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EDITORIAL: Nursing home industry must explore nontraditional models of senior care

Buffalo News - 11/9/2020

The coronavirus pandemic has amplified problems in America's long-term care system that have long existed. Some innovators in the field have developed promising solutions, including nontraditional nursing homes that provide more individualized care.

With the country in the throes of a new wave of Covid-19 infections, it remains to be seen whether there are nursing home operators who can look past the urgency of the moment and make long-term investments in new models of congregate care.

According to an ABC News analysis, through the end of October, more than 82,000 coronavirus-related deaths occurred this year in long-term care facilities in the United States. After a brutal spring, the pace of infections and deaths slowed in the summer, thanks to better testing, isolation of Covid-positive residents and improved therapies.

In the past four weeks in New York State, however, there were twice the number of new nursing home deaths as were reported in the previous four weeks, ABC said. Statistics like that will force some states to consider reimposing strict lockdowns in nursing homes, where the social isolation from prohibitions on visitors takes a harsh toll of its own, particularly for patients with dementia.

In addition to a mostly elderly population that statistically is vulnerable to Covid, the institutional design of most nursing homes also plays a role. Most are set up like hospitals, with double occupancy rooms, large dining halls where residents are seated together, and other common areas in which residents gather. It's an economical use of space, but the layouts can make residents feel they are being warehoused, while leaving them more vulnerable to the spread of infectious disease.

New approaches are being designed to care for the elderly, including nontraditional nursing homes and a shift toward aging in place in one's home. A nationally known model called Green House homes features smaller facilities in which residents live in groups of eight to 10 in a setting more like a home than a hospital. Green House homes provide residents with more individual attention and the feeling they live in a community.

The Green House model appears to have tangible benefits when it comes to coronavirus. The Washington Post reported this past week that Green House residents are five times as likely to be coronavirus-free as those who live in typical nursing homes, and 20 times less likely to die from the virus.

A facility in the Netherlands, Hogewey, provides another model of innovation. The so-called "Dementia Village" is a gated community for 152 residents with severe dementia. The village setup features a town square, a hairdressing salon, restaurant, pub and other shops, and residents are under watch by caregivers at all times. Reports say residents are more active and need less medication than those in traditional nursing homes.

The Dutch government provided most of the funding when Hogewey was built in 2009. The village represents a Cadillac solution to memory care that's unlikely to be affordable under the U.S. nursing home system that relies on billions in federal Medicaid and Medicare payouts.

Similarly, the Green House facilities tend to be located in upscale neighborhoods that are more within reach for private-pay patients than Medicaid recipients, though that's not always the case. Catholic Health based its Mercy Nursing Facility at Our Lady of Victory on the Green House model. The nursing home, on Melroy Avenue in Lackawanna, has 84 beds on four floors, with all private rooms. It's located on a campus opened in 2008 called OLV Senior Neighborhood, which also features low-income senior apartments and an outpatient center. It's a popular facility that shows new models of senior care can thrive.

U.S. nursing homes operate on thin profit margins, stressed by ever-tightening Medicaid reimbursement rates. The pandemic has forced many operators to spend money acquiring personal protective equipment for their staff and residents. It also deprived many homes of a significant revenue source this year: short-term stays paid for by Medicare. Patients discharged from hospitals are often sent to nursing homes for a rehabilitation stay, funded by the federal government. Worries over coronavirus in nursing homes caused a steep drop in short-term stays this year.

Despite the aging of the baby-boom generation, total nursing home enrollment has been decreasing for several years. More Americans are remaining in their homes, getting their care needs met there, and increasing life spans -- 75 is the new 60 -- allow many to put off being institutionalized. The effects of the pandemic, including the nationwide deaths and the fears of infection, have caused nursing home enrollment to drop by 10% during 2020, according to the Wall Street Journal.

This year's struggle by nursing home operators to keep their facilities safe as well as solvent doesn't leave much room for thinking beyond the next day's crisis, but those who embrace a future of nontraditional facilities will benefit in the long run.

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