As COVID-19 ravages the U.S., many of the nation's 15,600 nursing homes are among the most dangerous places to be.
In the early months of the pandemic, more than a third of those who died from the virus were residents or workers at nursing homes, according to multiple analyses. In at least 18 states, nursing homes accounted for more than half of all deaths related to COVID-19.
The individual stories are horrific. In Brooklyn, one nursing home reported 55 coronavirus deaths. In New Jersey, police discovered bodies in a makeshift morgue at one facility. In a nursing home outside Richmond, Virginia, a quarter of the residents — at least 45 people — died from the virus.
Suddenly, the nursing home industry, which has long operated out of public view, finds itself at the center of scrutiny. Elaine Ryan, vice president of government affairs for state advocacy at AARP, says the outbreak will push nursing home residents and their families to question whether many facilities should survive. “I think as the data becomes clearer, families and individuals are going to rethink if nursing homes are the best and safest places for them to be,” Ryan says.
But change will be difficult.
The nursing home industry exists largely out of necessity, housing more than 1.3 million Americans. Most of these people cannot care for themselves and don't have resources to pursue other options or family that can take them in. For many older Americans, nursing homes are their only choice, says Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.
It is an industry paid for in large part by tax dollars. The federal government requires all states to provide and pay for nursing home care for eligible seniors and people with disabilities through state Medicaid programs, funded mostly by contributions from the federal government.
Medicaid currently pays the bills for more than 60 percent of nursing home residents at a cost of more than $41 billion a year. But because Medicaid is a hybrid federal-state program, states have some discretion on spending, so benefits can vary dramatically based on where you live.
Adding to the complexity is the range of nursing home types, often with different oversight or demands. Nursing homes for veterans, for example, are run by the Department of Veterans Affairs (VA). Nursing homes that serve people with dementia have far different demands than others. At least 70 percent of nursing homes are for-profit businesses. Many offer other services in their facilities, such as short-term rehabilitation — paid for by Medicare — to keep beds filled and revenue flowing.
As the industry faces a reckoning, experts hope the pandemic will inspire change.
AARP interviewed more than a dozen national experts to hear their views on what the crisis has exposed and what needs to happen for the industry to be safe and secure.
Challege 1: Lax enforcement of nursing home standards
U.S. Sen. Chuck Grassley (R-Iowa) responded to the crisis by calling for strict oversight of nursing homes. The federal government has a fundamental responsibility to ensure that “the tens of billions of tax dollars that pay for long-term care” are well spent and pay for quality care, Grassley said in a statement.
Before the pandemic, government safety standards for nursing homes were strong but often not enforced, says Richard Mollot, executive director of the Long Term Care Community Coalition. Mollot thinks those standards should include increased focus on infection control — with rigorous enforcement.