The Future of Long-term Care in a Post-COVID World

elderly man wearing mask with health care professional pushing him in a wheelchair

It has been more than a year since COVID cases began to be reported in the United States. During that time, we’ve endured lockdowns, quarantine, job loss and tragic deaths as we continue to learn more about the coronavirus. 

The elderly population has been hit particularly hard during the pandemic. Since the first major outbreak of COVID, which happened at a nursing home in Kirkland, Washington, we have seen policy changes put in place to protect our elderly and our long-term care institutions. 

We spoke with two experts in the field of healthcare management to learn more about where we are now with long-term care and what we have learned for the future. 

Impact of COVID on Long-Term Care Patients

According to the New York Times, 5 percent of all COVID cases in the United States and 34 percent of deaths have come from nursing homes. At least 172,000 COVID deaths have been reported among residents and employees of nursing homes and other long-term care facilities. 

Neeraj Dayama, PhD, is an assistant professor of Healthcare Management and Leadership in the TTUHSC School of Health Professions. He is quick to remind that “nursing homes” is a very broad term that covers a wide range of retirement living. Counting these less-traditional facilities, he is certain the death rate is even higher than what’s being reported. He explained that larger nursing homes located in urban areas and facilities with a greater percentage of African-American residents are more likely to have higher COVID numbers than others.

The effect that COVID has had on elderly patients in long-term care facilities cannot be ignored. 

“It’s had a large impact on elders, especially those with great cognition status,” said Morgan House, PhD, LNHA, assistant professor and former director of TTUHSC’s Healthcare Management Department. 

“Residents are like you and I,” she continued. 

House explained that the mental and emotional toll that all of us feel while in quarantine is no different than what the residents of nursing homes have endured during the pandemic. Their routine has been drastically altered: They’re no longer able to receive visitors or take their regular trips out for groceries, entertainment and exercise. 

House and other healthcare professionals are now dealing with mental declines in the elderly as a direct result of COVID and the lack of normalcy for long-term care facilities.

“There were mental cognition declines and mental issues because of the quarantine,” she said.

Impact of COVID on Administrators and Staff of Long-Term Facilities

The COVID pandemic has affected the administration and staff of long-term care facilities in many ways. House summed it up: 

“We don’t know what we don’t know.” 

She explained that there has always been a risk of infectious disease in nursing homes, but the slow rollout of personal protective equipment (PPE) and difficulty getting supplies was not expected or budgeted for by many facilities.

Another fallout from COVID has been the negative effects on the staff of long-term care facilities. 

“Nursing homes are grappling with how to retain adequate staffing while making operational changes to ensure the safety of workers and residents,” Dayama said. 

The pandemic has imposed greater demands on nursing home staff in order to reduce transmission and contain the spread, he explained. But this has led to burnout because of staffing shortages, increased workload and the emotional burden of caring for isolated patients. Dayama is seeing many attempts by long-term care facilities to retain staff, including bonuses, increased wages and more hiring to lighten workloads and schedules. CMS, the primary regulator of nursing homes, also relaxed their licensing, credentialing, and training requirements address this shortage. He predicts that these relaxations will continue in the short to medium term. 

Impact of COVID on Administrative Costs for Long-term Care Facilities 

House and Dayama agree that the three biggest cost increases to long-term care facilities have come from supplies, increased employee hours and a decrease in facility occupancy.

“Nursing homes leave very little room in the budget,” House said. This means that a catastrophe like COVID most-likely would not have been planned for. House said that costs have increased tremendously during COVID, including supplies, lab work and testing. The cost of supplies for some nursing homes went up 100 percent due to the lack of PPE and infection control supplies, she explained. And, while these costs were going up, occupancy rates went down by about 100,000 residents, according to Dayama. 

“Some reports suggest that estimated revenue loss to the nursing-home industry due to the pandemic was $57 million,” he said.

In addition to the increased costs for PPE and supplies, long-term care facilities are enduring increased labor costs as well. The pandemic has required more staff working more hours, which means paying overtime wages. 

Dayama pointed out that, because nursing homes were closed during the pandemic, hospitals weren’t able to send patients there for recovery. Instead, there was no choice but to keep patients in hospitals for extended periods, which is considerably more expensive.

“Providing post-acute care for patients at hospitals is costlier than at nursing homes,” he explained.    

Long-term Care After COVID

While changes are inevitable, it’s difficult to predict exactly what the future of long-term care will look like. Dayama pointed out that roughly two-third of nursing homes are for-profit. The pandemic has brought about closures and bankruptcies among these for-profit facilities, and there will likely be many more. Restructuring is imminent and necessary. 

Dayama believes COVID has proven that nursing homes can benefit from partnering with hospitals. 

“Nursing homes tied to hospitals are better able to manage geriatric care, telemedicine, getting support from senior hospital leadership and administration,” he said. “We might see more of this in nursing homes moving forward.” 

He also believes there should be major policy renovations to achieve greater transparency and accountability on for-profit and chain affiliated facility owners. 

When looking at the future, House said, “We are still embarking on change, we just don’t know what that change will be.” The paradigm is shifting, giving administrators more of a responsibility to know what to do. As an educator, House tries to train her students to plan for the what-ifs. 

“Flexibility is important, but it’s hard to be flexible in one of the most regulated industries in the U.S,” she stated.  

The Heroes of the Pandemic

The pandemic has shown many deficiencies in the state of long-term care in this country, but we have also seen heroism and progress. The heroism comes from the staff who are on the frontline battling the pandemic. And while there have been a tragic number of deaths, there have also been many patients who have recovered in the care of long-term facilities. 

House asked us to remember that, of the approximate 640,000 confirmed resident cases, there have been 1,600 staff deaths. 

“Each one of them deserves a parade,” House said. 

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