This is a painful, sober article to write. I have for a long time felt like nursing homes were unfairly being targeted. But as I watch the surge of infections and deaths in nursing homes, I find myself wondering if nursing homes need to go the way of shopping malls, Blackberrys, fax machines, electric typewriters, and so many other things that are no longer relevant.
This really hit home this weekend while talking with a friend who works in a rehab department of a relatively high-end nursing home who has contracted COVID-19. This is in spite of doing all the things they are supposed to do. Her husband is showing symptoms and awaiting test results. Fortunately, their symptoms are fairly mild.
If it were just her, maybe no big deal. But something like 80% of the staff, including those in the kitchen, have tested positive. As well as many, many residents. The problem is twofold: too many people in a small space for long periods of time, and team members working in multiple locations.
The current building design and systems mean this is a near-impossible problem to fix.
Zero Nursing Homes?
I am not bold enough to suggest we should go to zero nursing homes. It is clear there is a small subset of older people who need more medical intervention than assisted living communities (or something else) can provide. These individuals fall into two categories.
- Those who are discharged from the hospital with significant rehabilitation needs. High-end rehab nursing homes are doing a great job of serving these individuals. Their stays tend to be a few days to a few weeks and are a lower-cost (and safer) alternative way for people to get better.
- Individuals who have a high level of medical/nursing needs that can only be provided on an ongoing basis in a more medical setting than is appropriate for assisted living.
The fundamental problem we face as a nation is that nursing home economics require cramming as many residents into the bare minimum of square feet. And this means cramming as many team members into that same space.
A Better Model
Perhaps what we need is a brand new model that is mostly assisted living with a little bit of nursing home rolled in. It would have to include government payment and sensible regulation, which is not what we have today.
The Cost Factor
It is near impossible to know what it would look like if thirty, forty, or fifty years ago we had, as a nation, taken eldercare seriously. If we had said CNAs deserve to be paid as much as postal carriers. While I am not meaning to say anything negative about postal carriers, I think it is safe to say that being a CNA is a tougher, more skilled job. Yet postal workers get a living wage, plus health insurance and a pension. This is not true for most CNAs.
And while CNAs technically work for private organizations, in truth the bulk of the money that pays their wages comes from the government.
The Chickens Have Come Home to Roost
We are paying the price for the system we have created. So many infections, so many deaths, so much misery, and if we are honest, a financial disaster for the nation. This is not the operators’ fault. Most operators have done an amazing job given the resources they have at their disposal. They need the first crack at this new thing that actually honors our elders.