Experts describe America's nursing home system as 'ineffective, inefficient, fragmented'

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The COVID-19 pandemic exposed issues in America’s nursing home system that had plagued it for years, with some experts warning that the current situation is ‘ineffective, inefficient, fragmented, and unsustainable’.

A report published this week by the National Academies of Science, Engineering, and Medicine (NASEM), based in Washington D.C., cites massive underinvestment in nursing homes for decades, along with a lack of accountability and oversight for the issues plaguing the industry.

Nursing homes were struck hard by COVID-19 in particular, especially early in the pandemic, with nearly 150,000 residents dying from the virus.

The issues are much deeper than the pandemic, though, and NASEM warns that the current situation is doing a disservice to elderly Americans that may require this kind of care.  

‘[The system] is ineffective, inefficient, fragmented, and unsustainable,’ the team who wrote the paper said.

As of February 2022, the time NASEM researchers gathered data, 149,000 nursing home residents and over 2,200 staff members had died from Covid.

These figures could be undercounts as well, with states like New York and Michigan both embroiled in controversy over the reporting of nursing home deaths early in the pandemic.

The already existing issues in nursing homes likely exacerbated the pandemic situation, and could have even caused more deaths among the residents.

A major issue is staffing, which has been a universal problem for much of the medical field for years.

The NASEM team reports that many of America’s over 15,000 nursing homes are hiring unqualified staff at low numbers.

Pay and benefits is poor as well, making it hard to attract and retain quality employees. Those who are hired are often inadequately trained.

‘Workers in nursing homes are often underappreciated, undercompensated, and underprepared for their roles in providing increasingly complex care,’ researchers wrote, as reported by JAMA.

‘Decades of evidence support the need to enhance their training, salaries, and working conditions, yet little progress has been made to improve the quality of these jobs.’ 

Many of these nursing homes receive federal funding through Medicare and other programs, but a lack of transparency and oversight in how those funds are used leads to severe mismanagement and corruption at the top levels.

‘Underinvestment in ensuring the quality of care and a lack of accountability for how resources are allocated,’ NASEM blamed for the issues.

These issues came to the forefront during the pandemic, where the highly vulnerable residents of many American nursing homes were not given adequate protection from the virus.

The writers of the report point to research from 2016, which finds that nursing homes’ top deficiency was the lack of preparedness for dealing with infectious disease.

In order to fix this dire issue, NASEM writes that new protocols and more oversight needs to be put in place for any facility that receives funding through Medicare.

First, they recommend that each have an action plan as to how they would properly deliver patient care that is reviewed quarterly. Plans for medical, psychosocial, and behavioral health needs must all be outlined within the review.

They also call for nursing homes to be renovated, first to upgrade facilities, but also to build housing that allows for more social distancing incase of a future pandemic. 

The biggest onus falls on the federal government, though, who must step up the oversight of nursing homes to make sure that they are properly delivering patient care, and the funding is not being misused.

NASEM also calls for the Centers for Medicare & Medicaid Services to step up its enforcement of regulations related to nursing homes, and punish nursing home owners guilty of mismanagement more harshly to prevent future issues from occurring. 

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