In a recent article published in AARP, FAMILY CAREGIVING Medical, the “experts” identified 10- steps to reform and improve nursing homes. Some of the key points of the article were not “new” to those of us in the trenches however it is interesting how it was presented. Here are a few things that the organization and experts think we need to do to improve long-term care:

• Require more registered nurses. In a perfect world I couldn’t agree more, the problem is finding RNs who are willing to take on the demands of caring for frail elders 24/7. Our world isn’t one of code blues, triage, ambulance arrivals, etc. but rather caring for the seniors who cared for all of us growing up. Providing a home for them that is comfortable, pleasant, provide socialization while meeting medical needs at the same time. Many RNs weren’t trained to do this or aren’t interested in caring for the same patients day-to-day.
• Partner with hospitals. In the past 10-15 years we have done a fabulous job partnering with our acute care neighbors. We have established ACOs and relationships where we can be unafraid to ask questions, approach sensitive topics, agree to disagree and at the end of the day, provide quality care. Could we do more? Sure, but take a bow and continue building those relationships!
• Improve infection control. There isn’t a nursing center in the country who hasn’t taken this challenge head on. Every single organization has trained infection preventionists, staff who have been competency checked and physicians practicing antibiotic stewardship. COVID is mentioned in the article as a concern and that we need to “stockpile” PPE. I remember acute care hospital running out of PPE as well! I say, manage your PPE, track and use a burn calculator to assist in ensuring adequate supplies and keep up the good work!
• Reduce isolation. The suggestion is that we expand virtual visits. Honestly, we have and continue to provide creative “visits” with our families and residents and most organizations have spent a lot of time, money and energy making it work. Isolation is a real health problem and our health care associations have gone to the government begging to have restrictions lessened to no avail. Again, I think we have done the best we could with what we had!
• Address funding. Nursing home industry groups are lobbying for legislation adjusting Medicaid reimbursement rates to fund what they say are the actual costs of care. A conservative back-of-the-envelope equation suggests it would cost another $15 billion a year. I can’t think of a better way to spend our government money, can you? Our work is physically and emotionally demanding yet the average wage is $13 per hour.
• Revamp the staffing model. The article isn’t clear on what the recommendations on this are as this section of the article continues to discuss wages and training requirements, not staffing models.
• Improve oversight and reporting. Per the article, the rules and regulations for operating a safe and sound long-term care facility are detailed and strict. The problem, advocates for nursing home residents say, is these laws and regulations are not strictly enforced. I am not going to comment on how strictly the regulations are enforced however I can say there is a lack of consistency. Maybe it is time to look at consistency versus punishment. If everyone knows they are on the same playing field the rules are easier to adhere to.
• Rethink ownership. “About 70% of nursing homes are for profit and many are part of large, complex and often opaque organizations”. Charlene Harrington, professor emerita and a nursing home researcher at the University of California, San Francisco said “regulate nursing homes like a utility so that we know exactly where the money goes, only a certain amount could go for profits and the rest would have to go for services”. Unlikely. There are two types of ownership in our nursing home industry, for-profit and not-for-profit. It would be difficult to dictate that all organizations operate under one type of ownership or the other.
• Provide more care at home. Nearly 1 in 8 nursing home residents were considered “low care” in a recent study at the Providence VA Medical Center in Rhode Island. This information is based on 2014 data from around the U.S. These residents needed some help with daily living but didn’t have complex medical or rehab needs and could independently eat, use the bathroom, stand up from a chair and get in and out of bed. I’m not sure that this sample of residents mirrors the typical nursing home resident today.
• Create smaller nursing homes. At 300 Green Houses in 32 states, just 10 to 12 residents live in a housing center and share an open kitchen, dining room and living room. Specially trained CNAs work exclusively in one house, making meals, doing laundry, socializing, helping residents pursue their interests and looking for early signs of health issues. This is a great concept and I don’t think anyone disagrees. One hurdle that many providers face is that many states have tight restrictions on the model and how it can be formalized.

I love that long-term care is getting much-needed attention and ideas now that we have hit a bump in the proverbial road however, we also need to be realistic and find a way to make some of these changes work in today’s environment. Stay the course, get vaccinated, mask up and stay tuned!