COVID-19 has exposed a crisis in our long-term care system | Ray E. Landis

The impact of COVID-19 on long-term care facilities has made headlines over the past few weeks.

From the Seattle-area center where the first cases in the United States were identified to the deaths occurring at skilled nursing facilities and assisted living campuses across the Commonwealth, it is evident long-term care has become are an epicenter of the outbreak.

The grim details of the dangers that residents and staff face have been well-documented by journalists. The sad reality of families now isolated from their loved ones is reported on the evening news.

But this attention only scratches the surface of the situation our long-term care system is facing and how this crisis has exposed the serious flaws in the way our society cares for individuals who no longer can care for themselves.

“Nursing homes” are not what many Americans envision them to be. The image of the white-haired grandmother quietly rocking in the corner of a room with a bed and a clothes bureau and pictures of her grandchildren surrounding her isn’t what you’ll see should you be permitted to visit.

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The truth is skilled nursing facilities provide two different types of care. They are shorter-term rehabilitation centers, where individuals who have encountered medical setbacks not requiring hospitalization but not allowing them to live at home can recover. They are also home for individuals who require intense 24-hour a day care and who are, unfortunately, never likely to again live anywhere else.

The majority of those in the latter situation are older, many in their 80s, 90s, or even over 100. Most have severe mobility issues and need assistance with activities of daily living, such as bathing or using the bathroom.  They have chronic health conditions that may confine them to bed.

They are cared for by an underpaid and overworked staff, but the care is still tremendously expensive, resulting in many individuals residing in this environment for a significant period of time exhausting their personal assets and relying on Medicaid.

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Skilled nursing home providers fall into different categories – for-profit, non-profit (often associated with religious organizations) and local governments. But the industry has recently changed.

Some county governments, which operate local facilities, have found them to be a significant drain on local tax resources and a number of Pennsylvania counties have gotten out of the long-term care business, finding for-profit entities to take over what many Pennsylvanians knew as the “county home.”

Although county governments found these facilities to be too expensive to operate in the public’s interest, large for-profit corporations continue to expand their operations by incorporating them into their growing networks.  As these entities seek to maximize their earnings, they look for ways to reduce costs. Medicaid’s payment rates for skilled nursing care are far below the rates charged to residents paying for their own care. Thus, most of those relying on Medicaid reside in a shared space resembling a 1970s college dorm room – without the blacklight posters.

Individuals with numerous health problems residing in close proximity to others is a recipe for contagion. Even in long-term care facilities taking every precaution they can, one small exposure can result in the rapid spread of a virus and inevitable deaths, and tragically, these deaths are now occurring in isolation, as families are prohibited from visiting their loved ones.

This raises the question of whether this situation is the best we can do for our older population who can no longer care for themselves. We undervalue those who provide care to those who need it most, whether they are 1 or 91.  We also equate the businesses coordinating the care with businesses selling tires or televisions – accepting them cutting corners to make the biggest profit they can.

It’s time for a change.

We must have providers of 24-hour-a-day care, and perhaps the reality of how COVID-19 has impacted these facilities will change our perception of their place in our society. Individuals in need of long-term care must not be used as pawns by for-profit corporations in budget battles about reimbursement rates and regulations impacting profit margins.

COVID-19 has demonstrated the vulnerability of those residing in long-term care facilities. We must agree to reduce these vulnerabilities by placing the interests of these individuals, and the people providing direct care to them, first.  Our current model of long-term services and supports cannot be the future of care for those who cannot care for themselves. These residents and their families deserve better.

Opinion contributor Ray E. Landis writes about the issues that affect older Pennsylvanians. His work appears biweekly on the Capital-Star’s Commentary Page.