Two Years of COVID-19 in Nursing Homes

Bob Edwards:

Hi, I'm Bob Edwards with An AARP Take on Today.

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            Less than 1% of Americans live in nursing homes and other longterm care facilities. But during two years of the pandemic, more than 20% of all COVID related deaths have occurred in these places. That amounts to more than 200,000 resident and staff deaths. The pandemic cast a light on longstanding problems in nursing homes, such as staffing shortages, and poor infection control.

            Although the COVID case rates are falling from the Omicron peak, nursing home advocates, such as Susan Reinhardt, say these problems will not disappear without intervention. She is Senior Vice President of the AARP Public Policy Institute, and is an expert in health and longterm care policy. She discussed an uptick in resident cases back in August, on episode 140 of the show. Welcome back, Susan.

Susan Reinhard:

Thanks, Bob. It's good to be back.

Bob Edwards:

Two years after the start of the pandemic, tell us what's happened in nursing homes and what we can learn from it.

Susan Reinhard:

Yeah. And thank you for the question, it's so important. We spent a lot of time at AARP on these issues, and I am personally very committed to this. So you mentioned that last we talked in August, that we were starting to see an uptick in nursing home cases and deaths among both the residents who live there and the staff who take care of them. And that did continue, that was Delta. Then we had the Omicron back in December, and that is coming down. That's good news. However, there are still 4,000 deaths in nursing homes over the last four week period. So we're not finished with this, because deaths are ... they lag behind cases, by several weeks. So we are at where we were the end of December, actually. We're not done with this. It's quite concerning.

            And right now, it's still a matter of vaccinations. And AARP really pushed this before the centers for Medicare and Medicaid services even mandated that staff get vaccinations. We said that everyone should get vaccinations. The residents, the staff, visitors. Everybody who's in a nursing home should be vaccinated, and now boosted, so that you can really protect these individuals who are so vulnerable. They usually have multiple chronic conditions. Many are quite frail. And they're sitting in this environment of a ... we call it a congregate setting. Lots of people there, and they just need to be protected.

            And what we find, is that some states have done a good job of this, and other states are still far behind. So we keep pushing, like, get vaccinated.

Bob Edwards:

President Biden alluded to the mismanagement of longterm care facilities in his State of the Union Speech. Here's a clip from that night.

President Biden:

And as Wall Street firms take over more nursing homes, quality in those homes have gone down and costs have gone up. That ends on my watch. Medicare is going to set higher standards for nursing homes, and make sure your loved ones get the care they deserve. And that they inspect and they were looked at closely.

Bob Edwards:

Would you say this is your assessment too?

Susan Reinhard:

Nursing homes have been costly all along. It's the most expensive option for longterm care, and continues ... costs continue to rise. And we were very grateful for the White House proposals that he announced in his State of the Union Address, which are quite significant. A lot of it is being what transparent, that's the fancy policy word for, put it out there. We really need to know what's going on. And that people should know who owns the nursing home, sometimes it's not very clear. And what is the record on quality? And when it's bad quality, what do we do about out that?

            So for example, in New Jersey, there's a very recent report that's come out that has shown the number of nursing homes that have a one star. That's really not very good, a one star in quality. For quite some time, multiple times, for every time they get inspected. And yet they are still able to take care of people and get reimbursed by Medicaid, which is a federal state financing program that is primarily in nursing homes. So that's not good. We have to make sure people are accountable in how they're using the money. So in New Jersey, they are passing regulations that say, well, you have to spend a good 80, 85% of these public funds on actual care. So that's something we should be looking at. How is the money spent?

Bob Edwards:

You just don't want to spend those golden years in the one star.

Susan Reinhard:

No. Absolutely not. Absolutely not. And they should be able to be improved. Nobody's saying that you can't improve, but why aren't they improving?

Bob Edwards:

You've discussed a need for an overhaul in longterm care, from reducing patient out-of-pocket costs to increasing pay for workers. What are some models that policy makers should look at?

Susan Reinhard:

Well, the increase in pay for workers is really important. And what happens very often is workers cannot get a full-time job. They're reduced to less than 20 hours, because once an employer has got you for 20 plus hours, they have to give you benefits. That's the law. So therefore, they don't want to do that very often. Not all employers, but it's a problem. And so we call that shared-staffing, where the direct care workers have to jump from nursing home to nursing home, to get enough hours to make a living. And that is definitely not good because that is another way to spread infections from one nursing home to another one. Not to mention that the worker isn't getting benefits. So that is something that should be looked at. A couple of countries, for example, have made that illegal. We should be looking at that in New Jersey.

            These workers, I mean, they have been amazing. Those that have stuck with it. About 36% of nursing homes now say they have a severe shortage of workers. So we need to consider them, I think, a scarce resource, and make sure that they are getting an adequate level of salary and benefits. And that's why I'm saying is states should be looking at this model of New Jersey ... and I think a couple of others states are looking at it now. That says, okay, we're giving you this money to take care of people. You have to spend that money on the care. Which usually means the workers, as well as infection control.

Bob Edwards:

You're not only an advocate for better longterm care facilities, but also for improving caregiving overall. How should family caregivers be better supported?

Susan Reinhard:

Yeah. Family caregivers ... by the way, once somebody's in a nursing home, it doesn't mean the family caregiver isn't engaged. They need to be able to visit. That was a real problem during COVID, when nursing homes kept family members out. And the social isolation was deadly, as deadly as the virus, frankly. So that's very serious. So we have to make sure that family caregivers are considered part of the care team, legitimately, and included and respected for that.

            We need to realize that their out-of-pocket costs are considerable. Our data says about $8,000 a year. And if you're a long distance caregiver, it's more like $11,000 a year. So we have been advocating for tax credits for family caregivers to help get them the reimbursement that they need for giving all this care. I mean, that doesn't even count their time. Their time alone constitutes about $470 billion of free care a year across the United States. On top of that, there's the out-of-pocket costs.

            So we need to respect them, we need to get them some economic relief for what they're doing, and we need to teach them what they have to do. What we call medical nursing tasks. All these medications and dressings and wound care, and all kinds of things. Oxygen, things like that. That they are doing, that they get very little training and support from professionals to do. We need to make sure that they get that.

Bob Edwards:

Now, what has AARP done to help solve these problems?

Susan Reinhard:

Well, for family caregivers specifically, we've done a lot. We have a lot of resources on our website, aarp.org/caregiving. But we've also developed ... in relation to that last one about complex care. We've created videos to teach family caregivers how to do this. Our latest one is just being released, it's on pain management, because about half of family caregivers are doing these things ... that's 20 million family caregivers are doing this complex care. And 70% of them are dealing with pain. And they really need help knowing how to get the medication, how to give of the medication, how to use things other than medication to relieve pain.

            So that's just one example. We have things on special diets, and mobility, how to help people get in and out of a bathtub. So we have many of them. And many of them are in different languages, particularly Spanish, as well as tip sheets that are in many different languages. And that's all on our website also.

Bob Edwards:

Anything else you'd like to mention?

Susan Reinhard:

Well, we need to change nursing homes ... back to the nursing home piece. Because it can be better, there are models. Greenhouse is one of them. They're smaller, they're private rooms, and the staff is trained in a different way. They have more training and they are more respected than in the typical nursing model. And therefore, their turnover is less. And the infection rate was way below what other nursing homes discovered ... or experienced.

            So we are working with states like Delaware, New York is considering this, Wyoming already has, and invest in a new kind of nursing home. Not so new, I mean, they've existed for 20 years. But how do we scale it up and make it more available to people to have better options? Because some people want to stay at home, and some people need an option like a nursing home. We can do better. And there are great models to show.

Bob Edwards:

Susan Reinhardt is Senior Vice President at the AARP Public Policy Institute. Thank you, Susan.

Susan Reinhard:

Thank you, Bob.

Bob Edwards:

That's it for this week's show. You can find more resources in the show notes. If you liked this episode, please let us know by emailing us at newspodcast@aarp.org. Thanks to our news team. Producers Colby Nelson and Danny Alarcon. Engineer, Julio Gonzales. Executive producer, Jason Young. And my co-hosts, Wilma Consul and Mike Ellison.

            Become a subscriber on Spotify, Apple Podcast, Stitcher, or other apps. And be sure to rate our show as well. For An AARP Take on Today, I'm Bob Edwards. Thanks for listening.