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What Can Be Done To Make Nursing Homes Safer


We've been looking into the many challenges that will still be facing the country under a new administration, and now we want to turn to the nursing home crisis. Moving a family member into a nursing home has always been a difficult decision for most families because of concerns, well-founded or not, about the cost, the distance or the quality of care.

But the coronavirus pandemic has added another layer of anxiety to all this. That's because about a quarter of all deaths from COVID-19 in the U.S. have occurred in nursing homes. And that's prompted new discussions about what can be done to make residents safer.

NPR's Ina Jaffe covers aging, and she's been reporting extensively on nursing homes during the pandemic. She says the challenges facing the long-term care industry vary depending on whom you ask and that nursing home operators say their biggest problem is money.

INA JAFFE, BYLINE: They get most of their income from the taxpayer through Medicare or more often through Medicaid. And what you'll hear pretty uniformly across the industry is that the government reimburses so little for Medicaid that nursing homes lose money on those residents. And they say the tight margins are a cause of the other complaints, from low staffing to lousy food.

Now the American Health Care Association, the trade group which represents mostly for-profit nursing homes, says with the additional challenges of dealing with the pandemic, many of their members are in danger of going out of business. So the group is asking the federal government for $100 billion for all health care providers with, quote, "a significant amount going to nursing homes." I should add that nursing homes have already received about $7.5 billion in federal aid as well as billions more in paycheck protection funds.

MARTIN: So apart from interest group representatives or trade group representatives, what do independent observers say has led to this terrible infection rate and death toll?

JAFFE: Well, even before the pandemic, the leading deficiency cited by nursing home inspectors was poor infection control. And if you want to get an idea of how serious this is, there are up to 3.8 million infections in nursing homes every year, leading to almost 400,000 deaths. That was before COVID.

Also, advocates for nursing homes will tell you that the facilities, especially for-proper facilities, are chronically understaffed. And there is growing research that shows that lower staffing levels and for-profit status are associated with more severe outbreaks of COVID-19.

MARTIN: So, as I said earlier, the decision to move a loved one to a nursing home was a decision that a lot of people made reluctantly even before the pandemic, so it has to be more difficult now. So are people in the industry talking about what could make nursing homes safer? Like, what are some of the ideas that they've come up with?

JAFFE: Well, one idea that's got a lot of currency now has been around for nearly 20 years. It's called the Green House Project. These are nursing homes with an emphasis on the home part of it. They're small, with maybe eight to 12 residents. That cuts down on infection spread. Everyone has a private room, which also helps control infection. And during the pandemic, Green House homes have been one-fifth as likely to have cases of COVID-19 as traditional nursing homes.

Of course, the small is beautiful philosophy means that nationally, there are only about 2,500 people living in Green House Project homes compared with about 1.3 million living in traditional nursing homes.

MARTIN: You mentioned research earlier that links low staffing to COVID outbreaks. What could be done to improve that?

JAFFE: Oh, this is something that factions have been warring over for decades. Federal law says nursing facilities have to have sufficient staffing, which is certainly something in the eye of the beholder. Some states have specific staffing minimums, but advocates think even those levels are too low. And last year, Congresswoman Jan Schakowsky of Illinois and Senator Richard Blumenthal of Connecticut introduced measures to create federal minimum staffing requirements for nursing homes.

But the American Health Care Association, the nursing home trade organization, warned that facilities could go out of business if forced to shoulder these additional costs. And they've successfully lobbied the Trump administration to ease regulations they consider burdensome. To give just one example, fines for substandard care have declined by about a third under the Trump administration. But advocates have fought these efforts, saying that the regulations are needed to keep nursing homes accountable.

MARTIN: That was NPR's Ina Jaffe.

Ina, thank you so much.

JAFFE: Thank you.

(SOUNDBITE OF LEX AMOR'S "PRAISES") Transcript provided by NPR, Copyright NPR.

Ina Jaffe is a veteran NPR correspondent covering the aging of America. Her stories on Morning Edition and All Things Considered have focused on older adults' involvement in politics and elections, dating and divorce, work and retirement, fashion and sports, as well as issues affecting long term care and end of life choices. In 2015, she was named one of the nation's top "Influencers in Aging" by PBS publication Next Avenue, which wrote "Jaffe has reinvented reporting on aging."