Nursing homes should be mandated to employ more registered nurses and create smaller living communities, say seniors advocates investigating ways to improve the industry in the wake of the COVID-19 pandemic. 

A report released Wednesday by the AARP features 10 steps on how the country’s long-term care system can become “healthier and more stable in the short-term, and ultimately more inviting and responsive” for residents.

Along with increasing staffing levels, the report suggested that nursing homes should begin partnering with local hospitals in order to have additional support for preventing deadly disease outbreaks. Advocates added that additional mandates for nursing homes should also focus on improving infection control and ensuring that facilities have the means to help reduce isolation among residents. 

“Social isolation has been a mental and physical health problem in nursing homes long before COVID-19,” says Bei Wu, director for research at the Hartford Institute for Geriatric Nursing at New York University.  “Any plan for improving nursing home quality of care has to address isolation.” 

The report also stressed the need for the federal government and operators to reexamine business approaches. This would include addressing the chronic lack of Medicaid funding for providers, revamping the staffing model and salaries for workers, improving the oversight process for troubled providers, and revisting ownership requirements. 

“Regulate nursing homes like a utility so that we know exactly where the money goes,” said Charlene Harrington, professor emerita and a nursing home researcher at the University of California, San Francisco. “Only a certain amount could go for profits, and the rest would have to go for services.”

The AARP analysis also detailed the need to push for more home care and creating smaller nursing homes that resemble a homelike environment. 

“COVID-19 rates have been far lower in small nursing homes,” said Susan Ryan, senior director of the Green House Project. “All the features that make them a great place to live also make infection prevention and control easier.”