Executive Outlook 2021: Nursing Home Stigma Will Linger ‘for Some Time’ — for Both Residents and Staff

If there’s been one recurring theme for SNN’s annual executive outlook, it’s the idea that putting 2020 to bed represents a chance to reset and move on past the worst year in the history of the post-acute and long-term space, both in the United States and around the world.

But that can only happen if the public and the frontline workers who serve our seniors believe that change is possible — and forthcoming.

The stories of admission declines and vaccine hesitancy among caregivers prove that trust in nursing homes has never been lower, and that coming back from a world-historic disaster won’t be a simple matter of flipping over a calendar page.


For the final installment of our 2021 crystal ball, three more leaders lay out a vision for evolution and revolution, one that crucially must start with convincing residents, families, and frontline caregivers that the space is serious about making sure that a year like 2020 never happens again.

Sidney Greenberger, CEO, AristaCare Health Services

Last year this time, experts throughout the post-acute and long-term care industry opined on what challenges and opportunities the year 2020 would bring. Little did they know. Little did any of us know.

At this time last year, the newest buzzwords our industry had just become acquainted with were things like PDPM, NTAs, ends splits, comorbidities, GG scores, IPA’s, BIMS, SOB, QRP, PHQ9, VDPs, and so on.


Who could have imagined then that as we transition into 2021, we’d be talking a new language consisting of words and terms such as positivity rates, transmission rates, PPP, PUI, virtual visits, hazard pay, cohorting, antigen vs. PCR testing, and PPE conventional, contingency, and crisis modes?

Our sector faces a colossal battle entering 2021 and beyond. Skilled nursing facilities have been bruised and battered in more ways than one. Our collective reputation as in industry has, for lack of a better description, been dragged through the mud. We’ve become the convenient scapegoat for actors in all level of government — local, state, and federal — in their quest to deflect blame for their own malfeasance and ineptitude.

Reported fatalities within the entire spectrum of “congregate living facilities” (adult homes, assisting living facilities, etc.) were all conveniently reported by government, media, and others as having occurred at “nursing homes.” As a result, consumers have lost confidence in nursing homes — or better said, they’ve become deathly afraid of entering one.

2021 will be a year in which the first order of business for “rehabilitation centers” (nursing homes) as a collective will be to rehabilitate the public’s perception of our industry as a whole. Vaccinations will go a long way if rolled out correctly, but the nursing home stigma will still remain for some time.

With national occupancy rates down 15%, according to a recent Wall Street Journal article, there’s a lot of ground to be made up. While the industry will need to work together on a national level to reestablish public confidence, we must also realize that, on a hyper-local level, competition among operators will be as fierce as ever.

Will it be possible to eke out any sort of profitability in 2021? One would have to be a prophet to be able answer that question.

Lori Porter, CEO, National Association of Health Care Assistants

I — along with many, many others — am happy to see the year 2021 and have 2020 in the rearview. The last year was incredibly difficult on everyone, especially those in our field. The pandemic has been on a rampage through America’s nursing homes, wreaking havoc on our elders.

However, the new year signifies a new beginning, a fresh start, and new opportunities. New opportunities often come with new challenges.

As co-founder and CEO of the association of and for certified nursing assistants (CNAs), my focus is lasered in on the front line. What was once a generally safe profession is now one of the most dangerous in America due to the pandemic.

In part, I believe long-term and post-acute care was ill-prepared for such an emergency. Our field was incredibly short-staffed even before COVID-19, increasing the costs significantly when providers had to look to agency to ensure our frail and elderly had enough people to care for them during this unprecedented time.

Somehow, our heroes on the frontline heeded the call and met the challenge. I call to solve this staffing crisis once and for all in the coming months. Our elderly deserve better and we can do better. Take care of the caregiver, and you will see better caregiving.

Hope is not only on the horizon; it is here. The vaccine created, manufactured, and approved in record time is being administered to residents and health care professionals across the country. Here is our chance to wreak havoc on the virus and strike back.

The challenge our association has found is great hesitancy among CNAs for the vaccine. Through our polling, we’ve found that nearly 72% don’t want it. There are two major themes as to why: the lack of education and information on the vaccine, and the lack of trust.

It is their lives and their health, and they deserve to get as much accurate information possible to make the proper decision. Moving headstrong in just administering the vaccine, without educating the front line on the vaccine, could cause a mass exodus from the profession. We must educate and inform so we don’t create yet another problem. This is vital if we plan on winning this war against our invisible enemy.

2020 is a year I would much rather forget but cannot — we mustn’t. It proved that the CNA profession isn’t an entry-level position. The profession can be dangerous; it takes a level of expertise, and it takes a ton of dedication and commitment. I ask my contemporaries not to forget their sacrifice and reward them accordingly. They are heroes, the same as everyone else that answered the call.

Let us all meet every challenge and take advantage of every opportunity in 2021.

Owen Hammond, CEO, and Steve LaForte, Director of Corporate Affairs and General Counsel, Cascadia Healthcare

As we all know, it has been a crazy, challenging, tragic year for our industry in the face of the novel COVID-19 virus. Novel indeed.

However, interestingly, our challenges remain largely the same as they were a year ago — staffing shortages and wage pressure, reimbursement pressure, and a regulatory system that focuses on punishing operators rather than collaborating to promote better quality and outcomes. The one change to these challenges has been that COVID has exacerbated them in a myriad of ways.

Our staffs are tired and, frankly, burned out; there is trepidation that as the CARES Act money runs out, the additional costs for staff and infection control will further eat into our already limited margins. As states grapple with the global costs of the effects of COVID, there is a fear of cuts to Medicaid reimbursement. Finally, as we are already seeing with the increased pace of infection control surveys, the regulators are looking to point a finger of blame at operators.

In the midst of those gloomy challenges, we do have hope. As the vaccines dampen the effect and spread of COVID, there is opportunity.

Opportunity to change the perception of our industry in the public’s eyes as regulatory changes get debated. Opportunity to advocate for higher reimbursement for staff, as the issues with staffing have become front and center in the examination of the post-acute industry and how it was affected by COVID. For operators committed to the industry and the long-term change and evolution of operations, there will also be growth opportunities as some leave our difficult industry.

Beyond all of that, for those of us committed to caring for our elderly and vulnerable adult populations, and serving our communities, all of the challenges of COVID — and heroic efforts of our staff in the face of it — serve to inspire us to be better and create positive change out of one of the worst years of our collective lives. So we look forward to the challenge and opportunity that 2021 brings.

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