Can We Continue Failing Our Nation’s Elderly? — National Report Inspires Change in Nursing-Home Industry

Care Worker Mistreating Elderly Man

If any shape of a silver lining comes from the COVID-19 pandemic, perhaps it will be the desperate rallying cry to transform the business of nursing homes before another wave of unnecessary deaths among helpless seniors occurs.

It was at the peak of the virus – the Fall of 2020 – when the Committee on the Quality of Care in Nursing Homes began its work of unearthing and exposing fatal shortcomings in the industry.

“While much of society previously had little awareness of the care delivered in nursing homes, the evening news channels and social media projected daily images of the pandemic’s impact and of the inadequate care that put the safety of both residents and staff at risk while distraught family members watched from afar as their frail older loved ones were kept in isolation,” the report’s preface states.

A massively ambitious study ensued.

“The committee was given a substantial task of examining how the United States “delivers, finances, measures, and regulates the quality of nursing home care,” according to the preface. “The challenge was enormous, but as reflected in the final recommendations, real change in nursing home care will require bold action in each of these domains.”

The nearly two-year effort has resulted in a 578-page document titled “The National Imperative to Improve Nursing Home Quality.” Its early chapters present less-than-pleasant evidence of the need for change while the last chapter concludes matter-of-factly, “…the way the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.” Truth be told, the study’s findings reveal what every daughter and son would want for their father and mother and what every husband and wife would want for their significant other – humane treatment instilled with dignity and respect for the elderly, who have earned as much.

The preface in the report sets for in the form of questions the failings we see every day in nursing homes:

• Is it too much to ask that each and every resident in every nursing home receives care that includes high-quality physical care, behavioral health, safety, and psychological support?
• Is it too much to ask for a plan of care to establish what is most needed for each resident to receive high-quality care that is truly person-centered?
• Is it too much to ask that nursing assistants are better trained to deliver care to often frail people with limited social support or resources in the last years of their lives?

The report has made national news and caught the attention of Katie Smith Sloan, president and CEO of LeadingAge, an organization representing 5,000-plus nonprofit service providers for the aging.

“This report is a piercing wake-up call for policymakers,” Sloan said in a statement. “Decades of underfunding have left America’s nursing home system in desperate need of an overhaul. As our nation grows rapidly older, millions of older Americans will need safe, high-quality care. It’s time to act to ensure they can access and afford the vital care nursing homes provide.”

David Grabowski, a member of the Committee on the Quality of Care in Nursing Homes, did not mince words about the findings.

“I will stress that this is a comprehensive package of reforms,” Grabowski told Advisory Board in a daily briefing. “Many stakeholders will want to grab their preferred recommendations and ignore the ones that are more challenging. That is a mistake. We can’t nibble around the edges and expect transformative change.”

The committee issued seven action steps to tackle the issue:

• Develop emergency-preparedness plans for nursing homes
• Create smaller, more homelike environments for patients
• Incentivize owners of nursing homes to implement a system of electronic health records at their facilities
• Establish national training standards and staffing requirements
• Better-compensate frontline workers
• Overhaul the methods by which nursing homes are financed and supported administratively and governmentally
• Increase federal oversight

“Underfunding” is largely the result of placing an emphasis first on profit with patient care falling somewhere down the line. We see cases everyday in which nursing home corporations intentionally understaff and use unqualified, overworked nursing assistants to deliver patient care. The result is patients throughout the nursing home industry sometimes lack even the most basic care and suffered some of the most grievous injuries.  

Victor Dzau, president of the National Academy of Medicine, said an eighth action step would be well-advised – one of changing societal views on aging.

“Aging should not be something to be dreaded, but something to be revered, and as such, nursing homes should provide the highest quality and compassionate care to enhance the lives of those in their care,” Dzau said in a news release titled “Wide-Ranging Systemic Changes Needed to Transform Nursing Homes to Meet Needs of Residents, Families, and Staff.” “This report delivers a blueprint to build a system of nursing homes that truly centers the lives of older adults and gives them respect, dignity, and protection. The COVID-19 pandemic highlighted the persistent inequities and inadequacies in American nursing home care, clearly illustrating that this system is broken. Addressing these vulnerabilities must include building a high-quality workforce, ensuring a more rational payment system, and directly addressing ageism so we can provide care that improves, not only sustains, the lives of our aging loved ones.”