Experts offer 10 ways to reform and improve nursing homes

Grabowski also says there are state funding fixes available, such as mandated public long-term care insurance programs. Washington state instituted such a program in 2019, funded through

payroll deductions, similar to Social Security and Medicare, and will provide a lifetime benefit of $36,500 to those who meet the eligibility requirements. It is projected to save the state

upward of $440 million in Medicaid spending by 2050, according to state Rep. Laurie Jinkins (D), speaker of the Washington state House of Representatives. 6. REVAMP THE STAFFING MODEL A

nursing home aide can be responsible for more than 20 residents on a shift. The job is physically and emotionally demanding, and lives can be at stake, yet the average wage is around $13 an

hour. Requirements for the job vary by state. In most, workers complete a hands-on training course and a certified nursing assistant (CNA) program, which generally take from 75 hours of

training to more than three months. But don't be fooled by the terminology. State requirements to gain a hairstylist license are more demanding than for a CNA, says Lori Porter,

cofounder and CEO of the National Association of Health Care Assistants. Now that COVID-19 restrictions have limited CNAs to working at just one facility, many are unable to afford basic

living expenses. Researchers at UCLA and Yale University found that nursing home aides who worked in multiple facilities in order to make more money contributed to the spread of COVID-19.

Restricting workers to a single facility had the potential to reduce COVID-19 infections by 44 percent, according to the study. But given the low-pay, high-stress nature of the work, there

is a chronic shortage of workers to draw on, notes April Verrett, president of the Service Employees International Union (SEIU) Local 2015 based in Los Angeles, which represents about

420,000 long-term care workers across the state. Without increased pay and benefits, nursing homes will remain short-staffed, Verrett says. “We have seen during this outbreak that staffing

is so stretched that they hardly have time to wash their hands and make sure their protective equipment is on properly,” she adds. 7. IMPROVE OVERSIGHT AND REPORTING On paper, the rules and

regulations for operating a safe and sound long-term care facility are detailed and strict. The problem, advocates for nursing home residents say, is these laws and regulations are not

strictly enforced. Take the case of the Pontiac Nursing Home. In April 2019, the for-profit facility in Oswego, New York, was cited by state inspectors for “immediate jeopardy,” the most

serious violation, after an employee declined to send a resident with a temperature of 104.4 degrees to the emergency room. The man died. An inspection revealed that a second man died after

employees waited 11 hours to send him to an ER while he struggled to breathe. The federal government fined Pontiac $21,393. Mollot notes that it's cheaper to pay the fines and “continue

business as usual instead of making improvements to quality of care.” Sen. Bob Casey, a Democrat representing Pennsylvania and the ranking member of the Special Committee on Aging, says

that COVID-19 has “supercharged” the need to root out nursing homes that are failing seniors. Casey and Sen. Pat Toomey, a Republican representing Pennsylvania, introduced new legislation 

that aims to hold nursing homes more accountable. Casey says the bill, which AARP supports, would “transform the oversight process for nursing homes that have consistently failed safety and

care standards." 8. RETHINK OWNERSHIP About 70 percent of nursing homes are for profit, and many are part of large, complex and often opaque organizations. "Regulate nursing homes

like a utility so that we know exactly where the money goes,” says Charlene Harrington, professor emerita and a nursing home researcher at the University of California, San Francisco. “Only

a certain amount could go for profits, and the rest would have to go for services." Even better, Harrington argues, would be ending the for-profit ownership model that dominates the

industry — especially the private-equity investment model of flipping properties for big, fast returns. GOAL: RESHAPE THE INDUSTRY 9. PROVIDE MORE CARE AT HOME Innovative nursing home

alternatives that have been cropping up across the U.S. are getting new attention as Americans question nursing homes as the default model of care. “Until recently we've chosen as a

society not to really see nursing homes until we need them. Then we're surprised, shocked and appalled by the conditions and the facilities,” says Terry Fulmer, president of the New

York City-based John A. Hartford Foundation, an organization dedicated to improving care for older adults. “In their current state, they're overregulated, underfunded and have low

societal respect,” she says. Nearly 1 in 8 nursing home residents were considered “low care” in a recent study by the Providence (Rhode Island) VA Medical Center that looked at 2014 data

from around the U.S. These residents needed some help with daily living but didn't have complex medical or rehab needs and could independently eat, use the bathroom, stand up from a

chair and get in and out of bed. The solution may be extending home care services, says Nora Super, senior director of the Milken Institute Center for the Future of Aging. State programs

that allow Medicaid funds to be used not just for nursing homes but also for home care allowed more than 100,0000 people to move out of nursing homes between 2008 and 2019. Medicaid's

program, called Money Follows the Person, costs about $882 million a year but must be reauthorized every five years by Congress. “Permanently reauthorizing the MFP program will reduce

Medicaid's institutional bias toward nursing facilities,” Super says. 10. CREATE SMALLER NURSING HOMES Too often, nursing homes look, feel and function like hospitals. Susan Ryan,

senior director of the Green House Project, says small, family-like households are a better option. At 300 Green Houses in 32 states, just 10 to 12 residents live in a housing center and

share an open kitchen, dining room and living room. Specially trained CNAs work exclusively in one house — making meals, doing laundry, socializing, helping residents pursue their interests

and looking for early signs of health issues. “COVID-19 rates have been far lower in small nursing homes,” Ryan says. “All the features that make them a great place to live also make

infection prevention and control easier.” One 2016 study comparing costs at 15 Green Houses to 223 conventional nursing homes found that Medicare Part A costs for hospitalizations were about

30 percent lower — $7,746 less- — for a Green House resident. Super notes that small nursing homes may gain traction as operators of nursing homes confront the need to upgrade their

facilities. “At a certain point,” she says, “it's easier to rebuild than to renovate."