Verma: COVID-19 Shows LTC ‘Relies Too Heavily on Nursing Homes’

The nation’s top Medicare and Medicaid official this week called on states to boost their home- and community-based services for the elderly, arguing that the impact of COVID-19 on nursing homes has exposed a key flaw in the overall system.

“The COVID-19 crisis has shone a harsh light on the human costs of a long-term care system that relies too heavily on institutional services like nursing homes,” Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said in a statement. “Too often, they are seen as the default option, even for those who may not require round-the-clock care.”

The comments came as CMS rolled out a new toolkit highlighting innovative ways that states have invested in HCBS, primarily through a process known as “rebalancing” — shifting dollars from brick-and-mortar nursing homes to a variety of community programs that support both older citizens and people with disabilities.


“States continue to be at the forefront of innovation in designing new models for the delivery and financing of LTSS,” the agency noted. “CMS supports state efforts to help older adults and people with disabilities to access care and services at home and in other community settings, so they may live their lives with as much dignity and independence as possible.” 

Statehouses across the country have shown an increasing preference for such services — including home health, non-institutional supportive housing, and transportation programs — in response to both consumer preferences and the generally lower cost of such initiatives relative to traditional nursing home care.

The rate of spending on HCBS has grown at a faster rate than overall long-term services and supports (LTSS) funding over the last 30 years, but CMS noted that the trend has slowed in recent years despite a rapidly aging population.


The COVID-19 pandemic, which has run rampant through nursing facilities and put increased focus on outdated nursing home design, could serve as a spark to restart that trend — particularly as lawmakers, resident advocates, and providers look to improve their offerings and prevent future disasters.

“While nursing homes will always be an important part of a complete care continuum, many elderly individuals and their families should have access to a more robust set of home care and community-based care options,” Verma said.

The administrator’s comments also came during the same week as her public pushback on nursing home operator Life Care Centers of America, which was recently profiled in a “60 Minutes” segment critical of the federal government’s response to the first coronavirus outbreak at a nursing facility.

Responding to the program’s framing on Twitter, Verma pointed to fines that Life Care had received prior to COVID-19, as well as its overall revenues; a Life Care leader had accused CMS of looking for a “scapegoat” in conducting an investigation and levying fines on the suburban Seattle facility.

“Tonight on @60Minutes, you may hear some revisionist history from people who have a vested interest in deflecting responsibility for the disaster at the Kirkland, WA Life Care nursing home & the tragic deaths in the nation’s first #COVID19 outbreak,” Verma wrote.

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