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Top National Researcher Sheds Light on COVID-19 Crisis in Skilled Nursing Facilities and Challenges Us to Envision New Solutions

Vincent Mor of Brown University PHOTO: Brown University

The COVID-19 pandemic has highlighted grave challenges in the nation's nursing homes, and long-term care for seniors is facing a crisis. The infection and mortality rates in nursing homes are staggering, but Dr. Vincent Mor, a Brown University School of Public Health professor and author of over 40 NIH-funded research papers on health services and aging, has both short-term recommendations and a long-term solution.

In two webinars hosted by the Jewish Healthcare Foundation (JHF) in partnership with the Pennsylvania Health Funders Collaborative, Dr. Mor reported it wasn't the staffing levels or quality rankings that determined the number of COVID-19 cases in U.S. nursing homes. Rather, based on Dr. Mor's research, the spread is affected more by the facility size and community prevalence due to the virus' characteristics. Simply put, nursing facilities faced a perfect storm of an opportunistic virus, a vulnerable population base, resource shortages born of years of underfunding, and current policies that favored an acute care focus over all other settings. The results have been, and will continue to be, devastating to the residents of long-term care, their staffs, and the sector as a whole.

The webinar series, attended by leaders from skilled nursing facilities (SNFs) and advocacy associations, allowed participants to collaborate on short-term and long-term responses to the current crisis.

In the first session, the group discussed the urgent need to implement strategies to protect Skilled Nursing Facilities and the frail seniors that they are caring for during this pandemic. SNFs and long-term care facilities were not adequately prioritized for PPE or testing, and the burden of paying for and acquiring those resources was overwhelming. In addition, policies that prioritized the needs of hospitals over SNFs were endangering seniors. Though the PA Department of Health recently announced testing for nursing home residents and staff, there is still room for improvement to make sure that the residents and workforce in long-term care are protected.

Providers called attention to their staff's need for increased and continued support as testing is implemented, especially given the broad marketplace of testing options. Nursing homes already experiencing staff shortages could face additional challenges, as testing may identify many asymptomatic staff cases and send more staff home temporarily. Residents, families, and staff need the assurance that patients must test negative before they are admitted from hospitals, and nursing home leaders need the assistance of infectious disease experts to manage the spread of COVID-19. Dr. Mor recommended that facilities' infection protocols be enhanced even as the pandemic plateaus. 

Some of the participants during the second webinar on May 28, 2020

A May 22, 2020, JAMA article co-authored by Dr. Mor and David C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School, states that COVID-19 has exposed long-standing issues in how nursing home services are structured and financed.

That longer term challenge to long-term care was the focus of the second webinar on May 28th. Dr. Mor's comments focused on envisioning new long-term solutions to how and where seniors live and are cared for, and how those potential models could be financed. Those who participated recognized that COVID-19 exploited the weaknesses in long-term care and exposed the imbalances of the current system that care for seniors.

Skilled nursing facilities are at a crucial juncture. Without a radical redesign of everything from their physical structures to staffing and payment models, more and more SNFs will be faced to make strategic decisions, including closing their doors. This will leave seniors and their families with few viable options for their care when they need it most.

Under the current scenario, the competition for resources at the state-level will only intensify and will pit the needs of seniors against the needs of the education system, maternal and childcare, prisons, etc. Absent new models of senior living and care, including new collaborations with health systems who could provide for the complex healthcare needs of frail seniors, long term care facilities will face an existential financial crisis going forward.

For over 25 years, JHF and its aging and long-term care team have been active in efforts to improve policy, care, payment and delivery systems for frail seniors. We have been engaged in efforts to reduce the comorbidity of hospitalizations, reduce readmissions, advance palliative and end of life planning and care, improve supports for persons with dementia and their caregivers, and test new workforce training models for long-term care settings, including SNFs, home and community based care, and LIFE (Living Independently for Elders). We have come to appreciate the challenges that families, seniors, providers and policymakers face in developing and scaling affordable models of quality housing, care and engagement for this growing segment of our population.

The webinars led us to ask the following questions: What could the future for long-term care for seniors look like if we thought beyond incremental change or a temporary financial boost to a broken system? How could we create and test a comprehensive model that integrated payment (federal, state and private) and quality of care, while assuring the availability of creative, complementary social and supportive care? How can we redefine the current model that separates the roles and payment of hospitals and SNFs, to create a new model that takes advantage of the strengths of each? Can we test a population health model to care for seniors in which traditional acute care systems assign medical teams to bring clinical and rehab care to long-term care operators who would provide the ongoing daily services and housing options? How do we create models of senior living that we would want to live in ourselves, and that we would be proud to fund with our private and public dollars?

Attendees affirmed the need to address reform and to do so quickly, as leaders echoed conversations they've had with other nursing home executives across the country about impending bankruptcy. In addition to creating the short-term crises that threatens the health of residents and staff, COVID-19 has highlighted the need to accelerate solutions for the broader planning and funding crisis facing many of the nation's nursing homes and the seniors and families they serve. Time is running out to save these critical organizations, and to commit to designing the senior living systems that can address the housing, health, social and supportive care our growing senior population deserve. The time is overdue to prioritize long-term care reform on both the state and the federal agendas.

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