During the past year of the COVID-19 pandemic that we have been enduring, nursing homes have frequently been in the news because of the high rate of infections in many of these facilities. This has occurred despite the best efforts of staff to keep the virus out of their buildings. These efforts include testing staff for COVID twice a week; wearing masks, face shields, gowns and gloves when interacting with residents; frequent hand washing; and keeping all visitors out of the facility. Despite all these measures over the past year, the virus has frequently managed to creep in and then spread quickly among the frail elderly residents.
It has been well-documented over the past year that the COVID virus spreads quickly in ANY setting where people are living close together, including college dormitories, apartments and houses where families have been forced to share living quarters because of eviction due to job loss, and even correctional facilities. The fact is that it does not have to be this way for the elderly. Elderly people are often forced to move into a nursing home when they can no longer take care of themselves because they have no other option.
As a geriatrician and attending physician at a local nursing home for many years, I have heard over and over from patients, “I’ll die before I go into a nursing home” or from family members that “She made us promise not to put her in a nursing home.” Rarely does anyone WANT to go into a nursing home; we would much rather be in our own or a family member’s home. But the current payment system for elder care usually gives them no option.
Many people assume that Medicare, the federal health insurance program for Americans over the age of 65 and for the disabled, pays for nursing home care. The truth is that the program pays only for a few weeks of rehabilitation care, such as after an operation or an extended hospital stay. This allows the patient to receive physical and occupational therapy and skilled nursing care, overseen by a physician, as they get stronger and heal, with the eventual goal of returning home. Once recovery has occurred but the patient is unable to live independently, Medicare stops payment and one has to pay the nursing home bill out of pocket.
Very few Americans can afford to purchase insurance to cover long-term care, so they must deplete their savings to pay the bill. Once they have impoverished themselves, they can then apply for Medicaid, the federal health insurance program for the poor. Medicaid pays for the majority of nursing home residents in this country.
The solution to this problem is simple: Reform Medicare so that it pays for home care. Most of the residents of nursing homes in the United States do not require skilled nursing care; they need someone to be with them 24 hours a day to help them get to the bathroom, change their clothes, prepare their meals, give them their medications and in cases of dementia, prevent them from wandering away.
Unfortunately, only those people with long-term care insurance or a great deal of money can afford this service. Family members often provide this care, but frequently their own health suffers as they are “on call” around the clock. If we could keep these older Americans at home, they would be exposed to far fewer potentially infected people and be less likely to contract a disease that could kill them. The current viral pandemic will eventually fade away, but our recent experiences with the zika, ebola and SARS viruses make it inevitable that there will be another.
My own parents had insurance and adequate finances to pay for 24-hour care at home for the last few years of their lives and I am forever thankful that they did NOT have to be in a nursing home for those years. We should make that care available to all Americans so they can live out their days in their own homes, surrounded by family and friends, and cared for safely by trained home health aides and nurses.
Dr. Benjamin Friedell is medical director of Oneonta Family Practice.