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, the 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 thinking too much about it.” But after many families tried to provide home care during the pandemic, they found that leaving an elderly relative at home was a viable alternative.
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 nursing 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 the nursing homes, go there,” said Dr. 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 percent in recent years, according to the Kaiser Family Foundation.