Warehousing America's Elderly

More than 1.4 million Americans reside in nursing homes. A few go voluntarily.  Most are placed in facilities by spouses or family members no longer able to provide around the clock assistance, despite their heroic dedication.  Costs are steep, the quality of care varies and abuse can be a problem.  

There are more than 15,500 Medicare and Medicaid-certified nursing homes nationwide. The Centers for Disease Control and Prevention estimates there are 1.7 million beds in licensed nursing homes.  The majority are small facilities with 61 beds are fewer.  About 70% are for-profit operations.

Typically, nursing homes provide assistance with daily living, including preparing meals, bathing, dressing and assisting residents to the toilet, managing medications and feeding residents. Skilled nursing is often available on site.  

Costs are an added stress for families.  A 2021 study by Genworth Financial, the most recent data available, found the average nationwide cost of care in a private room at a nursing home costs $108,405 annually, versus $94,000 for a semi-private room.  Costs vary by state but prices are towering. 

An estimated 80% of aged adults lack the financial resources to pay for two years of nursing care, reports a study by the National Council on Aging. The data shatters the myth that most seniors, especially Baby Boomers, have the financial resources to pay for nursing care.    

Only 12.6% of seniors have long-term care insurance to cover the cost. Medicare pays for the first 20 days at a skilled nursing facility. Many seniors are forced to sell their homes, cash in insurance policies, drain savings and bank accounts.  Often the money runs out while they are in the nursing home.  

A report by the National Center for Health Statistics documented that 83% of nursing home residents are 65 or older.  However, 38% are 85 or older and 26% are between the ages of 75 and 84.  Nearly one-half (49.1%) have Alzheimers or another form of dementia. 

About 818,000 Americans reside in assisted living facilities, which offer less care than nursing homes because patients are usually mobile and able to perform general hygiene.  About 18% of assisted living facilities have a dementia unit and 11% serve only patients with dementia or Alzheimers.  

Research published by the National Institutes of Health (NIH) found patients in long-term care settings are at high risk for abuse and neglect.  Physical abuse may include hitting, slapping, pushing or striking patients with objects, according to the research. Incidents of theft too often occur at a facilities.

Oversight of facilities is spotty at best.  The Centers for Medicare and Medical Services (CMS) is tasked with broad oversight. State regulators, licenses and inspects skilled nursing homes. Significant  violations of standards, may result in a state rescinding a facility's license.

Statistics are a sterile view of the nursing home industry.  Your reporter has seen first-hand the level of care at facilities where family members were housed.  These observations are admittedly unscientific, but most have been collaborated by others with loved ones in nursing homes.

A heartbreaking issue for patients being warehoused: About 7 in 10 receive no visitors. Ever. These poor souls are lonely, frail and virtually shackled to their beds.  They stare vacantly at a small television.  It is an existence in name only.  

It is gut-wrenching to watch patients waiting to be fed, their heads slumped down on tables.  Staff is too busy with other patients, which means some residents wait an hour or more for a meal.  Even those who can feed themselves, are not served in a timely manner in the dining area.  

The meals may include the minimum daily calories and dietary proteins but at the expense of appetizing food. Patient complaints about meals are disregarded as the ramblings of a grumpy old people. If staff were forced to eat the same meals, it would make a difference in quality and variety.

Patient rooms, even the private ones, are spartan and void of color. Wafer thin mattresses on the beds and lumpy pillows are standard. Some patients have televisions, but in many facilities the TVs are provided by the family.  The smell wafting from some rooms testifies to the lack of constant cleaning.

These conditions exist, despite dedicated, trained staff. Facilities are nearly always understaffed.  COVID dealt a devastating blow to nursing homes, killing more than 200,000 residents and staff, according to the Kaiser Family Foundation. 

Isolation protocols forced staff to work excessive long hours, which caused burnout, triggering a worker exodus at many facilities.  As of the fourth quarter of 2022, the annual turnover rate at a nursing home was 53%. One-quarter of facilities reported turnover rates greater than 64%. 

Industry experts estimates there is a shortage of 200,000 nurses at long term care facilities. Recruiting firms forecast it may take five years or longer to reach pre-2020 staff levels.  The workforce problem must be addressed to improve care at nursing facilities.

Another issue is economic.  Although Medicaid pays for most patients' care, the government program reimburses facilities only 86% of the costs for a patient.  Nearly half of nursing homes are losing money, according to the American Health Care Association (AHCA).

As a result, the number of nursing homes is dwindling. An estimated 300 closed in 2020 and a combined 400 went out of business from 2021 to 2022.  This year already 135 facilities shuttered their doors.  These statistics were culled from reports by the Centers for Medicare and Medicaid.   

Understaffing and economics aren't the only problems. With so many aged adults unable to afford more than two years of nursing care, Medicare and Medicaid are ill equipped to provide the safety net for the elderly. Both programs face financial shortfalls and prospects are dim for a short term fix. 

Nothing short of an overhaul of the nursing home model is required for America to meet the needs of a population living longer.  By 2030 more than 73 million Baby Boomers will be 65 or older. In 2035, the number of Americans 65 and older will outnumber those 18 years old and younger. 

Congress can help, but often Washington's heavy hand leads to regulations that add costs and disincentivize the adoption of technology and innovation. Throwing money at a problem without a coordinated plan leads to wasteful spending, fraud and misapplication of funds. See COVID spending. 

This issue requires an all hands of deck approach.

Solutions must involve the long term care industry, state governments, Medicare, Medicaid, nursing schools and organizations that represent seniors.  The technology industry has a role to play also. One solution to the staffing shortage is to use wearable devices to monitor patients. 

Alarm bells are sounding. Urgent action is required to prevent long term care from erupting into a national crisis. Up to now, the siren call is being ignored, putting in peril millions of elderly Americans.