Investing in Home-Based Senior Care Can’t Come at Expense of Nursing Facilities

The COVID-19 pandemic has rightfully prompted lawmakers at the state and federal level to reconsider the way government payers incentivize or discourage the use of nursing homes relative to other options, such as home- and community-based services (HCBS).

But one prominent long-term care researcher this week warned against looking at the reform equation as a zero-sum game, challenging leaders to invest in all types of post-acute and long-term care in the wake of the coronavirus devastation.

“If there is a silver lining to COVID-19 and long-term care, the pandemic will hopefully accelerate the decades-long push towards expanding HCBS while also causing a reconceptualization of nursing home care,” Harvard professor and researcher David Grabowski wrote in a new commentary published in the journal Nature Aging. “These are not competing goals but rather complementary ones.”


Grabowski in particular turned his attention toward the calls for abolishing nursing home services altogether after the setting became the epicenter for coronavirus deaths in the United States.

“Abolishing nursing homes might serve some individuals well, but it also may leave others without access to needed services,” he wrote. “For these individuals requiring nursing home care, the problem is not nursing homes per se, but rather the way in which countries like the USA structure their nursing homes. It is not that countries like the USA need to spend less on nursing homes, they need to spend their nursing home dollars differently.”

He specifically envisions the wider development of small-home style facilities staffed by well-paid workers, pointing to the success of Green House homes in keeping the coronavirus at bay; residents of facilities designed with Green House principles were one-fifth as likely to contract COVID-19 and one-twentieth as likely to die from the disease, Grabowski observed.


That said, the opportunity to expand home- and community-based services in is significant. The U.S. lags behind other industrialized countries in the proportion of seniors 80 and older who receive care at home, and demand for the services will only accelerate along with the aging population.

Source: Nature Aging

Grabowski’s vision involves increasing overall investment in all types of services for seniors, with a distinct bias toward HCBS — along with continued support for new models of institutional care proven to promote safety and quality of life.

It won’t be easy; Grabowski compared the financial and logistical lift involved to wide-reaching projects such as the so-called “war on cancer.”

But such a vision will be necessary to avoid a repeat of the devastation wrought during the past year.

“The goal should not be to abolish nursing homes, but rather abolish the institutional models and the underfunding of HCBS that have plagued long-term care for far too long,” he concluded.