“COVID-19’s Deadly Lesson: Time To Revamp Long-Term Care,” by Deborah Gastfreund Schuss, Health Affairs
“Among the many painful lessons COVID-19 has inflicted is this: Our approach to caring for the vulnerable among us has failed, with nursing home residents disproportionately stricken. It’s time to abandon our deeply entrenched and outdated views of long-term care in favor of a disruptive model that invests more heavily in quality home and community services such as leading-edge adult day health programs, each with rigorous standards. This will require a shift in funding that traditionally has skewed toward large institutional settings with shared rooms, which COVID-19 demonstrated just don’t work, says Tony Chicotel, staff attorney for California Advocates for Nursing Home Reform. … Such a giant pivot hinges on a broad commitment to enhancing the care of our growing disabled community while also supporting their caregivers, paid and unpaid. It calls for entrepreneurial ingenuity, and it will take strong political will regarding care-coverage options and the creation of and adherence to authentic quality standards.”
Whether from ignorance or ideological bias, articles like this help not at all. Everyone has known for decades that home care is preferable to institutional care. The first question to ask, therefore, is this: why is funding “skewed toward large institutional settings with shared rooms.” The answer is that keeping expensive LTC, which is mostly provided by Medicaid, undesirable is the only way to control its cost. If you want more home care, the way to get it is to channel fewer middle class and affluent people away from Medicaid by closing eligibility loopholes and enforcing estate recoveries. That is the only way to incentivize consumers to plan and prepare for long-term care risk and cost before it’s too late for them to avoid Medicaid. For the full analysis and recommendations, read Medicaid and Long-Term Care.