Public Opinion of Nursing Homes Takes COVID-19 Hit, But Most Think Government Didn’t Do Enough

Two months of stories about COVID-19 deaths in nursing homes have taken a toll on the public’s opinion of the industry, a new poll commissioned by SNN found — but the vast majority of people believe that the government has not done enough to support the facilities during the pandemic.

Only 3% of people have a higher opinion of U.S. nursing homes in the wake of the COVID-19 crisis, according to a poll SNN conducted in conjunction with the Pittsburgh-based survey and consumer intelligence firm CivicScience.

More than half, or 54%, of respondents said they had a worse opinion, while 43% reported no change in their perception of the industry.

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That pattern generally held across age groups, though those closest to the age of nursing home residents had the strongest negative feelings, with 62% of respondents aged 55 and older reporting a worse opinion.

That said, a separate question revealed an overwhelmingly negative opinion of the government’s performance in assisting nursing homes during the crisis.

Nearly half of respondents strongly disagreed with the notion that nursing homes had received sufficient support; combined with those who somewhat disagreed with that statement, more than two thirds had a negative view of the government’s actions on long-term care.

Just 18% either strongly or somewhat believed that the government had done enough, while 15% said they weren’t sure.

A similar pattern appeared in the age breakdown of the second question: About 57% of people aged 55 or older strongly disagreed with the idea that the government had done enough to support nursing homes during COVID-19, compared with just 34% of those under the age of 25.

SNN provided CivicScience with the questions, which the firm then posed to groups of respondents using its platform; each particular question had a different number of responses ranging from about 1,000 to 2,000, with margins of error ranging from plus or minus 3% to plus or minus 5%.

As the epicenter of the COVID-19 crisis in the United States, nursing homes have been in the headlines since the pandemic’s earliest days, starting with an outbreak at a suburban Seattle facility in February. The novel coronavirus targets older people and those with multiple existing health issues — the exact demographic that nursing homes serve — with deadly and brutal precision; Mark Parkinson, CEO of the American Health Care Association, as early as mid-March called it “the perfect killing machine for the elderly.”

Media outlets have reported on many other outbreaks in the weeks since, while also pointing out persistent problems with infection control that have plagued the setting for years.

But nursing homes have also been forced to contend with the same macro-level stresses that hospitals and other care settings face, including widespread shortages of personal protective equipment (PPE), a lack of testing access, and skyrocketing costs for both supplies and labor.

At the same time, they had to navigate a disorganized federal and state response, including rules — such as a controversial New York edict only recently reversed — requiring facilities to accept COVID-19 patients despite the dangers. In many cases, this happened even if nursing homes didn’t have the time, space, PPE stockpile, or testing capacity to form “cohorts” of positive and negative residents.

Federal assistance under the $2 trillion CARES Act stimulus package for weeks was limited to outlays based on Medicare reimbursements, which left Medicaid-heavy nursing facilities out of the equation until just last week, when the Department of Health and Human Services (HHS) released $4.9 billion explicitly for nursing homes.

But even that money will soon dry up if industry estimates are accurate: Testing every nursing home resident and staffer in the country just once will cost $440 million, according to AHCA’s calculations, with ongoing staff testing requirements racking up a bill of $1 billion per month.

On the federal level, the Centers for Medicare & Medicaid Services (CMS) took aggressive steps early on in the process, refocusing its survey efforts around infection control and banning visitors from facilities in an attempt to keep the virus out.

But the White House has issued mixed messaging on testing, with an informal goal on universal testing elevated to mandate status in the eyes of the press — despite repeated calls from the industry for more direct material and financial support.

The administration did team with the Federal Emergency Management Agency (FEMA) to arrange the direct distribution of PPE to all U.S. nursing facilities, announced at the end of April. But that initiative will only deliver two weeks’ worth of items by a target deadline date of July 4, prompting LeadingAge CEO Katie Smith Sloan to call the program “wholly insufficient.”

Stuart Almer, CEO of Gurwin Jewish Nursing & Rehabilitation in the suburbs of New York City, summed up the general feeling in the industry during an SNN interview published earlier this month.

“With regard to equipment, if there’s going to be any testing, any patient movement, any assistance, we seem to be 100% on our own,” Almer said.

The SNN/CivicScience poll tracks with an AHCA-commissioned survey of the general public released earlier this month, which found that 63% of registered voters wanted nursing homes and assisted living facilities to receive more funding from the government; a further 72% indicated that insufficient government support had a negative impact on care quality in nursing homes, while 85% called for nursing facilities to receive the same support as hospitals.

SNN and CivicScience also asked about the public’s perception of senior living as a whole.

Some leaders, including Sabra Health Care REIT (Nasdaq: SBRA) CEO Rick Matros, have asserted that skilled nursing facilities have a long-term advantage over senior living due to the vital nature of nursing home services.

“I think senior housing takes longer to come back than skilled nursing,” Matros told SNN at the end of April. “Independent living is an optional service. Assisted living and memory care is much more needs-based, but there’s still some level of optionality there.”

Overall, 65% of respondents to the SNN/CivicScience poll said that they were less likely to pursue senior housing for themselves or a loved one in the wake of COVID-19, compared with just 7% who said they were more likely; a further 28% had no change in their opinion on the subject.

Those opinions largely held stable among all age groups, with 68% of those closest to retirement age saying they’re less likely to consider senior housing — a figure edged out only by the 69% of people aged 25 to 34 who expressed similar concerns.

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