The Spotlight on Nursing Homes Has Never Been Brighter. Let’s Keep It That Way

Over the years, nursing home operators have found themselves in the spotlight for negative reasons — usually in the wake of isolated stories of abuse and neglect, or tales of owners who bilked the government for money at the expense of quality care.

But the industry has never been at the center of national conversation, the nexus of a gradually unfolding American tragedy, the way it is today.

COVID-19 has thrust both the systemic failures and quiet grace inherent in the nursing home industry into daily news reporting across the country. As the devastating death toll continues to climb, journalists and the general public are being forced to consider the fractured state of senior care funding and oversight in ways they haven’t before.

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I know there’s a lot of frustration among the operators whose yeoman’s work during this time — the long hours on the phone with suppliers of personal protective equipment (PPE), the mourning of deaths alongside family members and caregivers, the scramble to comply with near-daily regulatory updates — is getting buried under body counts and finger-pointing.

But the leaders in this space can’t let the national focus on nursing homes go to waste.

Senior care has the attention of the United States and the world right now. Instead of shying away from the spotlight, and hoping it’ll go away with a few carefully worded “no-comments,” post-acute and long-term care leaders must grab the microphone and not let go until the media glare invariably drifts elsewhere.

My current fear is that the wide network of stakeholders in senior care — operators, residents, regulators, lawmakers, lawyers, families, and anyone under the age of 65 today who might need that kind of care in the future — won’t learn much of anything from this crisis.

The absolute worst long-term outcome for nursing homes is a replay of the well-worn pattern these stories usually follow.

A newspaper or television station reveals a case of neglect or abuse, or a specific pattern of failures. An outraged public demands answers. Local officials and politicians rail against the owners and operators, who receive fines or even criminal punishments for their actions. Everyone pats themselves on the back, convinced the problem has been solved completely, and officials and the media go back to pretending that the post-acute and long-term care landscape doesn’t exist — until the next sordid story kickstarts the cycle anew.

We cannot afford to follow this playbook. There simply cannot be a next story with the size and scope of the one we’re currently living through each day.

After privately getting out their frustrations about the way they’re being portrayed in the media, leaders in the space must embrace and amplify not just the feel-good stories of celebrations through nursing home windows and nurses going above and beyond for their residents — but also the good-faith attempts at getting to the root of the problems blossoming all throughout the country.

An April 21 New York Times story about the precarious state of nursing homes’ finances even before the crisis serves as the perfect example of a piece that leaders should spread far and wide. There’s nothing in it that would surprise anyone who’s spent more than six months in the industry, but that’s exactly the point.

The person calling for the heads of every nursing home operator in the comments section of a local news story might not know that Medicaid often doesn’t cover the cost of long-term care in many states, forcing even the best providers to make difficult staffing and capital investment decisions.

The family scared out of their wits for the safety of their ailing loved one in a nursing facility has never had to unravel the complex reimbursement dynamics that every nursing home CFO must balance each day to keep the lights on.

The local reporter staring down death tolls and getting no comment from a facility operator might not realize that a complete freeze on non-essential surgeries cut off a vital Medicare funding source — at the same exact time that the cost of PPE skyrocketed by more than 6,000% for some items.

Shocked and outraged people are looking for someone to blame right now. But there’s no one scapegoat whose downfall will make things better.

There’s also no one person whose bright idea will fix everything.

It’s up to all of us to explain the depth of the problems to anyone who will listen; find partners and leaders willing to get into the weeds with us; and lay the groundwork for a transformation of how we fund and provide senior care in this country.

Many of the best advocates for the people who live and work in nursing homes have rightfully described the setting as forgotten during the COVID-19 pandemic.

While hospitals have been hailed as the domain of heroic doctors and nurses, long-term care facilities were largely left out of PPE and testing prioritization efforts. Plans to support them once the outbreaks began have been scattershot and poorly organized; even New York Gov. Andrew Cuomo — who has received praise for his handling of the COVID-19 response — publicly admitted last week that he had no idea why his own state health department still requires nursing homes to re-admit coronavirus patients despite the danger of spreading the disease.

The stories of deaths and disarray in the American nursing home infrastructure have ensured that the space is forgotten no more — but only as long as the virus continues to spread and take the lives of the people in its care.

In the days and weeks after the September 11 attacks, as a middle-schooler growing up in the suburbs of New York City, I thought there’d never be another day in my entire life without the images of burning towers and falling bodies in every newspaper and on every TV newscast.

It may have taken months or even a year, but that day certainly came. And it happened so gradually, I can’t tell you when the world’s attention shifted.

It’s hard to believe here in the trying spring of 2020, but the media narrative will move on eventually. It’s up to the leaders in the industry to make sure that their voices are heard before they’re forgotten once more.