Dr. El

With staffing shortages, reduced occupancy, the ongoing pandemic and other challenges, it’s a worrisome time for long-term care. A scan of trade headlines might even make one pessimistic about the future of the industry. 

Despite these difficulties, dedicated, thoughtful professionals — from LTC leaders to researchers to regulators to front line staff — are endeavoring to continue their mission to serve elders, knowing that the growing aging population will need us.

From my perspective after decades in the field, certain aspects of eldercare services require intervention from those in the position to effect change. Some on the list below have received attention recently, others perpetually, and some not so much, but I believe attending to these areas will contribute to success in the next few years and well into the future.  

  1. Become part of a continuum of care – Even before the pandemic, no one wanted to come into a nursing home (unless they had no home of their own). Since the pandemic, this sentiment has grown exponentially. For the financial health of the country, the emphasis should be on home-based care. For the financial health of the industry, facilities should be part of a continuum of care that allows participants to be admitted, discharged and to return as needed, while the continuum earns money for assistance throughout the process.
  1. Become part of the community – To ease fears about nursing homes, facilities should build on the fact that most residents or their family members are local citizens. Nursing homes could be more like community centers, with educational and recreational programs for elders, and educational and supportive programs for their families, so that the facility evolves from a dreaded possibility to a friendly, informative, comfortable place filled with familiar helpers. In other words, the kind of place it wouldn’t be so dreadful to move into if necessary.
  1. More single rooms than doubles – “Semi-private room” has got to be one of the worst euphemisms in the healthcare world. Double rooms, in addition to increasing the risk of transmitting infection, contribute greatly to the emotional distress of residents. Two words best sum it up: “sleep” and “dignity.” Modernized, livable nursing homes will have private rooms and, if possible, private bathrooms. 
  1. Financial transparency – It’s difficult for the industry to credibly argue for additional resources when the status of current funds is unclear. Increased financial transparency could weed out bad actors and allow others to procure necessary financial assistance.
  1. Increased Medicaid payments – A system based on paying rates that are below the cost of services will never add up. Maybe 2022 will be the year this problem is tackled.
  1. Capitation and value-based care – If I wanted to reduce costs within a capitated system, I’d increase the number of aides, improve their training and career ladder, and offer more end-of-life support to residents and families. Well-trained aides would catch changes in physical and emotional health before they become expensive medical crises. End-of-life education and support would reduce the frequency of unpleasant, futile, and costly medical procedures and make it more likely that residents would have a “good” death.
  1. Livable wages – As I pointed out here, livable wages help retain staff, and reducing turnover is the key to better, and more preventive, care.
  1. Family-centered care – In theory, we admit residents. In reality, we admit families. A system designed around this reality would provide more assistance to families as they navigate essential paperwork, shifting familial roles, end-of-life issues and transitions between providers and levels of care. For more thoughts on this, read “7 powerful ways to deliver family-centered care.” The aging care system will also need to find a way to address the needs of a growing number of residents without families to assist them. Investments in families (and care managers) will be recouped by improvements in care transitions.
  1. Enhanced mental health care – Mental health treatment under the current, fee-for-service model is inadequate for the needs of the system. Services should be offered not just for individual residents with diagnosable mental health problems, but also include supportive educational groups for residents and families, EAP services or open office hours for staff members, staff and team training, regular behavioral rounds, and ongoing consultation as required for the wide variety of organizational concerns that would benefit from a psychological perspective.
  1. Services for individuals with severe mental illness – As I wrote about in “Severely mentally ill residents: A ‘perfect storm’ creates a SNF wave,” this cohort has grown significantly over the years. These residents typically enter LTC following a brief medical crisis and, after its resolution, have difficulty finding community housing and services that can manage their concomitant mental and physical health needs. This relatively young population would be much better served in a less restrictive environment and one that isn’t designed for and filled with frail elders. 

Despite the many impediments on the road ahead, there are even more creative, compassionate people trying to overcome them. Working together, these challenges, while difficult, are not insurmountable.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.