Officials Mull Mandatory Single, Double Rooms in Nursing Homes by 2022 in Wake of COVID-19

A state hit particularly hard by the coronavirus pandemic may soon mandate the end of triple- and quadruple-occupancy nursing home rooms in less than two years.

Under new proposed state guidance, nursing homes in Massachusetts would need to convert all of their rooms to single- or double-occupancy by the end of January 2022, the State House News Service reported last week.

The move from the state’s Department of Public Health would also come with updated square-footage requirements to reflect the reduced occupancy, as well as increased per-patient care requirements.


“The goal of this initiative is to hold facilities to higher standards of care in infection care,” Martia Callahan, director of policy and health communications for the state health department, said, according to the report.

Outdated nursing home infrastructure has been blamed in part for the devastating death and infection toll in long-term care settings, with proper cohorting difficult or impossible at midcentury facilities designed to house more than two people per room.

Earlier this year, Massachusetts officials acknowledged that while a 2000s-era law required single occupancy rooms for new facilities, existing properties were simply grandfathered in and thus not required to comply. State health secretary Marylou Sudders specifically pointed to the state’s aging nursing home infrastructure as a reason for struggles with effective cohorting early in the pandemic.


The proposed regulations would supplement a $140 million cash injection and Medicaid-rate update proposed by Gov. Charlie Baker, the State House News Service noted.

Nursing home design has emerged as a key area of reform as the industry, advocates, and policymakers look to apply the harsh lessons learned during the COVID-19 pandemic. Writing in the journal NAM Perspectives, a group of leaders last month argued that the current institutional model cannot meet modern standards of care.

“Nursing homes were never, and will never, be equipped to deal with infectious disease outbreaks unless major changes are made, including redesign and payment reform,” John A. Hartford Foundation president Terry Fulmer said in a statement. “These facilities and their dedicated workforce have borne the brunt of COVID-19 and need actionable solutions to prevent dire outcomes from continuing to happen.”

But the construction of new facilities, or renovation of old ones, also comes with challenges. Innovative single-occupancy “cottage” models such as the Green House Project have achieved substantial success in curbing infections and deaths during the current pandemic, but developers and operators must contend with potentially increased construction and ongoing staffing costs.

Such projects have also been met with skepticism from regulators who are accustomed — and in some cases, legally bound — to the more traditional nursing home model.

“The only way I can see this working is for everybody along the chain to take less,” Wendy Simpson, CEO of LTC Properties (NYSE: LTC), said of ground-up cottage-style development earlier this month. “So the developer is not taking as big of a profit on making the development. The person selling the land is not making as big of a profit.”

Simpson pointed out that changes to nursing home bed counts can also scramble the sector’s traditional financial and valuation math.

“How would you value the number of beds you’re going to buy? Is it one bed per room now, and then in two years, when COVID is under control, you could increase the number of beds in the facility?” Simpson said. “So I think the valuation and the underwriting of skilled nursing is going to be very difficult, but the market will come back.”