John O'Connor
John O’Connor

Almost exactly two decades ago, we saw a huge push to move residents from nursing homes into home-based settings.

Reasons for the sought-after adjustment were fairly straightforward: residents would prefer to stay at home, costs would go down, and those icky, icky nursing homes would be put out of business.

But a funny thing happened once the number crunchers started doing the math. It soon became clear that such a shift would actually increase long-term care costs. Not surprisingly, the plan was given a quiet, decent burial.

But that doesn’t mean that regulators, policy makers, consumers and other disgruntled constituencies have not continued to feverishly pursue nursing home alternatives. Usually, with similar outcomes.

Consider what’s been going on for the past six years. Federal and state officials have been aggressively giving people a chance to return to their communities through the Money Follows the Person demonstration program. More than 40 states are participating in this effort, which has already cost taxpayers $4 billion. As for the return on this investment: Fewer than 1% of eligible nursing home residents have transitioned out. Among the relatively few who have, almost all are younger people with disabilities.

Reasons for the program’s dismal failure vary. But they all lead to a hard-to-miss conclusion: It’s hard to leave a nursing home once you are admitted into one. By the way, that has less to do with the quality of nursing homes than the needs of residents who tend to land in them. Put another way, it can be very difficult for surrounding communities to ensure basic necessities, such as housing transportation food and social supports.

Yet nursing homes routinely provide these things and more, with minimal fanfare. In fact, to the extent that their efforts are pointed out, it often tends to be within the framework of a negative critique.

Which begs an obvious question: If nursing homes are doing such a universally lousy job, why aren’t other preferable options making them obsolete?

The answer is one that many people probably don’t want to hear. Simply put, nursing homes are the most efficient long-term care option that exists. And until this basic equation changes, talk about putting nursing homes of business will continue to be just that, talk.


John O’Connor is McKnight’s Editorial Director.