COVID-19: Where We Are Now and What Must Be Done

September 22, 2020

Caregivers in nursing homes and assisted living communities have done everything in their power to protect our most vulnerable from COVID-19. Despite unprecedented challenges and delayed support early on, they have bravely answered the call of duty and have saved thousands of lives.

COVID-19 was a new virus that the health care sector had never seen before. Older Americans and those with underlying health conditions were among the most susceptible, and the virus could rapidly spread through people who showed no symptoms. For these reasons, I called the virus early on “the perfect killing machine” for the elderly.

Initial O​versight Tragic

Long term care facilities were not made a priority at the outset. Critical resources, namely personal protective equipment (PPE), testing, and additional workers, were directed to overburdened hospitals. Lack of priority left long term care providers feeling forgotten and pleading for help. 

This led to nursing homes and assisted living communities bearing the brunt of the tragedy. COVID-related cases in long term care facilities account for 8 percent of total cases yet over 40 percent of deaths nationwide. Independent research from some of the top experts in the country has found that a facility’s quality ratings or for-profit or nonprofit status has little correlation with the presence of the virus, but rather its location. Facilities located within areas with a high percentage of community spread are more likely to have more positive cases.

But the disproportionate effect the virus has had on long term care brings two immediate needs into focus. The first is ensuring that nursing homes and assisted living communities receive top priority for resources to continue fighting the crisis at hand. The second is implementing long-awaited reforms that will help secure the future of our sector.

A Continuing ​Threat

Temporary federal funding has helped us turn the tide on the virus, but as long as COVID-19 is a threat to the general population, it’s a threat to our most vulnerable. Even though positive cases have stabilized throughout the country, we must be prepared for a resurgence in the fall. At minimum, long term care providers must have the PPE and testing needed to prevent outbreaks. This requires ongoing support from federal and state governments.

The Associated Press reported that one in five long term care facilities lacked PPE in the early part of the summer. This equipment—gloves, gowns, eye protection, and N95 masks—are the most basic necessities that residents and staff need to protect themselves, yet months after the pandemic commenced are still in short supply for many facilities.

Surveillance testing is critical, especially for workers who regularly come in and out of facilities and have close contact with residents. The Centers for Disease Control and Prevention (CDC) Director Robert Redfield said rapid and widescale testing is the best way to limit transmission. However, cost and supply continue to be prohibitive to implementation. Long wait times for lab results have made some testing counterproductive. In certain cases, providers have to wait five days or more to receive results, giving asymptomatic carriers ample time to unknowingly spread the virus.

Testing, PPE, and hiring of additional staff have caused expenses to skyrocket, while occupancy rates in long term care facilities have declined. In fact, one study found that occupancy rates dipped below 75 percent at the end of June. The combination of these factors has left many facilities teetering on the edge of collapse. Some have already closed their doors permanently, leaving vulnerable residents displaced without the care they need. 

Reimbursement Reform Critical to Future

There must be a monumental shift in the way we think about long term care. We have an opportunity to make pivotal changes that will shape the future of millions of seniors who will rely on our services. As a recent New York Times editorial noted, “In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long term care can be reimbursed with Medicare dollars.”

Current Medicaid reimbursement rates fall short of the actual cost of the high-quality care we provide. A fully funded Medicaid program will enable us to offer competitive wages to hardworking staff. We can invest in our physical structures and bolster infection control processes.

We need to think creatively about how we recruit and retain the next generation of workers to our field. We have long advocated for tuition reimbursement and loan forgiveness as incentives to attract new talent. We are committed to working collaboratively with Congress to make these reforms for the sake of the millions of residents in our care.

The same editorial noted, “Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.”

We must be vigilant and forward-thinking. We cannot sit idly by and wait for the next pandemic to make the changes necessary to strengthen our sector. With a growing senior population, we need viable options to meet demand. Federal and state governments must put their full weight behind supporting long term care. We must take action today so we can confidently continue to fight COVID-19 and prepare for our future.

Mark Parkinson is the president and chief executive officer of the American Health Care Association and National Center for Assisted Living and former governor of Kansas.​

Originally published in Provider Magazine.