A New Model of Nursing Homes Badly Needed

The entire issue of the December 2020 AARP bulletin is dedicated to multiple articles and perspectives on the horrific loss of life to COVID in the U.S. nursing home industry. And believe me, it IS an industry. Seventy percent of all skilled care facilities (the licensing nomenclature of ‘nursing homes’) are for-profits. 


While many researchers, experts, and workers in long-term care long saw it as a disaster, not just waiting to happen, but actually happening throughout their history, it took massive loss of life to get the journalists, politicians, workers, to put nursing home fatalities on the front page.

“Fewer than 1% of Americans live in long-term care facilities. But 40% of COVID-19 deaths have occurred there” (AARP.org/bulletin 12/2020). Within four months of the first known infection, some 54,000 residents and workers in long-term care facilities died of causes related to COVID.  

There is finger-pointing every which way. Lack of personal protective equipment, lack of availability of timely testing, too many residents per staff, poor infection control, and lock downs that kept long-term care ombudsmen from seeing what was actually happening.

Blame goes back to the 50s with misguided laws that ultimately made nursing homes, “The bastard child of the poor house and the hospital,” the late Rosalie Kane, Ph.D., revered expert on long-term care.

According to the AARP special edition, we wound up with a medical model of a crowded hospital, as opposed to, for example, a college dorm or a modest hotel. Forcing frail folks into small multiple-occupancy rooms with beds four feet apart is a petri dish for disease. If it were not for the pandemic, many people would not have foreseen the disaster predicted by experts for decades. In addition, one expects to spend a few days or at most a few weeks in a hospital. To live a life lacking in privacy, autonomy, and choice for months or years is cruel.

Many facilities have long been understaffed and underfunded. “For-profit structure appears to have reduced quality at many nursing homes.” The funding structure, with three-fifths of residents paid for by Medicaid, doesn’t make for a balanced budget. “The relatively small number of well-paying (private pay) residents make up for the money they say they lose on the rest.”

As I have ranted elsewhere, we needed a total transformation of long-term care into one that is person-centered, affordable, homey, and respects individuals, caregivers, and families. 

Published by jeannettefranks

Jeannette Franks, PhD, is a passionate gerontologist and for over 20 years has taught ethics, grief and loss, and courses on geriatrics and gerontology for the University of Washington. Franks' most recent book is, To Move or To Stay Put: A Guide for Your Last Decades. Look for it now on the University Bookstore website http://www.bookstore.washington.edu/home/home.taf? It is also available at Eagle Harbor Books on Bainbridge. Franks previously published a definitive guide to independent and assisted living titled Washington Retirement Options, and often speaks on retirement options, disability issues, end-of-life issues and is an advocate for accessibility. She has a goal of making Bainbridge an elder-friendly community and is available to groups and families to discuss these issues. She served for nine years on the Kitsap County Advisory Council on Aging and Long-term Care. She also has the privilege of working in a small way for the past 15 years with the Suquamish tribal elders.

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