By Kate Leo
There is a lot of discussion about how COVID-19 is affecting long term care services and supports (LTSS). The first outbreak known in the United States happened in a nursing home in Washington State. By July 2021, 2.5 million nursing home residents were impacted, and there were 50,000 deaths. These numbers keep increasing at an alarming rate. Both the elderly and those with developmental disabilities that require long term care services and support are disproportionately affected by COVID-19. Those who work in these facilities are also greatly impacted. Black and Latinx workers make up about half of the care workforce, and disparities within these populations became even more apparent as many got sick in the workplace. The pandemic emphasized the need to make improvements to issues in long term care services and supports.
The first major issue is how LTSS is financed. Although Medicare is health insurance that provides health benefits to the elderly, it does not pay for LTSS except for short-term use. Medicaid is the largest funder of LTSS. However, there are extremely low reimbursement levels, causing problems like short staffing and outdated facilities. LTSS was ill-equipped to handle a pandemic that would impact patients in these facilities.
Short-term solutions to this problem include making a solid plan to deal with COVID-19. This includes having the appropriate amount of PPE on hand, having a protocol to deal with sick patients, having readily available testing, and ensuring that the workforce is able to have paid sick leave and appropriate wages. However, long-term solutions are also needed to ensure that LTSS has a strong infrastructure to better the system and respond to crises in a more efficient manner.
A long term solution that should be addressed is to have more home and community-based LTSS. These types of services allow patients to stay at home and have services delivered to them. Home and community-based LTSS (when implemented correctly) address social determinants of health and provide a more holistic form of care. There needs to be a shift in focus and funds so more people can have this type of care plan.
There also needs to be more communication between LTSS and the health care system. This would involve a care management team so there is a plan of action for a patient going from clinical care to long-term services and support. This would also provide a more holistic plan of action.
Although these are only two long term solutions out of many that should be addressed, these two changes are some of the most essential and feasible plans. With a better system in place for long term services and support, the elderly would be at less risk for diseases like COVID-19 and experience a better quality of life. COVID-19 did not create the problems in these facilities, they just emphasized what needed to be altered.
Source:
Chernof BA, Mann C. Building The Long-Term Care System Of The Future: Will The COVID-19 Nursing Home Tragedies Lead To Real Reform? Health Affairs Blog. Published July 31, 2020. Accessed February 15, 2021. Available at https://www.healthaffairs.org/do/10.1377/hblog20200729.267815/full/
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