Responding to a Call to Abolish Nursing Homes

As the first cases of COVID-19 infiltrated long-term care facilities in the US, the public attention focused on the large proportion of COVID-19 deaths among nursing home residents.  At the height of the pandemic, 40-50% of deaths in most states were attributed to the virus, attributed to the residents’ comorbid conditions as well as issues around infection control, staffing, education, management, and leadership.  Nursing homes became poster child for health care deaths and COVID-19 transmissions.  By May 31, 2020, one in every 40 nursing home residents died from the virus and at least 600 long-term care facility employees have died.

Government directives from state health departments, the CDC, and CMS changed and sometimes contradicted previous policies. Residents were transferred to and from dialysis, and hospitalized patients with and without positive COVID-19 tests were admitted to long-term care facilities and nursing homes that already had staffing pressures faced even more difficulty providing safe care.

Numerous voices outside the industry have used these current circumstances to raise the question as to whether or not our society needs to have any long-term care facilities, and it is argued that COVID-19 is proof that the only solution is nursing home closure. 

In a recent article published on Quartz¹, Michael Schulson explained that advocates for the disabled have long argued that people are best served in a de-institutionalized environment and that resources should be directed away from long-term care facilities into long-term care home and community-based services. COVID-19 has raised the awareness of this need beyond the disabled and now encompasses older adults who may have second thoughts about the competencies of nursing home staff as well as the government mandates that prohibited families from visiting, adding to the psychological stress imposed by the virus.

Community-based care has long been the goal for the younger, disabled consumer, and older adults with multiple co-morbidities populated skilled nursing facilities.  These facilities provided 24-hour and services that would not available outside of the institutionalize setting. Even when Medicaid funding is diverted to home and community-based care, there will be a proportion of patients who will require assistance for toileting, bathing, meal preparation and an array of services that depend on the availability of a caregiver.

It is clear that most older adults would prefer to live at home rather than in a skilled nursing facility.  When probed further, however, most would choose to have the security of caregivers available rather than the risk of limited or intermittent care.

It remains unknown if COVID-19 has a permanent impact on perceptions of the value of long-term care facilities.  Will nursing homes be viewed as the source of care or the source of infection and death? Will hospitals continue to discharge rehabilitation and skilled patients to long-term care facilities? Will residents and families have confidence that care will be provided by competent staff who care about the quality of the services they provide? Will government agencies use the pandemic as a reason to shift further resources to home and community-based services? Will the nursing home industry survive COVID-19?

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society. 

Reference:

1. Quartz. Coronavirus is renewing a call to abolish nursing homes. https://qz.com/1872956/is-there-a-better-alternative-to-nursing-homes/. Published June 2025. Accessed September 2020.