In only a few months, the fundamentally dysfunctional operations, infrastructure and economics of nursing homes (US) and care homes (UK) have been exposed. It is hard to exaggerate how very bad the situation is.
Pandemic infections and deaths have been disproportionately high in nursing homes and care homes, and the responses by government and regulators have failed to make the situation better – often making it worse. Congregate seniors’ housing owners, operators and providers have been trying to “stay the course” keeping employees and residents safe, while at the same time managing the grief and anger of communities outside their buildings. These efforts continue, despite the lack of testing and personal protective equipment (PPE), resources which have been showered on hospitals. And it has been a field day for the press, with continual stream of heart-wrenching stories about lonely deaths, separated families and loved ones, as well as exposes about procedural errors and poor decisions by owners and managers.
It should be clear to everyone – government policymakers, regulators, intermediaries and insurance companies as well as families and consumers themselves – that a sustainable, accessible and affordable congregate senior’s housing and care sector is critical to well-being of our communities. Recent events have exposed the yawning gap between where we are now, and the ideal. Even as the consumer-based economies in many locations begin to reopen, early assessments of the damage done in congregate long-term care raise questions about the future of nursing homes and care homes. Long-term congregate care is not an optional service; nursing homes and care homes are need-driven; they are essential social & healthcare services.
Congregate Long-Term Care: Failure to Thrive
Urgent questions about the future of congregate long-term care must be addressed in a sober, eyes-wide-open discussion. At this juncture, if we are rigorous about not carrying biases, profit motives or legacy models of control and management into these discussions, we have an opportunity to create a far more rational model. This must start with a sober assessment of the current situation. For example:
- Financing – the federally-funded model for financing nursing home residency in the US is riddled with contradictions, conflicts and profiteering. This need-driven system is deeply embedded in the legal and cultural mores of the nation and has spawned an entire industry of asset cloaking and maneuvering. Or, if you have significant assets or income, and don’t wish to “hide” them, you can relocate to an assisted living residence, pay privately and receive essentially the same level of supervision and care as in a skilled nursing center. In the UK, the method of financing care home residency is a patchwork of pension fund money mediated through local contracts, which together seldom cover the true costs, and force cross-subsidization from other private sources.
- Regulation – operating standards, staff recruitment & training requirements, medication management & dispensing, routine data reporting, sentinel event reporting, nursing, therapy, nutrition, fire & safety code – the list goes on. The regulatory burden on nursing homes and care homes is far out of proportion to other forms of congregate care (especially hospitals) and the potential revenue inherent in the business model. No one would suggest that oversight is not important, but the oversight should not be disproportionate to the care!
- Technology – it is no exaggeration that grocery stores have more sophisticated technology than nursing homes and care homes. While there have been widescale initiatives backed by government funding to deploy health information technology (HIT) such as electronic medical records (EMRs) in hospitals and doctors’ offices, nursing homes and care homes remain “the land that technology left behind.” Regardless of how the congregate long-term care sector repositions itself going forward, there must be greater levels of efficiency, which can only be achieved through sophisticated technology.
- Human Resources – those who work in long term care – the frontline caregivers – often hold down two jobs, are employed in stressful, unpleasant situations and are paid at the bottom of the income scale in virtually every marketplace area. On top of that, during the pandemic, they have had to perform their work worried about contracting an illness which they could easily bring back to their families or to their other colleagues in their other jobs. Recruiting and retaining the frontline caregivers had been extremely challenging before COVID-19 and will be even more so going forward.
Congregate Long-Term Care: The Road Ahead
This moment in time is painful for the long-term care sector but is also a distinct opportunity to rethink and reconfigure congregate long-term care. There are basically two scenarios:
- Rebuilt & Recharged: The congregate long-term care sector is rebuilt and recharged with new energy and a clear, transparent operational and financial model. Even though many centers do not survive, new models emerge, including “small houses” and many new variants, which were impossible or illegal under prior regulatory structures. Success in managing through the pandemic inspires new interest in employment in the sector. New funding models offer reasonable margins and access to capital for technology investment. The public perception of congregate long-term care is gradually improved.
- Ravaged & Relegated: Political and public pressure produces further onerous regulation, sending owners and operators heading for the exits. The flood of properties for sale depress asset values, and access to capital dries up. Fewer frontline caregivers seek employment in the sector, driving up labor costs, placing even more financial pressure on margins. Centers in rural and exurban areas are shuttered, and with no alternatives, families are forced to seek even more inconvenient options. This erodes the already damaged public perceptions.
Which scenario comes to pass depends on many factors including our willingness to step into the political and policymaking fray and argue for what is needed – which is a sustainable, accessible congregate long-term care sector.
For Long Term Care Resources click here: https://stackpoleassociates.com/long-term-care-resources
Irving Stackpole is President of Stackpole & Associates, marketing, market research and training firm at www.StackpoleAssociates.com. He can be reached directly at: firstname.lastname@example.org.