Getting Nursing Home Care Right

Share on Facebook
Share on Twitter
Share on
LinkedIn
+

Pioneer Institute has long recognized that seniors deserve the best of care and that innovative policy solutions are necessary to ensure that this population enjoys a high quality of life in their later years. In the 1990s, early 2000s and most recently in 2017, the Institute dedicated Better Government Competition topics to policy issues related to aging in America. Our goal each time was to find solutions and to take advantage of new innovations that would improve the quality of life and care for the elderly.

COVID-19 has hurled intense, disproportionate and deadly challenges at seniors and their caregivers. Since the beginning of the pandemic surge in Massachusetts, Pioneer expanded its focus on nursing homes and the response of the Commonwealth to contain COVID-19 spread among seniors. We have looked at both the lack of state transparency and the substance of measures taken to contain spread. In both cases, transparency and substance, Pioneer found the Commonwealth’s response inadequately protected those in the vulnerable circumstances of long-term care facilities.

Some of our key recommendations include:

  • Oversight: Pioneer called on leaders to appoint an individual (preferably a public health expert, epidemiologist, or virologist) with sole responsibility for oversight and coordination of the responses of state agencies and nursing homes, reporting directly to the Governor.
  • Transparency: Pioneer called for increased public accessibility of data, including disclosure of COVID-19 case and death totals in absolute numbers by facility, and disclosure of whether a nursing home is accepting COVID-19 patients from hospitals.
  • Equipment: Pioneer recommended requiring nursing homes to maintain a stock of PPE (including gloves, surgical masks, N95 masks, hand sanitizer, booties, etc.), with state inspections and financing mechanisms to allow all homes to obtain it.
  • Testing: Pioneer called for regular COVID-19 point-in-time and surveillance testing among all nursing home residents and staff, including antibody testing for homes with significant outbreaks as needed.
  • Reducing spread: Pioneer urged requiring nursing homes to demonstrate their ability to form isolation units with adequate numbers of beds for infectious onslaughts as a prerequisite for continued operation.

The Boston Globe’s recent Spotlight Team coverage of COVID-19’s impact on nursing homes prominently quoted Pioneer Institute’s Barbara Anthony, who noted, “Holyoke was a microcosm.” The problem here is broad and continuing. Pioneer has been actively involved in this crucial topic from the start and will continue to advocate on behalf of Massachusetts elders and their families.

Below, we share more details about the problems identified, and the proposals prepared, by Pioneer staff around these issues. This list is illustrative, not exhaustive – and there is more to come.

  • Mary Connaughton’s April 17 blog, “Transparency Needed at Long-Term Care Facilities” was an early warning of the pandemic’s outsized impact in Massachusetts eldercare facilities, and an early call for transparency.
  • On April 20, Andrew Mikula’s blog, “Elderly People Were Already Vulnerable to COVID-19. Then it Came to Nursing Homes” again warned of the pandemic’s growing threat to Massachusetts eldercare facilities – “Senior living facilities are uniquely vulnerable to this pandemic,” it stated — and proposed concrete improvements, including staff education, isolation of residents, and reconfiguration of common areas.
  • On May 18, Greg Sullivan and Andrew Mikula’s report titled “Understaffing at Long-Term Care Facilities is Not Unique to the Holyoke Soldiers’ Home. It’s Embedded in Federal Standards diagnosed an important cause of the tragedy at the Holyoke Soldiers’ Home — weak federal staffing standards. This report received extensive coverage by, among others, the Boston Herald and MassLive, with related coverage quoting Greg Sullivan in outlets including WHDH and WCVB.
  • Barbara Anthony and Mary Connaughton’s May 20 WGBH Op-ed underscored deepening severity of the crisis, warned of “limited transparency,” and called for answers to core questions including “who in state government was/is in charge of the health and safety of long-term care facility residents and what lessons have been learned thus far?”
  • On June 2 Pioneer directly enhanced transparency, launching its online COVID Tracker for Long-Term Care Facilities, which gives the public key data from the state’s weekly public health report for 320 eldercare facilities in a user-friendly format.
  • On June 10, NECN/NBC Boston quoted Barbara Anthony on the “deplorable” failures to date, and the importance of changing course.
  • On June 28, Barbara Anthony, Mary Connaughton and Andrew Mikula issued a 7-page open letter to the legislatively-created COVID-19 Task Force about “the unique vulnerability of nursing home residents to the Coronavirus.” Among much else, it suggested 14 practical, near-term fixes including the appointment of one person with “sole responsibility” for eldercare issues. The Globe dedicated an entire article to this open letter — “Group Calls for Urgent Nursing Home Reforms Amid COVID-19” – and then ran a July 5th Editorial which focused on the letter and its “promising” recommendations, again quoting Pioneer’s Barbara Anthony.
  • August 11 brought Andrew Mikula’s account of a Pioneer records request for basic information about COVID-19 deaths among individuals with dementia in state-regulated facilities, which “potentially revealed shocking gaps in information on the facilities that the agency [DPH] oversees.”
  • David Clancy’s September 17 “A Step Backwards,” covered by the Boston Herald and the Berkshire Eagle, said the state is wrong to stop its daily reporting of cumulative data about the impact of COVID-19 on different age-groups, switching instead to weekly reports about age-group impact, based solely on the prior two weeks of data. The state should do both: report age-group impact on the basis of short-term data and cumulative data.

Get Our COVID-19 News, Tips & Resources!

  • This field is for validation purposes and should be left unchanged.

Related Posts

Massachusetts Should Disclose More Information about Its Recent Reduction in the Official Count of Long-term Care Deaths

The public -- particularly in Massachusetts, where COVID-19’s toll on elders has been so great -- has a right to know how many deaths occurred in state-regulated eldercare facilities, and how that compares to the total number of deaths. But the state's new counting standard clouds this information, and should be corrected or at least disclosed.

Preparing For Disaster: Health Readiness Expert’s Performance Review

Hubwonk Host Joe Selvaggi talks with Emergency Preparedness expert Dr. Paul Biddinger about how experts plan for disasters, and what went right and wrong in this pandemic.

COVID-19 Vaccine Tracker

Pioneer is proud to present a new vaccine tracker, the newest tool in our COVID-19 tracking project. Pioneer distilled the vaccination data down to those who are either fully vaccinated or partially vaccinated, by all the demographic categories published by the DPH. Use the new tool below to compare rates among groups, by municipality and by county. We will update the data every week.

Doctor Heal Thyself: Insider’s Prescription For Healthcare Reform

Host Joe Selvaggi talks with surgeon and New York Times bestselling author Dr. Marty Makary about the healthcare reform themes in The Price We Pay, the 2020 Business Book of the Year.  The discussion covers the value of price transparency, provider accountability, and performance information to drive better medical outcomes and improve doctor and patient satisfaction.

Patient-centered Model Outshines Insurance-centered Healthcare during Pandemic

/
Joe Selvaggi talks with Pioneer Institute Senior Fellow Josh Archambault about his newest research paper entitled, "Direct Health Care Agreements: A New Option For Patient-Centered Care That Costs Less and Reduces Provider Burn-out" and how this emerging service model provided its patients with comprehensive health service throughout the COVID-19 pandemic.

Study: Massachusetts Should Embrace Direct Healthcare Options

Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system.  One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid, according to a new study published by Pioneer Institute.

Pioneer Institute Statement on Governor Baker’s New COVID Restrictions

Read Pioneer Institute's public statement about Gov. Charlie Baker's new executive orders related to the state’s reopening plan that will go into effect on Nov. 6, issued in response to a significant uptick in COVID infections in Massachusetts,

Voting for Health: Party Opinions, Election Results & the Healthcare Policy Implications of Election 2020

/
Join Host Joe Selvaggi as he discusses with Harvard Professor Bob Blendon his New England Journal of Medicine Special Report, "Implications of the 2020 Election for U.S. Health Policy," which covers broad differences in both party’s view of the role of government in health care and what the election results will mean for Americans.

Hockey Sidelined Again

/
After months on the sidelines, youth hockey players across the state eagerly laced up their skates in August. Under current youth and amateur sports guidelines, locker rooms operate at 50 percent capacity, only one spectator should attend per player, and players wear masks on the bench. Unlike in MIAA high school sports, players do not wear facemasks while they play, except during faceoffs. 

Staving Off Disaster: Lessons from Covid Applied to the Epic Battle Against Drug Resistant Microbes

/
Join Hubwonk host Joe Selvaggi and Pioneer Institute’s Bill Smith as they discuss with inspirational public health advocate Gunnar Esiason the findings of his latest white paper, "Antimicrobial Resistance: Learning From the current health crisis to inform another."  The episode looks at the challenges to global health presented by evolving drug resistant diseases and how the lessons learned from COVID-19 could potentially save millions of lives.

Getting Nursing Home Care Right

Pioneer Institute has long recognized that seniors deserve the best of care and that innovative policy solutions are necessary to ensure that this population enjoys a high quality of life in their later years. In the 1990s, early 2000s and most recently in 2017, the Institute dedicated Better Government Competition topics to policy issues related to aging in America. Our goal each time was to find solutions and to take advantage of new innovations that would improve the quality of life and care for the elderly.

COVID-19 Transparency – A Step Backwards

/
Massachusetts has unfortunately taken the backwards step of ending its longstanding daily reporting of something basic and important: the virus’s cumulative impact on various age groups.

Drug Rebates: How Pharmacy Benefit Managers Manipulate Price & Limit Choice

/
Join host Joe Selvaggi and his guest Dr. Bill Smith as they discuss the complex incentive structure between drug manufacturers, health plans, and pharmacy benefit managers. In this episode, they focus on how drug rebates work and how a system intended to optimize value may actually deliver higher costs and fewer choices. Joe and Bill also use this framework to speculate on the price of a COVID-19 vaccine, and who will likely pay for it.

Confronting COVID Constraints: How Certificate of Need laws stifle innovation, increase costs, and reduce quality in healthcare

/
Join Joe Selvaggi and co-host Josh Archambault, Pioneer Institute's Senior Fellow in Healthcare, as they talk with Institute for Justice’s Jaimie Cavanaugh about the effects of Certificate of Need laws on the healthcare system.

Doctors Beyond Borders: Firefly Health Shines a Light on Virtual Primary Care

/
Join Hubwonk host Joe Selvaggi as he speaks with Firefly Health President Fay Rotenberg and Primary Care Doctor and Co-Founder Jeff Greenberg as they discuss the promise and potential of virtual primary care to deliver direct doctor access, price transparency, and more holistic healthcare that may revolutionize the healthcare system.

HHS COVID Funding Tracker

As of July, the Feds have distributed $86.7 billion to medical providers, of which $2.3 billion came to Massachusetts. Pioneer’s new HHS COVID-19 Funding app shows who and how much, from the $1 sent to American Current Care of Massachusetts, to the $418,034,675 sent to the MA Department of Public Health. We also break down the distribution by city or town.

COVID Transmission: A Scientist’s Insight on What Matters

/
Join Joe Selvaggi and Pioneer Institute co-host Bill Smith as they talk with Harvard Medical School’s Dr. Ed Nardell about his scientific observations on how the novel coronavirus is spread and what can be done to make our schools, buildings, and lives in public safer.

Foster Family Fixes: Serving Our Most Vulnerable Children with Foster Care Reform

/
Join Joe Selvaggi and Pioneer Senior Healthcare Fellow Josh Archambault as they discuss specific reforms that could improve the current foster care system. Josh shares findings from his recent research, as well as his experiences as a foster parent himself.

Pioneer Urges Future COVID-19 Study and Recommendations Task Force to Consider Impact on Nursing Home Residents

After over 5,000 people have died of COVID-19 in Massachusetts nursing homes, Pioneer Institute is issuing an open letter to the state’s future COVID-19 health equity task force that outlines an extensive list of recommendations on infection control and preparedness in eldercare facilities.