For decades now, nursing homes in the US have failed to provide older residents with a dignified and humane life. Their horrifying response to the COVID-19 pandemic and inability to provide residents safe shelter or quality care only underscore the need to rethink nursing home care. We need to replace large institutional nursing homes with smaller facilities that feel more like home.
For a long time now, most institutional nursing homes have had persisting deficiencies. Of late, more than 54,000 nursing home residents and staff have died as a result of the novel coronavirus. COVID-19 provides an opportunity to see the grave vulnerabilities of institutionalized nursing home care today.
The Green House model of nursing home, small and focused first on the needs and desires of residents, is a great model. Green Houses offer a dignified way and patient-centered way to provide long-term care.
Dr. Joanne Lynne, an analyst at the Program to Improve Eldercare at Altarum, explains why we should defund today’s nursing homes, shut them down and provide care to people in need of long-term care in the community.
Dr. Lynne argues that different types of nursing care are best suited to older adults, depending upon their conditions. Small nursing homes are appropriate for people in need of a lot of assistance and of sound mind who need care over a long-stretch of time. Dr. Lynne sees five categories of people who need nursing care.
- People discharged from the hospital who need short-term care so that they can return home or to another place in the community.
- People with brain damage, including dementia and stroke, who do not know where they are and do not have family or friends to provide them assistance.
- People who need a lot of assistance and don’t mind moving out of their homes and having someone take care of them in a home-like setting.
- People who need a lot of care because of significant disabilities and favor congregate care, and can either afford it or who have coverage to pay for it.
- People at the end of life who need hospice care for a short period of time.
People who have been discharged from the hospital and need short-term care and people who have dementia or otherwise do not know where they are could manage in a less-homelike setting. A small nursing home might not be best for them.
But, people with serious disabilities need a comfortable living space, where they can socialize, build relationships with others, and their personal needs can be tended to. A small nursing home could be appropriate for them. No more than a small group of people should live together to ensure good outcomes.
People in hospice also need a home-like and comfortable setting, but they do not need an environment conducive to establishing long-term relationships.
Nursing homes in the age of COVID-19 are more like prisons for their 1.3 million residents. No visitors. No family or friends with whom to socialize. Often, residents are isolated in a single room. They have had no choice in this arrangement for four months now. They have been disenfranchised and their well-being jeopardized. Smaller nursing homes would make it much easier to contain the spread of a deadly virus.
Medicaid must be able to pay for smaller nursing homes, as it does in many cases with Green Houses. And, in order to help ensure patients needs are met, these homes must be required to spend at least 85 percent of their revenue from insurers on direct patient care.
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