ALBANIA – Nursing homes of the near future may look less like hospital complexes and more like small, cozy houses with eight or ten residents. This includes sanitary “safe rooms” for family visits and the use of robotics and drones indoors experts across the country.
They said the staggering death toll from COVID-19 in nursing homes is forcing a revision of a system that, due to its design and traditional practice, is ill-prepared and ill-suited to dealing with such threats.
“COVID has compounded what was already a terrible problem and really made it a lot more obvious,” said Howard Gleckman, senior fellow at the Urban Institute in Washington.
“The devastating impact of the pandemic on nursing homes is the result of inadequate attention to the needs of residents and staff in long-term care facilities in our country,” said Terry Fulmer, president of the John A. Hartford Foundation, which supports research to improve elderly care. “As a nation, we didn’t invest or plan to take care of people who will live longer.” The foundation supports a national study on the improvement of nursing homes after the pandemic.
The pandemic, which killed more than 100,000 people in nursing homes across the country and more than 15,000 in New York state homes, learned lessons from the tragedy, according to experts.
A revelation was made to Dr. Morgan Katz, an infectious disease expert at Johns Hopkins University, made it clear early on: keep most of the infected residents in their nursing home.
“My goal was to keep them out of hospitals to keep the acute care system from surge in early March,” said Katz. “There have been a large number of (nursing home) residents who tested positive and didn’t need to be hospitalized. If they’d all been hospitalized, the system would likely have overwhelmed them. Obviously, it’s pretty worrying for those residents Um Having to go to the hospital, we’ve definitely tried if it can be treated internally. “
In New York state, nursing homes sent infected residents to hospitals for care, and then residents were returned to nursing homes to recover.
Some nursing home residents, as well as Republican and Democratic lawmakers, have argued that the March 25 return of COVID-19 patients to nursing homes, led by the Cuomo government, exacerbated the spread of the virus in homes. Cuomo says 98% of households that have admitted COVID-19 patients who have been treated in hospitals already have the virus in their residents.
The problem worsened after a top governor’s advisor admitted the administration delayed submitting state lawmakers data on the deaths of nursing home residents. Following that confirmation, the U.S. Attorney General and the FBI opened a criminal investigation last week into the government’s handling of the virus in nursing homes.
Rather than sending COVID-positive residents to and from hospitals, the Johns Hopkins and Maryland hospitals created “scratchy teams” of hospital workers going to nursing homes that they were paired with to prevent a case or two from becoming one major outbreak were.
“If a nursing home resident tested positive, we’d go straight to that nursing home and say, ‘Hey, we’re going to send a team out to test your facility. Do you need PPE? What do you need now? And we would have constant communication . “
Further discoveries were a study by the University of Rochester that showed that registered nurses were the “linchpin” to responding early to the virus and that their presence was a major factor in whether a nursing home had more or less COVID 19 infections and deaths. In addition, Minnesota finds success for patients and in lowering government costs by keeping seniors with low medical needs out of nursing homes and providing services in senior centers or at home.
There is also growing support for the expansion or replacement of nursing home complexes with small houses of eight or ten residents with communal kitchens, some resident staff, and some visiting nurses and doctors. This experimental enclosure in some states has been shown to be better for the care of many patients and shows signs of decreased COVID-19 infection, experts say.
“Smaller, more homely environments are ideal for long-term care home residents, including people with dementia,” said Dr. Joseph G. Ouslander, Professor of Geriatrics at the Schmidt College of Medicine at Florida Atlantic University.
The goal is to create a more comfortable environment while continuing to provide medical care when needed, said Bei Wu, professor and director of Global Heath and Aging Research at New York University.
“We can think of building small neighborhood nursing homes that are in communities that residents are familiar with,” said Wu.
A change is already underway in nursing homes.
“We have learned to be flexible and adapt to changes that happen every day,” said Stuart Almer, executive director of Gurwin Health System on Long Island. “The future of nursing homes will be different.”
Scientists said change should start with higher pay for direct caregivers. Nursing homes faced low staffing levels almost a year ago prior to the pandemic and lost more to illness, death and other paid jobs during the crisis. The low wages often forced workers to work shifts in more than one nursing home, potentially causing the virus to spread or leaving them home because they couldn’t lose wages.
However, staff remuneration is one of the proposed changes that will require higher funding.
Stephen Hanse of the New York State Health Facilities Association said nursing homes are receiving about $ 8.79 an hour in government funding per inhabitant, less than “most people pay their babysitters”.
Most countries finance elderly care through a tax for all citizens. However, the US opted for private insurance for middle and wealthier Americans, while poorer people could rely on home care through Medicaid and Medicare. But with the cost of a nursing home usually around $ 10,000 a month. Experts say few Americans can afford private insurance. The result is that most Americans, including the middle class and the rich, depend on government programs designed for the poor.
“That has become a public policy failure,” said Gleckman of the Urban Institute.
The Urban Institute made the proposal to create a wage tax to be applied to the long-term care of the worker, much like paying Social Security wage tax, rather than requiring a potential resident to donate all of their tax assets.
But it’s a tough sell for politicians who would have to sponsor the tax and workers who would have to pay it.
“Everyone denies,” said Gleckman.
The growing demand is also becoming prohibitive to governments, including New York, where Medicaid funding for nursing homes has been cut three times in the past two years alone.
On Friday, Governor Andrew M. Cuomo called for nursing home reform. He said homes would need to stockpile protective gear, test staff and residents more aggressively during the pandemic, and set salary caps for administrators and profit caps for for-profit nursing homes so care isn’t sacrificed for profit.
“Without this reform of the nursing home, I will not sign the budget,” said Cuomo.
Experts agreed that the pandemic created a turning point. “If we don’t step back and see the problems of the past, we are doomed to do it again,” said Michael Balboni, executive director of the Greater New York Health Care Facilities Association.
“Our aging services infrastructure is on the verge of collapse,” said Katie Smith Sloan, CEO of LeadingAge, a Washington-based not-for-profit think tank researching and promoting aging Americans. “We can’t just put a patch on the systemic problems that the pandemic has made worse.”
Many ideas are explored to make nursing homes safer for residents and staff during the next pandemic, while seizing the moment to improve care for the elderly. Among them:
– “Socialization Bots” in the form of a playful seal or other animal that checks in residents, forwards calls from relatives and tries to brighten their day.
– Indoor drones that detect spills such as urine and require cleaning quickly, possibly by a robotic electrostatic device.
– Self-propelled wheelchairs that take patients to physiotherapy or the cafeteria while they talk about the news or the agenda.
-Gov. Andrew M. Cuomo plans to limit the profit that can be made in nonprofit nursing homes, which comprise about 70% of the industry nationwide: “If you are trying to make a profit, it is too easy to sacrifice patient care.”
-Change enforcement of the many health regulations in nursing homes from a penal system to one that seeks to find and share best practices
– Higher fines, so a nursing home cannot simply accept the penalties as a business expense.
-Apps for constant monitoring of a resident’s vital functions.
– “Health passports” that show the test results and the infection status of visitors, providers and employees before entering a house.
-Reducing Residential Isolation to Curb Dementia, Heart Disease and Stroke: “Social isolation was a mental and physical health problem in nursing homes long before COVID-19,” said Bei Wu, director of research at the Hartford Institute for Geriatric Nursing at New York University.
Michael Gormley has been with Newsday since 2013, dealing with state government, politics and issues. He has covered Albany since 2001.