The COVID-19 disaster presents an opportunity to reimagine the role of nursing homes.
Nursing homes account for 8% of COVID-19 cases and 41% of COVID-related deaths nationwide.
The exact causes of these infections and fatalities are complex, according to the authors of a commentary published by the National Academy of Medicine. However, they write, there is agreement that America’s nursing homes “are not designed, operated, or funded to deal effectively with infectious disease epidemics.”
Terry T. Fulmer, Christopher F. Koller, and John W. Rowe acknowledge that nursing homes are continually learning more about how to best care for residents during COVID-19. But the authors suggest that, over the long term, nursing homes could best serve residents by employing targeted strategies designed to meet the needs of specific subsets of the nursing home population.
They discuss several potential strategies that could be considered:
- Revising the physical design and operating model of nursing homes to accommodate the need for resident isolation and social distancing, reduce the cycling of staff and patients from the community to the nursing home, and protect staff during times when infectious diseases are rampant.
- Using “unpacking strategies” to better match services provided with the needs of specific resident groups. For example, relatively homogenous subsets of nursing home residents—residents requiring hospice care, for example—could be matched to other care settings that are specifically designed to manage their needs.
- Strengthening current programs, including the Program for the All-Inclusive Care of the Elderly (PACE) and traditional home care programs, so they could help care for individuals who would otherwise be in nursing homes.
- Establishing extended care wings, contiguous with acute care facilities, to manage the needs of individuals who need short-stay rehabilitation after a hospital stay. These wings would offer patients proximity to their primary care and specialty providers during the post-acute phase of illness. However, hospitals may not be able to effectively manage this population since post-acute care is very different from acute care.