Turning Away From Nursing Homes, to What?

Covid-19 has driven down Americans’ demand for senior care facilities. Building support for more elders to remain at home requires systemic changes.

By Mark Miller

Regina Smith has dedicated her career to keeping seniors out of nursing homes. A geriatric social worker at an adult day care network in Indianapolis, she strives to provide services that can help people live independently.

But Ms. Smith’s expertise didn’t keep her own mother from a nursing home — or prevent the worst from happening when the pandemic struck last year.

Ms. Smith’s 75-year-old mother, Katherine, suffering from dementia and other serious conditions, moved to a home in town in 2019. Last April, she contracted Covid-19 and died just a few days later. “The very thing I fight for for others I was not able to do for my mom,” Ms. Smith said.

That trauma has made Ms. Smith much more skeptical about institutional care settings, and inspired her to work even harder to find solutions that keep clients at home. “We deal with a lot of people who have dementia or Alzheimer’s, and the family members are looking for memory care as soon as possible,” she said. “I just share my story with them.”

Covid-19 had taken the lives of 181,000 people in U.S. nursing homes, assisted living and other long-term care facilities through last weekend, according to the Kaiser Family Foundation — 33 percent of the national toll. All types of nursing homes, no matter their quality, have been hit, according to an investigation of Medicare’s rating system by The New York Times.

The troubles have intensified a spotlight on long-running questions about how communities can do a better job supporting people who need care but want to live outside an institutional setting.

Becoming more age-friendly

Demand for such care has declined sharply during the pandemic.

The occupancy rate in nursing homes in the fourth quarter of 2020 was 75 percent, down 11 percentage points from the first quarter, according to the National Investment Center for Seniors Housing & Care, a research group. The reduced demand was tied to Covid-19, deaths from the virus and a steep decline in elective surgery that requires follow-up care in a skilled nursing facility, according to the group’s research.

“We’ve been seeing increasing levels of calls to our member agencies and other community aging providers from people who have Mom or Dad in a nursing home or an assisted living facility, and now they want to get them out and bring them home,” said Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging.

The shift may not be permanent, but this much is clear: As the aging of the nation accelerates, most communities need to do much more to become age-friendly, said Jennifer Molinsky, senior research associate at the Joint Center for Housing Studies at Harvard.

“It’s about all the services that people can access, whether that’s the accessibility and affordability of housing, or transportation and supports that can be delivered in the home,” she said.

Job 1: Finding a place to live

A major shortage of age-friendly housing in the United States will present problems for seniors who wish to stay in their homes. By 2034, 34 percent of households will be headed by someone over 65, a jump from 26 percent in 2018, according to the Harvard center, and the share of households age 80 and over will grow even more rapidly.

Yet in 2011, just 3.5 percent of homes had single-floor living, no-step entry and extra-wide halls and doors for wheelchair access, according to Harvard’s latest estimates. “And that figure doesn’t say anything about walk-in showers or accessible kitchens that people need,” Ms. Molinsky said.

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