Liza Berger

Crises have tendencies to expose fault lines. This pandemic has been no different.

Take long-term services and supports. The cracks were there, but it took a massive emergency, i.e., COVID-19, to lay them bare, suggests a recent blog post in HealthAffairs written by the The SCAN Foundation’s Bruce Allen Chernoff and Cindy Mann.

What are those underlying weaknesses in the system, according to the article? The underfunding of long-term care, which has led to outdated facilities in which older and frailer people reside; underpaying facility workers, who tend to be people of color and who have suffered disproportionately from the virus; and weak oversight of facilities in the area of infection control.

The solutions for the policymakers, according to the authors: Most immediately, isolating COVID-19-positive residents, improving workers’ wages, and creating a testing plan for residents and staff. More transformative moves entail improving oversight of facilities to promote transparency in ownership; creating smaller facilities, i.e., the Green House Model; and overhauling the funding system for long-term care so facilities are not at the mercy of the unsustainable Medicaid model.

Some pretty lofty ideas and not so new ones, those in the field know all too well. Criticism of funding and oversight have dogged the nursing home field for decades. One argument has been that no one in Congress wants to take them on because they are, frankly, too big to tackle and there are no quick fixes.

Will this time be any different?

“COVID-19 didn’t create the challenges facing the provision of LTSS, but it did expose them in harsh and compelling ways,” the authors say.

When the dust settles, it may well be that fundamental change is closer at hand than at any point in history. After all, what are crises for?

Liza Berger is senior editor of McKnight’s Long-Term Care News. Follow her @LizaBerger19.