Long-Term Care After COVID-19 – The Regulatory Review

Experts recommend regulatory policies to improve long-term care in the wake of COVID-19.

Nursing homes and other long-term care facilities have been devastated by the COVID-19 pandemic. Nearly one-third of coronavirus deaths in the United States have been residents and employees of these facilities. As of May 2021, confirmed cases in these facilities have reached over one million. The leading explanation for these high rates is that residents advanced age and comorbidities make them particularly at risk for severe illness and death from the virus. This risk is compounded by the communal nature of long-term facilities, which increases the likelihood of residents and staff spreading COVID-19. Still, some experts argue that regulatory failures and chronic underfunding are partly to blame for such tragic outcomes in one of Americas most vulnerable populations.

Although the challenges of the COVID-19 pandemic are new, the crisis in long-term care is not. Long-term care facilities have a long history of low-quality care. In 1986, a study by the Institute of Medicine found that nursing home residents were routinely given inadequate care, neglected, or abused. In response, Congress passed the Nursing Home Reform Act, which set new care standards, upgraded staffing requirements, and established an enforcement mechanism for noncompliant facilities. Today, states enforce these standards through unannounced surveys conducted every 9 to 15 months, with variable penalties depending on the severity of the violation.

Most nursing home quality measures have improved over time under this law, but the majority of facilities still fall short of federal standards. In recent years, over 90 percent of nursing homes have received at least one citation per year for violating federal regulations. The pandemic only exposed and amplified these issues. Numerous nursing home residents have reported instances of severe neglect during lockdowns, including extreme weight loss and untreated bedsores.

Neglect for long-term care is also visible in its patchwork funding regime. The majority of long-term care is paid for by Medicaid, which only becomes available once individuals have exhausted their personal assets. Medicaid funding for long-term care also varies dramatically by state and is frequently under threat of budget cuts, especially during economic downturns. For individuals who look to private insurance to cover costs, they often find prohibitively high premiums. Fewer than 1 in 30 Americans own a long-term care insurance plan. Medicare, the primary insurer of Americans over 65 years old, does not cover long-term care beyond 100 days.

As a result of this patchwork system, nursing homes are chronically underfunded. The majority of nursing homes in the U.S. operate at a net loss, and hundreds of nursing homes have been forced to close in recent years. Thin or negative profit margins prompt facilities to cut corners in care quality and staffing levels, perpetuating low quality care. During the pandemic, increased costs have placed nursing homes on the brink of collapse, prompting billions of dollars of federal aid.

Today, approximately 12 million people in the U.S. need long-term care. By 2050, that number is expected to more than double. The challenges of the pandemic present a unique opportunity for policymakers to evaluate how the long-term care system is failing, so as to better prepare for increased demand going forward.

In this weeks Saturday Seminar, scholars explore how regulatory failures contributed to COVID-19 outbreaks in nursing homes and provide potential avenues for reform.

The Saturday Seminar is a weekly feature that aims to put into written form the kind of content that would be conveyed in a live seminar involving regulatory experts. Each week,The Regulatory Reviewpublishes a brief overview of a selected regulatory topic and then distills recent research and scholarly writing on that topic.

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Long-Term Care After COVID-19 - The Regulatory Review