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Medical News & Perspectives
May 11, 2022

National Academies: US Nursing Home System Needs Fundamental Overhaul

JAMA. 2022;327(21):2063-2065. doi:10.1001/jama.2022.8050

The COVID-19 crisis publicly exposed systemic problems within the US nursing home system, where about 40% of deaths from SARS-CoV-2 infection occurred during the pandemic’s first year. Now, a major report provides a blueprint for overhauling what the authors concluded is an “ineffective, inefficient, fragmented, and unsustainable” approach to long-term and postacute care.

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    3 Comments for this article
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    Show Me the Money
    Michael Gross, MD | University of Michigan
    A major roadblock to this kind of institutional improvement is reimbursement for services. Unfortunately the primary source of funds is governmental, so it gets political given the need to appease anti-government voters and spend-less politicians. Without the funding all we have are good intentions.
    CONFLICT OF INTEREST: None Reported
    You Don't Get What You Don't Pay For
    Francis Holt, PhD, RN | Retired
    Until we have some consensus on 1) how to raise money (i.e., taxes) and 2) what it is that we value as a society, this problem will not be resolved.

    The problem is not insurmountable. But it cannot be solved on the cheap. I realize the irony in this statement, given that about 5% of nursing homes are owned by private equity firms. These people would be the first to tell you that you cannot make progress without cash-flow. "The mission is the margin."
    CONFLICT OF INTEREST: None Reported
    Agree, Intention Good
    Barbara Bigelow, MS, LNHA, HSE, CDP | Bigelow Community Consulting, LLC
    In theory, I agree with the abstract article. Nursing homes in America need much work. Bottom line; we are not a country that values its elders and taking care of older people is not sexy. It's hard work, but empathy and compassion for the space, especially ADRD that we will all occupy someday in one form or another, compels us to solve the problem. If we as a country are going to continue to warehouse our population, we need to figure out how to do it in a person-directed manner. Any individual who understands healthcare delivery and has had the heartache of having a loved one in a LTC facility knows that the best of them are not places the rest of us would choose to be.
    CONFLICT OF INTEREST: None Reported
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