate that averaged $14 nationally for certified nursing aides or CNAs.  Medicaid is hardly adequate, paying only 70 to 80% of care and requiring beneficiaries to be almost destitute in order to qualify. Meanwhile the majority of the elderly would rather remain at home.  Nursing homes ratings are largely self-reporting, and even so reports and investigations have determined that homes score poorly on a host of criteria.

The editors’ list of the issues stops short though when it comes to their recitation of the industry’s wish list.  Their trade association recommends one registered nurse on duty 24 hours per day in every facility and a 30-day supply of PPE.  Yes, I know what you’re thinking?  You thought they were doing that already, didn’t you?  No, indeed.  Most nursing homes are now for-profit, and the just-in-time ethos of manufacturing or just plain tight-fistedness prevails.  Yet, they are profitable enough that private equity is increasingly a big player in long-term care, which says quite a bit right there.  The industry would like $15 billion to upgrade these largely private facilities, which would usually be called a bailout in any other discussion.  To quote the editorial…

To pay for it, the proposal calls for several strategies, including increasing the federal government match for Medicaid, which states have underfunded, and mandating that states pay facilities at a rate sufficient for them to break even.

This is where science makes the mistake of ignoring politics.  In a ton of states, and certainly in the Southern states like Arkansas and Louisiana, the nursing home lobby is king.  In fact, many legislators are owners or investors in nursing homes, so part of the trade association’s proposal is an effort to pass off the responsibility for upgrading and increasing expenditures to the federal government rather than from

their own pockets and tallying their votes in the capitols.

The scientists come back on target when they note that nothing will fix this broken system without accountability, and that is where the fight will be the hardest in getting both the federal and state government to exercise their muscle and get facility operators to do right, while also funding fairly not just nursing homes but the whole range of care facilities and programs.  Until the public and the families caring for loved ones see some real accountability from operators, census counts and revenue will continue to fall.  The deaths in the homes from the pandemic sent a message to everyone, and the profiteers need to finally read that message word for word, line by line.