Time for a Change: The COVID-19 Nursing Home Disaster and the Urgency of LTSS Reform*

Abstract

The horrific death rate of nursing home residents due to COVID-19 has exposed the nation’s long- standing failure to effectively manage public policies toward long-term services and supports (LTSS). Government agencies’ dereliction in the enforcement of quality standards in nursing homes has been most visible. But equally important are provider payment policies that discriminate against people with low incomes, dependence on under-paid direct care workers or unpaid family caregivers, and—most broadly— underfinancing of LTSS that leaves people of all ages at risk of impoverishment and inadeqate care. These risks will only grow as the population ages. The Biden Administration and the Congress have an opportunity to capitalize on heightened public awareness with significant policy and management reforms. In the short term, that means not only the exercise of federal oversight authority to assure quality but also the enhancement of federal funding (through Medicaid) made contingent on adequate wages and support for direct care workers and auditable delivery of quality care—whether delivered in the nursing home or in the community. Over the longer term, enactment of a national program of social insurance is essential to address the LTSS risks and uncertainties facing people of all ages and assuring that, regardless of the state they live in, people receive the care they need.

Addressing the workforce crisis in (rural) social care: A scoping review

“…Exactly what these interventions might be or the extent to which they have been tested is unclear, with Scales also lamenting a lack of evidence for the effectiveness of workforce strategies. It is timely to review the evidence now since other researchers have identified increased political attention to social care and the social care workforce following the COVID-19 pandemic 7 and a global recognition that sustainable social care must be a priority for health and care policy makers and planners. 8 While there has not yet been an attempt to consolidate knowledge about 'what works' in addressing the workforce crisis in rural social care, there is a substantial literature on workforce issues in rural primary care, with reviews and even reviews of reviews 9 of workforce research, especially concerning family physicians and general practitioners.…”

“…Exactly what these interventions might be or the extent to which they have been tested is unclear, with Scales also lamenting a lack of evidence for the effectiveness of workforce strategies. It is timely to review the evidence now since other researchers have identified increased political attention to social care and the social care workforce following the COVID‐19 pandemic 7 and a global recognition that sustainable social care must be a priority for health and care policy makers and planners 8 …”