Design and Infection

Poor Design

As a nursing home lawyer, I have seen dozens of cases involving avoidable infections that lead to fatal sepsis. Poor design. Inadequate training. Insufficient staff. Poor infection prevention and control has been a problem in the industry for decades. It has gotten worse in the last couple of years. The COVID-19 pandemic has highlighted the limitations of the current system of nursing home care. Systemic failures in infection control, wound care, and personal hygiene are the norm now.

Several authors writing in the National Academy of Medicine publication NAM Perspectives argue that nursing homes will never be able to deal with another pandemic. The authors include John A. Hartford Foundation president Terry Fulmer, Milbank Memorial Fund president Christopher Koller, and Columbia University professor John Rowe.

They argue that the history of nursing homes in the U.S. and the current payment structures for care in these facilities is unsuccessful and fraught with abuse and fraud.

“Nursing homes were never, and will never, be equipped to deal with infectious disease outbreaks unless major changes are made, including redesign and payment reform,” Fulmer said. “These facilities and their dedicated workforce have borne the brunt of COVID-19 and need actionable solutions to prevent dire outcomes from continuing to happen.”

“This 1965 amendment created a cultural and economic preference for institutional long-term care,” the authors wrote. “The majority of nursing homes constructed as a result were with a distinctly institutional design — with double occupancy rooms — which has been an especially challenging factor during the COVID-19 pandemic.”

Alternative Settings

Many long-stay patients with pre-existing conditions do better in smaller facilities such as the Green House model. Smaller facilities saw much lower COVID-19 infection rates relative to the overall nursing home population. For that reason, the authors contend that residents need alternatives for appropriate settings including home-based care. They also advocate for increasing pay to a living wage. Increased training for caregivers is necessary. Safe staffing would solve many of the problems.

 “Despite these hurdles, the authors of this paper argue that the inadequacy of the current system has been put on display, and it is time to develop new strategies to better match the care provided with the needs of the varied subsets of the institutional long-term care population.”