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Can We Make Nursing Homes Safer and Healthier? AARP Says Yes.

Long-Term Care Should Improve Patient’s Lives. Right Now, It Doesn’t.

A year into the COVID-19 pandemic, the U.S. has watched multiple institutions struggle to keep up with the demands of the era. Nursing homes were a weak spot for our nation, hosting outbreaks that lead to hundreds of thousands of deaths. This failure, though triggered by the rapid spread of the disease, was caused by years of bad policy and insufficient enforcement of regulations. At some point, the successor to COVID-19 will come along. Whether we go face the same struggles and crises again depends on whether we take initiative right now to fix what’s broken.

With reports of inexcusable abuse and neglect happening at nursing homes all over the country, is our long-term care system even salvageable? That’s a fair question, but we think the answer is an unequivocal yes.

Senior advocacy organization AARP agrees, and even has some ideas on where to start. In a recent blog, the organization shared 10 steps to reform and improve nursing homes. Here is a summary of the suggestions.

  1. Improving Patient Care
    The quality of medical care matters to families whose loved ones are in nursing homes. Right now, there are quality gaps that cause higher rates of resident illness and death. With attention to the right factors, nursing homes can fix some of the biggest risk areas.
  2. Increase the RN-to-Patient Ratio
    Common sense should make the point that having more registered nurses (RNs) per patient will increase care, but for those who need hard data, COVID-19 illustrated the link between care hours and patient welfare. Independent studies in both Connecticut and California found that even an additional 20 minutes of RN care per day was linked to a decrease in infection rates.
     

Federal regulations only require RNs to be onsite for 8 hours a day—meaning for the other 16 hours, patients may not be able to get the care they need. What happens when a nursing home does not meet these standards? It can apply for a state waiver that does absolutely nothing for patients. This loophole must be closed, and the regulations for RN hours increased.
 

  1. More Focus on Infection Control
    Infection control has long been a problem in nursing homes, where patients are likely to be more susceptible to illness or have underlying health conditions that increase their risk of serious infection. Flu deaths were common long before 2020, but facilities did not heed this warning in time to increase infection control measures before COVID-19.

    According to the U.S. Government Accountability Office, over 80% of nursing homes were cited for infection control violations in the past few years before the pandemic. As a nation, we failed to understand the scope of this issue until COVID-19 swept through nursing homes, devastating seniors and their families. We must act now to make the necessary changes that will protect residents against the next pandemic.
     
  2. Work Closely with Other Healthcare Providers
    Most of our medical institutions are insulated from each other, meaning knowledge sharing and coordinated care campaigns do not happen. However, when hospitals and nursing homes worked together, residents were less likely to contract COVID-19. Maryland and Virginia piloted partnership programs to great effect and will hopefully keep this system in place—and even expand it—after the pandemic.
     
  3. Focus On Patient Experience
    Physical health and mental health are linked, with unhappy patients becoming more likely to develop certain health conditions. Medical care and daily assistance are just the baseline for nursing home residents: They also need a comfortable and welcoming environment.
     
  4. Make Nursing Homes Smaller
    Large nursing homes tend to feel and operate like hospitals rather than residences. This is not an environment anyone wants to stay in long-term. In smaller nursing homes, patients are able to build stronger connections and develop a sense of belonging.

    There are also financial benefits to this model: A study of “Green Houses,” facilities with 10-12 residents living in a shared housing center, found a 30% decrease in hospitalization costs as compared to typical nursing homes.
     
  5. Pay More for Staff with Better Training
    Right now, certified nursing assistants (CNAs) make an average of $13 an hour. This is not a living wage in many places across the U.S. Additionally, working as a CNA is physically demanding and comes with high levels of stress. Without financial incentives, many people simply do not want these jobs, making it hard for nursing homes to hire enough staff.
     

There’s also the issue of CNA training, which is less rigorous than the process to obtain a hairstyle license in most states. Increasing training requirements and pay at the same time would boost the number of available CNAs by making the job more attractive. The more CNAs a nursing home has, the more care and attention each patient will receive.
 

  1. Reduce Social Isolation
    The term “social distancing” is now part of our daily lexicon, but for many nursing home patients, this type of isolation was common even before the pandemic. Aside from the weight of loneliness, patients who are socially isolated from loved ones are at a higher risk of suffering dementia, coronary events, and stroke.
     

Though in-person visits can’t be replaced, we’ve all found new ways to connect with our loved ones during the pandemic. Video chat, for instance, is much more effective than text-based communication when it comes to providing social support. Access to these technologies can lift patients’ moods and give them something to look forward to.


Nursing homes may also consider constructing a set of conjoined rooms optimized for socially distanced in-person visits. It’s not quite as good as physically sharing space, but especially if features like “hug walls” are included, it’s much better than nothing.
 

  1. Make Home Care Easier to Access
    Some patients who are in nursing homes today do not need to be there. With adequate home care, they could continue living independently, reducing the burden on the nursing home system and allowing them more freedom and opportunity.


Home care is expensive, however, and not always covered by Medicaid. A Medicaid program called “Money Follows the Person” gives seniors more options for care but must be re-authorized by Congress every 5 years. Creating a permanent system that covered home care as well as nursing home stays could make it easier for those who only need mild assistance to stay independent for longer.
 

  1. Aligning Business Incentives with Care Needs

If you’re asking why nursing homes haven’t implemented such obviously effective strategies already, the answer is simple: money. When nursing homes focus on turning a profit for investors, the quality of care decreases. Our government has the power to step in with regulations that require these facilities to put patients first.
 

  1. Address Medicaid Funding Gaps
    More than half of nursing home patients have their bills paid by Medicare—but the payment rates of this program only cover around 70-80% of a patient’s actual care costs. This leads facilities to take cost-cutting measures like operating with fewer staff members and devoting more resources to short-term Medicare patients who are charged much higher prices.


While state funding programs like public long-term care insurance can help nursing homes, the government should consider retooling Medicare and Medicaid to balance income streams and properly compensate nursing homes for the level of care they provide. At the same time, we should require nursing homes to take steps like those outlined in this post so we can see the impact of the funding increases.
 

  1. Strengthen Regulations and Oversight
    Nursing home residents have a Bill of Rights, but without sufficient enforcement, this law cannot protect them. Currently, nursing homes that violate patients’ rights get a mark on their record and are fined an amount that’s negligible compared to their profits. Even paying tens of thousands in penalties is cheaper than making systemic changes to improve patient outcomes.

    Failure to comply with regulations should result in a penalty serious enough to give nursing homes pause. A new Senate bill that proposes taking steps to penalize nursing homes that routinely receive citations during inspections is a great step toward effective regulation.
     
  2. Switch to a Non-Profit Model
    If finances are an obstacle to making changes for the good of patients, maybe it’s time to overhaul the nursing home industry. Currently, around 70% of nursing homes are for-profit companies with opaque financials. Owners and investors often have a stake in related companies that provide services to nursing homes. This means nursing homes that look like they are operating on the margin may simply be funneling profits through other companies owned by the same people.


Private equity companies seek to profit by buying nursing homes, increasing profitability (often by taking steps like cutting staff or decreasing services), and then flipping them to new owners. This process does not care about patient welfare—it’s just about enriching a few investors. Practices like these would be brought to a halt if nursing homes were required to operate as nonprofits with transparent finances. This might be the best move we could make to improve patient care across the board.

Dealing with an Abusive or Negligent Nursing Home

Nursing homes that fail to institute policies that protect patient welfare are more likely to face reports of patient neglect or abuse. No one should have to face this—but for those who do, we are here to help you find justice. Nursing home abuse cases hold negligent owners accountable in ways inspectors sometimes won’t or can’t. Filing a lawsuit is an effective way for consumers to push for better facility policies and practices.

Brown & Barron, LLC handles nursing home abuse cases in and around Baltimore. Schedule a free consultation with our team at (410) 698-1717.

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