Time to Restructure?


Wired Magazine had an article about the failures of the nursing home industry during the pandemic. With the history of neglect and abuse, should the industry change? Is it time to restructure long term care? The failure to prepare and respond to infections and contagious diseases was reckless. The failures caused thousands of unnecessary and preventable deaths. Indeed, COVID has killed at least 93,000 nursing home residents and staff so far. Almost 40% of all confirmed deaths.

The article reminds us of some of the known problems. “People unable to contact their parents or loved ones; bodies piled up in makeshift morgues; nurses without protective equipment abandoning their posts; those who are still alive left alone in squalor for days. It’s not hard to see why the deadly pathogen hits these places hard.”

Infectious diseases have spread in these settings before. They will continue to spread in the future. Between 2013 and 2017, 82 percent of nursing homes in the United States were cited at least once for failures to prevent or control infections, according to the US Government Accountability Office.  That is ridiculous. As a Reuters investigation showed, nursing homes never even report many negative events.


Experts and other advocates are wondering if now is the time to restructure the nursing home industry. Residents are now more likely to be evicted to boardinghouses or homeless shelters to make room for those with higher Medicare payments. Meanwhile, industry lobbyists seek legal immunity while asking for billions in bailouts. Resist oversights and regulations that increase the health, safety, and well-being of the residents.

“Even before the pandemic hit, nursing homes seemed like an odd, collective compromise. Most American adults, in a survey …, said they wouldn’t want to leave their homes or communities as they aged—and most also didn’t envision that they’d ever end up doing so.”

Adapt is an organization calling for the elimination of most long-term nursing facilities. Disability advocate Alice Wong recently wrote, “freedom to live in the community is a human right.”  Advocates argue that residents often end up there not because they want to, but because they have no other viable or safe options. Adapt hopes that Congress will pass the Disability Integration Act which protects the right to live in the community.


“According to the CDC there were 15,600 facilities in 2016, about two-thirds of which were for-profit. According to one market research firm, the global long-term care business will be worth $1.7 trillion in 2027.”

David Grabowski is a well-known expert and professor of health care policy at Harvard Medical School. He proposes a restructuring of the nursing-homes industry. This will increase safety while being cheaper in the long run. The Money Follows the Person program has demonstrated that their overall Medicare and Medicaid expenditures drop by 20 percent. Home-based care is cheaper than nursing homes.

“We have been underinvesting in nursing homes for many years,” he says. “This pandemic has just brought this underinvestment into broader view.”

Instead of housing people in congregate settings, Adapt and other activists argue that better outcomes can be achieved by supporting people in small group homes of two to four people or, even better, by supporting them in place.

“Some envision the future of nursing homes as a kind of hybrid between Adapt’s at-home vision and the current large-scale institutions. “My hope is that the nursing home of the future is somewhere we would all be willing to go to if the need arose,” says Grabowski. “I would envision nursing homes that are smaller, home-like settings that are more resident-centered.”

It is time to restructure the industry to save the residents!