Senior Living Communities have had to reform to the changes from coronavirus to ensure the safety of patients and staff members. Patients above 60 years are at risk as the virus adversely affects their lungs and could be dangerous or even deadly. Patients affected by COVID-19 require constant supervision, which could also affect the caregiver in the process. This predicament highlights the long-standing concerns and challenges of senior living communities.
COVID-19 and Senior Living Communities
The coronavirus pandemic has put senior living communities in the spotlight. COVID-19 had affected over 28,000 senior living patients and workers in the United States as of early May 2020 with residents of senior living communities accounting for 35% of the country’s overall deaths. More than 153,000 patients and workers of 7700 US nursing facilities have caught COVID-19 since the epidemic began at a senior living facility in Kirkland, Washington.
The apprehension that is unfolding in senior living communities is the product of years of long-term healthcare policy negligence. They lacked the resources needed to control the epidemic, such as testing and personal protective equipment, and their employees are frequently underpaid and undertrained.
Furthermore, senior living communities were prime targets for COVID-19 since they housed individuals who are particularly prone to the virus’s adverse effects, especially in shared living quarters and communal places. Senior living facilities in the United States, like those in many other nations, have also been ill-equipped to combat the virus spread.
Even though critical regulatory initiatives, including the Federal Nursing Home Reform Act of 1987, have sought to address problems in care quality, COVID-19 has emphasized that focusing on only extensive monitoring is insufficient. The coronavirus has highlighted and exacerbated a long-standing and more comprehensive issue— our inability to prioritize an effective and safe long-term care system.
For example, if staff are not accessible to assist patients who require help standing or walking, people may harm themselves while trying to get around independently. Understaffing has also been linked to abusive behavior. In the two years preceding the pandemic, ProPublica’s dataset of nursing home audit records reveal hundreds of cases of people with ulcers and skin issues.
The Under-Staffing Issue
Well before the pandemic, the consequences of staff shortages were widely known. Researchers have found that most hospitals lacked the personnel required to avoid systematic neglect even before the pandemic. According to a 2018 Human Rights Watch investigation, senior living facilities in the United States habitually over-medicate dementia patients in order to make them submissive and easier to manipulate.
The threat of continuous staff shortages in senior living communities has been highlighted as a significant issue since the COVID-19 outbreak. Low staff numbers, particularly among nursing staff, predict senior living communities inability to handle COVID-19 attacks and minimize fatalities. This can raise the risk of death and categorize people. Nonetheless, according to a 2017 assessment, understaffed hospitals tend to employ psychotropic medication as a cost-cutting measure rather than recruiting extra RNs.
Issues Regarding the Federal Regulations
The staffing need in senior living communities adds to the understanding of the possible link between staffing and quality. The federal government altered the surveying technique used to supervise senior living facilities as part of the National Health Regulatory Authority (NHRA). In general, researchers have limited their analysis to the more readily available post-NHRA statistics.
Understaffing is frequent because, while federal laws establish desired nursing homes, authorities do not hold senior living communities responsible for those results. Instead, whenever senior living facilities are shown to have broken national standards for patient safety, they are often not fined or otherwise penalized. They are simply urged to fix the problem.
As a result, unethical suppliers might boost revenues by understaffing facilities. With reduced staff, the need to pay their salaries is also lowered. Indeed, private equity corporations continue to purchase low-quality senior living communities for the profit they may create, especially when owners are ready to forgo patient safety to increase profit.
Ways to Solve the Crisis
- Adjust Penalties
To overcome this limitation, federal regulators could consider adjusting the way senior living facility penalties are calculated and enforced, charging higher fines and employing the entire range of penalties currently authorized by federal legislation. This involves not just monetary punishments, but also hinges on future enrollment and repayment suspensions.
- Direct Care Personnel
Regulators might also mandate institutions to maintain a minimum level of direct care personnel that corresponds to what studies have discovered is required to deliver quality care (A little above four hours per admission, every day).
- Focus on Long-Term Care
Indeed, long-term care has been sidelined in our federal welfare policies since the 1960s, when Medicare and Medicaid created narrow and incomplete social welfare programs for such care. These programs adopted a institutionalized model of care, prioritizing the utilization of licensed providers and institutions.
This model made senior living communities the default provider of long-term care and made the care provided by families et al. outside these licensed facilities invisible, leaving it unsupported. Furthermore, Medicare and Medicaid were never intended to be the primary financial contributor of long-term care.
Medicare only partially and indirectly pays long-term care by funding nursing home-based rehabilitation following a hospitalization. Medicaid finances half of all long-term care after people that need help with daily activities, like bathing, dressing, or eating, but it’s available only to people who have meet economic requirements and have coverage gaps.
After witnessing the consequences of the current system, it is time to focus on long-term care to improve the quality of life of senior living residents.
Financing of Senior Living Communities
COVID-19 has made senior living communities face a financial crisis in delivering and supporting long-term care, and there are no quick remedies. However, experts believe that robust strategies must be considered to ensure elderly Americans get appropriate funding.
Both Medicare and Medicaid funding for nursing home care has indeed been falling. Despite a large number of senior citizen populations in the US, enrollment has been declining steadily. The percentage of patients admitted to a senior living facility for recovery has also decreased.
To save healthcare costs, elderly patients are being discharged home from hospitals, putting pressure on a crucial source of income for senior living communities.
With Medicare’s recent relaxation of limits on the use of telemedicine, it is becoming increasingly practical to help patients’ recovery from hospitalization in their homes, and this method will most certainly outlive the pandemic.
At the same time, states have been transferring Medicaid-funded care into people’s homes, partly in reaction to a 1999 US Supreme Court ruling requiring that care be delivered in the least restrictive setting practicable. Olmstead v. LC Medicaid has transferred a more significant percentage of care into homes and away from senior living facilities since 2013, despite continuing to underfund treatment in both situations.
Many senior living institutions had no cushion to answer a national disaster since their census declined even before the outbreak. They are now directing resources on halting the spread of the coronavirus, including the purchase of protective equipment and SARS-CoV-2 tests for patients and employees.
For example, most have insufficient resources to provide a sufficient supply of PPE kits and other necessary supplies. Some senior living facilities are expected to struggle to pay rent or staff members in the coming months, forcing them to shut down or file for bankruptcy. Hundreds or even thousands of senior living inhabitants might be evacuated, causing significant inconveniences for them and their families at an already difficult time.
Reform Measures
The existing financing and delivery structure for long-term care services is a national disaster that must be addressed. Here are ten ways in which the long-term care market can change to be more robust and more sustainable in the near term and eventually more welcoming and responsive to those who need to live there.
- Collaboration with hospitals
During the pandemic, hospitals in Maryland began collaborating with senior living communities, providing testing and knowledge on preventing infection and the use of personal protective equipment (PPE). The collaboration aided in preventing disease spread in senior living communities, which may have overwhelmed emergency departments.
In another instance, a hospital dispatched rapid-response crews to assess infections and support care staff with infection management. In addition, it provided telemedicine services. The network’s senior living facilities had lower rates of death and hospitalization than the national average.
- Reduce the alienation
Long before COVID-19, social isolation was a health and wellbeing issue in senior living facilities. A lack of connection is linked to a slew of adverse outcomes, including a 50% increased chance of dementia, a 29% increased chance of cardiovascular disease events, and a 32% increased risk of stroke.
Any approach for enhancing senior living care must address isolation. The first step is to set up safe spaces for in-person visits. These would incorporate plexiglass walls, an audio system, antibacterial surfaces, and maybe even a bendable material hug wall for germ-free hugs.
The next step is to increase the number of virtual visits. Compared to emails, social networks, or text messaging, video conversations with friends and family were connected with a 50% reduced incidence of depression. Caregivers that have implemented advanced technology, in the form of iPads, promoted a positive way for patients to communicate.
- Increase infection management
It takes just one individual to put everyone at risk. Senior living patients sometimes have weaker immune systems due to both age and chronic disease, residents frequently share rooms and live within feet of one another, and members of staff flow in and out.
Every senior living facility should have PPE on hand, not only for this situation but for any other infectious situations that may occur. California, New York, and New Jersey have regulated that senior living facilities stock up on masks, face shields, gloves, goggles, gowns, and other protective gear for one to two months. That, however, is not inexpensive.
- Redesign the staffing model
On any given shift, a nursing home assistant may be accountable for more than 20 people. The job is physically and emotionally taxing, and lives may be at stake; nonetheless, the average hourly salary is roughly $13.
Additionally, the work varies by state. Most workers must finish a hands-on training program as well as a Certified Nursing Assistant (CNA) program, which can range from seventy-five hours to more than three months. The National Association of Health Care Assistants is a professional organization for health care assistants. Many CNAs are still unable to pay basic living expenses now that COVID-19 rules have confined them to working solely one institution.
However, due to the low-paying, high-stress nature of the profession, there is a chronic scarcity of people to draw from, according to research conducted by UCLA and Yale University. Senior living communities will continue to be understaffed until wages and benefits are enhanced. In this epidemic, personnel are so tight they barely have time to clean their hands to ensure their protective gear is correct.
- Consider the ownership options
Approximately 70% of senior living facilities are for-profit, and many are part of extensive, sophisticated, and sometimes opaque companies. Therefore, there is a need for the senior living communities to be regulated as if they were utilities, so everyone can see where the money is going.
Profits could only be deducted to a certain extent, and the remainder would have to be spent on operations. Even preferable would be to put a stop to the industry’s dominant for-profit ownership structure, particularly the private-equity investment model of flipping homes for high, rapid profits.
- Construct smaller senior living facilities
Very often, senior living communities resemble hospitals in appearance, feel, and operation. However, given the situation, smaller, more family-like households are preferable. COVID-19 rates in tiny nursing facilities have been much lower. All the characteristics that make them a desirable place to live also facilitate health and disease prevention.
Tiny senior living communities, according to a study, could make headway as owners face the need to improve their facilities. It becomes easier to rebuild than to maintain beyond a certain point.
For instance, The Green House Cottages of Wentworth Place, which were first opened in 2008, have the appearance of suburban development. Each of the six ranch-style cottages has a driveway, a front lawn, and a back patio. Inside, twelve individual rooms are arranged around a huge open space that includes a kitchen, eating area, and sitting area with couches, a fireplace, and a TV. Each room has its own bathroom.
In contrast to typical senior living facilities, the Green House personnel structure is flat. The shahbazim, a small band of universal workers qualified as certified nursing assistants, work within only one cottage and interact extensively with 10 to 12 people.
- More attention should be provided at home
Senior living alternatives that have sprouted up around the country are gaining traction as Americans challenge senior living communities as the standard form of care. Senior living communities are now over-regulated, understaffed, and have little public esteem.
The solution might be to expand home care services. During 2008 and 2019, state programs that permitted Medicaid funding to be used not only for senior living communities but also for home care allowed hundreds of people to transition out of senior living communities.
- Enhance supervision and reporting
Consider the Pontiac Nursing Home—in April 2019; state investigators cited the for-profit institution in Oswego, New York, for urgent peril, the most severe infraction, when staff refused to transport a resident with a fever of 104.4 degrees to the urgent care. The man passed away. An investigation showed that a second man died after staffers delayed 11 hours to transport him to an emergency room as he battled to breathe.
The standards and regulations for running a safe and sound long-term care institution are complex and stringent on paper. According to advocates for senior living patients, the issue is that these rules and regulations are not rigorously implemented. COVID-19 has heightened the need to identify senior living facilities that are failing elders. The American Association of Retired Persons (AARP)-supported measure would help the oversight process for senior living facilities that have frequently failed to meet safety and health requirements.
- Understand the role of funding
Almost 60% of senior living residents are covered by Medicaid, which is mainly for low-income Americans. Many senior living facilities claim they must broaden their operations by taking in higher-paying short-term patients to counterbalance those who require rehabilitation following surgery. Because of persistent Medicaid underfunding, caregivers were already working on razor-thin margins when the pandemic started.
Senior living communities advocate for legislation that would change Medicaid payment rates to cover what they claim are the actual costs of care. The idea is to make a new Medicare benefit, dubbed “Part E,” which would cover the majority of all the expenses of long-term care for Senior citizens. Higher Medicare payments and reduced Medicaid rates would be combined into a single payment channel to senior living facilities.
- More registered nurses are needed
Senior living facilities with a more significant percentage of registered nurses on staff performed better in coronavirus management and death reduction. A similar outcome was achieved in a California investigation. However, federal rules and regulations only require care facilities to hire one residential nurse for 8 hours a day. This can result in 16 hours with no Nurse coverage.
Federal law also permits states to give exceptions to senior living facilities that cannot comply with the rules. Regulations for Nurse staffing were enacted as part of the Nursing Home Reform Act of 1987. This was in response to a legislative investigation that indicated that many elderly residents were getting inadequate medical care in long-term care and subjected to mistreatment and abuse.
Senior living communities will have to be saved in the short term because, despite their vulnerabilities, they are a necessary part of any solution. Some advocates estimate that it will take up to $15 billion in federal funds for senior living communities to survive the COVID-19 pandemic. While recent relief packages for the healthcare and senior living industry have started to address the anticipated shortfall, until a definitive change is put in motion, it will not be enough.
