Experts recommend policies to better regulate long-term care in the wake of COVID-19.
Nursing homes and other long-term care facilities have been crushed of the COVID-19 pandemic. Nearly one-third of coronavirus deaths in the United States have been residents and staff at these facilities. From May 2021 have confirmed cases in these facilities reached over a million. The leading explanation for these high rates is that the high age and comorbidities of the residents make them particularly vulnerable to serious illness and death from the virus. This risk is reinforced by the common nature of long-term facilities, increasing the likelihood of residents and staff spreading COVID-19. Still some experts argue that regulatory failure and chronic underfunding are partly to blame for such tragic outcomes in one of America’s most vulnerable populations.
Although the challenges of the COVID-19 pandemic are new, the crisis in long-term care is not. Long-term care facilities have a long history of low-quality care. In 1986, one examination of the Department of Medicine found that residents of nursing homes routinely received inadequate care, neglected or abused. In response, Congress passed Law on the reform of nursing homes, which set new care standards, upgraded staffing requirements and established an enforcement mechanism for non-compliant facilities. Today, states enforce these standards through unannounced investigations conducted every 9 to 15 months, with variable fines depending on the seriousness of the violation.
Most nursing home quality goals have improved over time under this law, but the majority of the facilities still do not live up to federal standards. In recent years, over 90 percent of nursing homes have Received at least one citation per year for violating federal rules. The pandemic only revealed and exacerbated these problems. Numerous nursing home residents have reported cases of severe care failure during lockdowns, including extreme weight loss and untreated bedsores.
Neglect of long-term care is also visible in its rag-blanket funding scheme. The majority of long-term care is paid for by Medicaid, which only becomes available once individuals have exhausted their personal assets. Medicaid funding for long-term care as well varies dramatically by state and is often threatened by budget cuts, especially during economic downturns. For individuals who look to private insurance companies to cover costs, they often find prohibitively high prizes. Fewer than 1 in 30 Americans own a long-term care insurance. Medicare, the primary insurance company for Americans over the age of 65, does not cover over long-term care beyond 100 days.
As a result of this patchwork system, nursing homes are chronically underfunded. The majority of nursing homes in the United States operate with net losses, and it has been hundreds of nursing homes forced to close in recent years. Thin or negative margins fast facilities to cut corners on care quality and staffing levels, and maintain low quality care. During the pandemic, they have increased costs located nursing homes on the verge of collapse, incentive billions of dollars in federal aid.
Today, about 12 million people are in the United States need long-term care. In 2050, that number expected to more than double. The challenges of the pandemic present a unique opportunity for policy makers to evaluate how the long-term care system is failing, in order to better prepare for increased demand going forward.
In this week’s Saturday seminar, researchers explore how regulatory failure contributed to COVID-19 outbreaks in nursing homes and provide potential opportunities for reform.
- In a paper published in The Georgetown Law Journal Online, Nina A. Kohn of Syracuse University College of Law argues that the effects of COVID-19 on long-term care facilities highlighted long-standing gaps and enforcement failures in federal and state nursing home regulations. To close such regulatory gaps, Kohn recommend strengthening the enforcement of existing rules, connects Medicaid funding for residents’ well-being, and demands minimum investment in resident care. Kohn ends that a stronger regulatory system could help stop Medicaid’s preference for institutional treatment over community – based treatment, thereby increasing equality for marginalized populations and reducing structural ageism.
- In a paper published in Milbank Quarterly, Walter Dawson of Oregon Health & Science University and his co-authors attribute The COVID-19 crisis in nursing homes for lack of coordination between the public health system and long-term care facilities. The argue that partnerships between local and state public health departments and long-term care providers arose too late, leading to early and severe outbreaks in nursing homes. To better prepare for the next pandemic, Dawson and his team craving for the creation of well-functioning lines of communication between long-term care providers and public health authorities. They too argue that public health authorities must provide resources and supplement staffing in long-term care facilities during public health emergencies.
- In a recent paper, Howard Gleckman and Melissa M. Favreault of Urban Institute summarize the results of an expert round table on the reform of long-term care. Round table participants in general agreed that Medicaid long-term care should have more resources and that the current focus on nursing home care should be redirected to Home and community based services. The experts expressed however, differing views on whether and how a change in the Medicaid standard could be achieved. Many argued that Medicare was the more appropriate means of funding for long-term care, although others felt the option was politically unrealistic.
- The outbreak of COVID-19 in nursing homes highlights market failures and funding shortcomings for long-term care, Nora Super of The Dairy Institute and her co-authors argue. In a working paper with Wharton Pension Research CouncilSuper and her team Explore the failures of the private long-term insurance market, which is plagued by low profitability and market shrinkage. Concerned about rising costs and an aging population, Super and her team suggests expanding Medicare coverage for long-term care. The propose the creation of Medicare Part E (for “Extras”), which would provide a cash benefit to Medicare recipients for long-term care.
The Saturday seminar is a weekly feature that aims to put the kind of content in writing that would be conveyed in a live seminar involving regulatory experts. Every week, The regulatory audit publishes a brief overview of a selected regulatory topic and then distills recent research and scientific papers on this topic.