The New York Times
COVID is forcing families to rethink home care
At 86, Diane Nixon, who lives in an apartment in the back of a daughter’s house, has stopped driving and has trouble getting around. When her health worsened last year before the coronavirus pandemic, she and all four of her daughters spoke about whether a nursing home would be the next step. She worried that she had become a burden for her children. “She was very determined not to want her daughters to be caregivers,” said Jill Cooper, one of her daughters who lives in the Pittsburgh area nearby. Sign up for the New York Times’ The Morning newsletter. But when infections began to emerge in nursing homes across the country and tens of thousands of residents died last year, Nixon and her family realized that a group home was no longer a viable choice – especially after most of them banned visitors from containing outbreaks. “Not being able to see them wasn’t an option for us,” said Cooper. The family contacted a local health department to hire someone to help them during the day. “It made us look for an alternative that we may not have looked at too closely,” she said. The pandemic in nursing homes resulted in a significant decrease in occupancy – not only due to the 132,000 deaths, but also due to a drop in admissions. According to the National Investment Center for Seniors Housing & Care, the 14,000 qualified care facilities in the USA have an average vacancy rate of just over 25%. When the vaccination campaigns were a priority in them this winter and nearly 3 million residents and employees were fully vaccinated, the outlook improved somewhat. Nursing homes point to the sharp drop in COVID-related deaths, saying they have fallen 91% since December. While the industry has received $ 21 billion federal funding under the CARES Act as part of Congressional efforts to support healthcare facilities during the pandemic, nursing homes are pushing for more government aid to meet the higher personal costs Protective equipment, tests and personnel to cover their facilities. They say they are losing tens of billions of dollars in revenue due to the pandemic and that many homes are at risk of closing. But the death of so many elderly residents trapped in these homes has increased levels of fear and guilt in many families planning the next stage of caring for an aging relative. Experts say rethinking the purpose of nursing homes is long overdue. Even before the pandemic began 14 months ago, nursing homes had become the source of rampant, antibiotic-resistant infections. The facilities also faced systemic problems, such as the high turnover of nursing home staff and the game of the federal government’s rating system, which made it difficult for families to judge the quality of the homes. For years, federal health officials and some insurers have been trying to encourage more home care, and the pandemic has created a sense of urgency. “It really changed the paradigm of how older adults want to live,” said Dr. Sarita Mohanty, executive director of the SCAN Foundation, a nonprofit group that addresses issues older adults face. The vast majority of these adults would prefer to stay home in old age, she said. “What happened is a welcome kind of market correction for nursing homes,” said Tony Chicotel, an attorney for California Attorneys for San Francisco Nursing Home Reform. Some families, he said, “eventually agreed to a nursing home without really thinking about it.” But after trying to care for at home during the pandemic, many families found that leaving an older relative at home was a viable alternative, he said. Nursing homes grew out of the poor houses in England and America caring for the poor. In the United States, the passage of the Social Security Act in 1935 provided money to states that care for the elderly. Thirty years later, the Medicaid program expanded funding and made long-term care homes a central part of elderly care, said Terry Fulmer, president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay for the nursing homes, go there,” said Fulmer. It wasn’t until the 1970s that some programs to fund home care began and the number of nursing home residents across the country slowly began to decline, with occupancy falling to about 80% in recent years, according to the Kaiser Family Foundation. New technology is making it easier to monitor people at home, said Fulmer, who believes the pandemic could be a “turning point”. Beth Kreisman, a nurse who works at Debra D. Feldman & Associates in Buffalo Grove, Ill., Who helps families deal with these problems, faced the same dilemma with her stepmother, who is now 89. Her stepmother had shown signs of dementia and a hospital stay last spring “took a lot away from her,” Kreisman said. “She couldn’t go home alone,” she said. “We were really in a dilemma as to whether she should go to a qualified nurse or go home with a nurse.” But concern that she might catch the virus in a facility convinced the family to opt for home care. “We were absolutely convinced that if she got COVID, she would die,” said Kreisman. After her stepmother was vaccinated, the family discussed again whether she could best be cared for in a nursing home. Her stepmother doesn’t want to leave the house where she spent decades with Kreisman’s late father. “In her mind, when she leaves her seat, she leaves my father,” she said. “We decided to keep her at home for now,” she said. Many of their clients also choose to have home care instead of a nursing home. “I think people will be more careful and ask more questions before they bring a loved one to a nursing home or choose one who goes to themselves,” said Lori Smetanka, executive director of National Consumer Voice for Quality Long-Term Care, a nonprofit group . “People are still concerned about their safety to some extent.” While the availability of a COVID vaccine has reduced a resident’s risk of illness, some residents and staff are reluctant to vaccinate, which still makes the environment potentially dangerous. In Kentucky, an unvaccinated worker recently triggered an outbreak, a study published last month by the Centers for Disease Control and Prevention found. And some people may not need home care. Debra Feldman, founder of the Chicago agency, said she made the decision to let a client with dementia leave the facility where she was recovering from surgery for a broken hip due to coronavirus restrictions imposed last spring. “It was really nice outside. She was locked in her room and couldn’t understand what was going on, ”said Feldman, who said that her client was getting increasingly excited. The nursing home did not allow her to go out on the terrace. The woman in her mid-80s recovered well at home. “Now she walks without a walker,” said Feldman. “She’s pretty solid on her feet.” However, many people have no choice because of their financial situation or physical needs. “There is limited leeway to avoid home care,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a not-for-profit group in New York. “You don’t have a lot of time and choice when you leave the hospital,” he said. And many families know that circumstances can change. Nixon’s family hasn’t ruled out the possibility of one day moving into a nursing home. “We’re continuing the journey,” said Cooper, emphasizing that they still positively view long-term care homes. Home care costs can be prohibitive. When a person is dependent on Medicaid, the state program, the services available in the community or at home vary widely by state. In some countries, paid home care is limited. “We are already seeing that because of the structure of the system, people on low incomes have fewer choices,” said Smetanka. The Biden government has proposed spending $ 400 billion to fill some of the gaps in long-term care by allocating more funding to these alternatives through Medicaid. However, the outlook for President Joe Biden’s $ 2 trillion package is unclear. In some regions of the country, staff shortages can limit the options available, said Liz Barlowe, former president of the Aging Life Care Association, a nonprofit that represents senior nursing professionals. Even with apparently low occupancy rates, nursing homes are slow to accept new long-term residents because they do not have enough staff and health authorities at home have difficulty finding enough helpers when people need 24/7 care. “This is a huge challenge, not just for facilities but for home care as well,” said Barlowe, a family counselor in Seminole, Florida. Still, she said she felt a shift in attitudes about long-term care in families as some of the worst nursing home experiences fade. The crisis has shown how ill-equipped many facilities are to deal with a pandemic, she said. It was also underlined that the industry needs to make fundamental changes to restore confidence in the country. “The damage is done,” said Barlowe. “Now we all know it can happen. We have to deal with system changes. “This article originally appeared in the New York Times. © 2021 The New York Times Company
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