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It’s No Place for Mom: Time to Rethink Senior Living

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Richard T. Moore
May 18, 2020

 “Grow old along with me. The best is yet to be. The last of life for which the first was made.” When Robert Browning penned those lines in 1864, old age was treated differently than it is today. Before there were nursing homes, rest homes, independent living and assisted living residences, elderly often lived with their families. Of course, at that time, 50 years was the life expectancy. Adult children were not all working, and one spouse, usually the wife was home. Today, economics often requires both to work and thankfully, women have more work opportunities.

Nevertheless, long-term care has become a big industry in the United States. The United States long-term care market size was valued at USD 443.2 billion in 2019 and is expected to register a CAGR of 6.8% over the forecast period. Demand for long-term care (LTC) has increased, owing to the recognition of unmet needs of the elderly, which are not fulfilled by hospital settings. According to estimates of the U.S. Department of Health and Human Services (HHS), around 69% of the United States population will require long-term care services in their lives for an average of about three years, thus impelling the demand for long-term care services in the region.

This year, the COVID-19 Pandemic has tragically exposed major flaws in the design of long-term care in America; the insufficient financing, the shortage of staff and the lack of adequate infection prevention, even basic cleaning. Writing on April 11, 2020, in Business Insider, Aaron Holmes reported, “Thousands of nursing home residents have died of COVID-19 across the US and nearly 2,500 nursing homes are facing outbreaks, according to separate reports from NBC News and The Wall Street Journal.” Holmes further noted that, “Nursing homes across the United States are struggling to contain outbreaks and are desperate for access to testing.”

Howard Gleckman, a Senior Fellow at the Urban Institute and author of, “Caring for Our Parents,” writes in an April 8, 2020 article in Forbes Magazine, “COVID-19 has exposed and amplified our profoundly flawed system of caring for older adults and young people with disabilities. We now have an historic opportunity to fundamentally rethink how we care for those frail seniors and provide the financial resources needed to make it work.”

“Nursing homes have been hit especially hard by coronavirus in recent weeks, with cases increasing so rapidly that some nursing homeowners have instructed families to take their loved-one’s home, if possible.” Holmes reported in that Business Insider 4/11/2020 article.

Harvard Professor of Health Policy and long-term care expert, David Grabowski, says of the long-term care system, “We get what we pay for.” Long-term care is funded by state and federal governments through Medicaid, which is inadequate for seniors’ needs and which can only be used in nursing homes. Even long-term care insurance, which is usually expensive, doesn’t provide enough help for the few who can afford it.

Even if families are willing to care for an elderly relative at home, as most state Medicaid programs permit, Gleckman points out, “Families receive too few hours of supportive care, care workers are paid less than a living wage, and states often mask their limited home care benefits behind waiting lists that can last as long as 2 or 3 years

Those who operate nursing homes fight any meaningful reform, and in the current COVID-19 crisis only want liability protection and a federal bailout. This won’t make life better for the elderly residents or their families. Any bailout should be targeted at increasing staff salaries and for protective equipment such as masks, gloves, gowns, etc. If it is not restricted, operators, especially those in for-profit homes, will keep the money for themselves and neither staff, nor residents will have their lives improved or made safer.

Before the President or any governor declares, “Mission Accomplished,” in the “war” with the coronavirus, national, or at least state level, investigations need to occur to improve long-term care. Both the funding and the delivery models need major overhaul. In the meantime, nursing homes need to significantly increase testing of residents and staff.

As Bernard Condon and Randy reported in The Huffington Post, “Dr. Deborah Birx, who leads the White House coronavirus response, suggested this past week that as more COVID-19 tests become available, nursing homes should be a top priority. We need to really ensure that nursing homes have sentinel surveillance. And what do I mean by that? That we’re actively testing in nursing homes, both the residents and the workers, at all times,” Birx said.

AARP is among the leaders in calling on the federal government to address the critical needs of seniors. They are, “Calling on Congress to act quickly on a number of pressing needs, including protecting residents of nursing homes and other care facilities, expanding food assistance for the most vulnerable, and helping state and local government close budget gaps,” said Nancy LeaMond, AARP Executive Vice President.


Author: Richard T. Moore has served in both elective and appointed public office at local, state, and federal levels of government. He served for nearly two decades each in the Massachusetts House and Senate, as well as being chosen as President of the National Conference of State Legislatures. He also served for a time as President of the Massachusetts Assisted Living Association. Mr. Moore is a long-time member of ASPA serving terms as Massachusetts Chapter President and National Council member. His email address is [email protected]

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