Nursing home advertising often paints a rosy picture for seniors: “Live in brightly polished, restful communities while licensed care providers monitor your every need.” Reality can be a different story. As the COVID-19 pandemic has made abundantly clear, too many nursing homes are culpable for disease, inefficiency and neglect. Over 35% of the deaths caused by COVID-19 have occurred in long-term care facilities, and that number may well be underreported. You Should Know what happened and what is being done to address this national crisis.

Nursing Home Residents, Staff Hit Hardest by COVID-19

Last year, mild panic turned to full-blown fear as the spread of the deadly coronavirus overcame the nation and the world. The disease moved with lightning speed, hitting the most vulnerable communities with fatal consequences. And no community was battered more than nursing homes. Residents and staff were lost in stunning numbers, exposing how fragile an already crumbling system really was.

Some numbers from the American Association of Retired Persons (AARP):

AARP estimates more than 170,000 residents and staff of long-term care facilities have died from COVID-19
Even though less than one percent of America’s population lives in nursing homes, 35 percent of COVID-19 deaths are tied to these facilities
94% of U.S. nursing homes have reported at least one confirmed COVID-19 resident infection

COVID-19 Lays Bare Facility and Governmental Failures

The signs were there. The warnings were there. In February of 2020, 22 percent of Chinese patients who died from coronavirus were over 80 years old. The World Health Organization implored other countries to take swift action to protect elderly populations. But lack of proper protective equipment, poor infection control and negligent oversight on behalf of state and federal regulators meant that the virus soon began its deadly siege. Across the nation, devastated loved ones watched as their elderly friends and family passed away, often alone. Advocates and researchers are just now starting to fully understand how the system failed so many residents and staff members at long-term care facilities. Some examples:

In Minnesota, an analysis of federal health records found that 70% of Minnesota’s nursing homes have been cited for lapses in infection control over the past four years.
New York Governor Andrew Cuomo and his aides rewrote a report to hide the number of nursing home deaths in New York.
Nearly one-quarter of Pennsylvania’s 692 long-term care homes are not consistently self-reporting cases or deaths as the state has ordered. Some facilities have not reported data since June.
Nursing homes with majority ethnic minority residents have seen triple the COVID-19 deaths compared to facilities with majority white residents.

What Does the Future Hold?

The COVID-19 pandemic is of course not over yet, but fortunately the number of cases and deaths are dropping sharply, including at long-term care facilities. A report by the Coronavirus Commission for Safety and Quality in Nursing Homes was published in September. The commission was made up of doctors and healthcare professionals across the nation, and includes both an account of the failures of the nursing home system during the pandemic and what can be done to prevent disaster in the future.

One of the commission members is Dr. David Grabowski, healthcare policy professor at Harvard University. He points to systemic problems such as low Medicaid payments, inadequate pay for staffing, an ineffective regulatory model, lack of transparency and fragmented ownership structures as among the key reasons for the explosion in pandemic-related cases and deaths at long-term facilities. “COVID-19 has revealed the fragility of nursing homes’ business model and our underinvestment in high-quality, long-term care,” said Grabowski. The commission report provided 27 recommendations and over 100 action items for the Centers for Medicare & Medicaid Services, including:

Smaller nursing home settings
Increased number of clinicians on-site
Stronger minimum nurse and nurse aide staffing standards
Better enforcement and quality improvement through regulatory reform
More investment in Medicaid home- and community-based services instead of large nursing homes