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Nursing Homes Need RX

Across our country, hundreds of thousands of people live in nursing homes, known as skilled nursing facilities (SNFs), not because they need specialized care or want to, but because Medicaid payment rules make that the only housing they can afford that gives them the daily living care that they need. Unfortunately, many of these residents died from COVID-19 at rates far in excess of the general population due to pandemic rules dictated by uncaring politicians.        Nursing homes serve two very different populations. One requires short-term, post-acute rehabilitation services following surgical procedures like joint replacement. The other are long-term residents, most of whom need only basic daily living care, and most of whom would rather be living in their own communities among friends. With nursing homes struggling to serve these different populations, the whole business model has come under scrutiny. Major projects to study the quality of nursing home care have been launched by the National Academies of Sciences, Engineering, and Medicine, AARP, and the Convergence Center for Policy Resolution.

The goal of these studies is to come up with a way to enable people to age in their own homes and communities. This will enable nursing homes to focus on treating those who really need institutional care. It will require changing the coverage rules for health insurances, especially Medicare and Medicaid.

We are seeing several innovations that are helping people remain in their homes. The senior village movement is one model that uses a network of supportive volunteers to help with needs like shopping, transportation, and physician visits. Another model is the CAPABLE program that uses teams comprised of a nurse, occupational therapist, and handyman to help older individuals achieve functional goals. The Hospital at Home program and the SNF at Home model are beginning to provide post-acute care at home. Some developers are designing healthy villages, transforming once-failing hospitals into hub-and-spoke networks of medical and support services for home-based care. Finally, advances in smart technology are making it easier to monitor the medical and safety status of older people in their homes.

Home-based services are expensive, forcing many people into nursing homes against their preferences once their funds are depleted and they have no other choice. Even so, Medicaid pays only room and board costs in nursing homes and covers home- and community-based services only for those with intellectual, developmental, or physical disabilities. Ultimately, the goal is to expand home-based care and pare back nursing homes. Some experts are advocating extended care wings in hospitals as an alternative to sending so many post-acute care patients to nursing homes.

Adjusting Medicare and Medicaid rules will lead to better quality of care than exists now, plus it will lead to savings for both plans. There is also a push to have Medicare Advantage plans cover nonclinical services. Ideas include integrating long-term-care insurance into Medicare Advantage and employer-sponsored insurance plans and reducing the cost of private coverage by limiting the risk to insurers of high and uncertain future payouts by capping those payouts through a federal “catastrophic” program. A version of the latter is being prepared as legislation by Rep. Thomas Suozzi (D – New York). In short, our cherished seniors deserve better care than what is currently available.

Questions and comments may be sent to editor@rockawaytimes.com.

By Peter Galvin, MD

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