Applying the Lessons of the COVID-19 Pandemic to Improve Nursing Homes

When COVID-19 was first reported in the U.S. a year ago, few anticipated that we would soon be in the throes of a once-in-a-century pandemic. Tens of millions of Americans have contracted the virus, and over 500,000 have tragically lost their lives.

Nursing homes quickly became the epicenter of our global health crisis. The age and frailty of the people in our care made them primary targets for the virus, and lack of prioritization for critical resources at the outset resulted in tens of thousands losing their lives.

After a year of unprecedented challenges, few words can describe what the vaccines have meant to our residents and staff. They are truly the life-saving turning point we have anticipated for so long. We are thankful for the exemplary leadership of governors who recognized the necessity of putting long term care residents and staff at the front of the line.

Since December, new COVID cases in nursing homes have declined drastically. In fact, nursing homes nationwide are experiencing the lowest number of weekly cases since the Centers for Medicare and Medicaid Services began tracking data in May 2020. This means that many providers are now able to reopen their doors and finally reunite residents with their loved ones, who for too long have had to visit from a distance.

We have every reason to be hopeful, but we cannot yet close the book on this time in our nation’s history. There is still a crisis in front of us, and complacency risks erasing some of the progress we have made. We will continue to do everything we can to ensure every resident and staff member remain healthy and safe. In turn, we hope that our leaders and members of the public will do everything they can to keep community spread down during this time of transition.

It’s time to learn from the events of the past year and begin to rebuild. The pandemic is a watershed moment for nursing homes. Systemic issues that have existed within our sector for years have been magnified by COVID-19. Nursing home leaders, policymakers and stakeholders must work hand-in-hand to ensure that the tragedies we experienced never happen again – and that every older adult has access to the high-quality care they deserve.

We believe that reforms based on four core principles are needed to strengthen our sector.

We have seen the devastating effect a rapidly spreading and highly contagious virus can have on our residents. Clinical safety measures are essential — not only to prevent the spread of infectious diseases, but also to improve the quality of care we provide. We must enhance the role of infection control preventionists, as well as require a registered nurse on staff 24 hours a day in every nursing home. Personal protective equipment will continue to be a necessary precaution for the long term. Every nursing home should remain prepared and keep at least a 30-day supply, with the help of federal and state stockpiles.

Like all health care professionals, our front-line caregivers and support staff are the heroes of the pandemic. And we need more dedicated professionals ready and willing to serve the most vulnerable among us. The pandemic exposed long-standing staffing shortages that left caregivers stretched thin. We need innovative policies that will bolster our workforce, including loan forgiveness for new graduates who work in long term care and partnerships with community colleges and other educational institutions to train our valued professional workforce.

Oversight reform remains key. We must design and implement a more resident-driven model that focuses on improvement. Chronic poor-performing nursing homes must be improved or closed. CMS’ Five-Star rating system should include customer satisfaction, which will help consumers monitor each facility’s quality and empower choice.

Finally, we must modernize the places where we deliver care. The average nursing home is around 40 to 50 years old, and the traditional design is no longer conducive to providing person-centered care. We must look into what it would take to help nursing homes transition to more private rooms. Increased privacy will help residents to maintain autonomy and dignity, while also promoting infection control best practices.

These proposals require a significant investment. The majority of nursing home providers, who already faced pre-pandemic financial hardships due to chronic Medicaid underfunding, now face an economic crisis. Providers have spent tens of billions of dollars fighting the virus, and as a result, more than 1,500 may close this year. Without adequate resources from lawmakers, financial challenges and access to quality care will worsen. It is time to properly fund Medicaid, the primary source of coverage for nursing home residents. This will help nursing homes take necessary steps to ensure high quality care including supporting their workforce.

We must seize the opportunity at hand and apply the lessons we’ve learned – chief among them that prioritizing our nation’s older adults can save lives. With a growing elderly population, there will be increased demand for our services. For the sake of the millions of people we employ, and the millions of residents we serve, it’s time to focus on and invest in critical steps to strengthen our nursing homes.

We hope that the pandemic is soon in our rearview. As we look toward the future, federal and state lawmakers must commit to enacting meaningful change. Let’s work together to protect nursing home options for our seniors.


Mark Parkinson is the president and CEO of the American Health Care Association, the largest association representing nonprofit and proprietary long term and post-acute care facilities.

Katie Smith Sloan is the president and CEO of LeadingAge, the association of nonprofit providers of aging services, including nursing homes.

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