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Nursing home transparency needs more than Covid-19 case-counting

No understatement, these are very difficult times for nursing homes. First off, thousands of residents have died, and news media organizations are now obsessed with counting and re-counting, totaling up the numbers (more than 10,000 as of today) and then counting some more. So many of the 1.5 million residents of nursing homes were already very frail people, needing help with 3 or more ADLs. 72% of residents are women, most are age 85+, and as noted, 'many also have only a small group of family and friends for support.' Yet there are people who should know better lined up to bash their performance at managing this virus: "If there was any type of senior-care facility that should have been most equipped to manage the COVID crisis, it should have been skilled nursing facilities,” said Brian Lee, a former Florida long-term care ombudsman who currently is a member of an advocacy group called Families for Better Care." Right.

Closing the gate, now that the chickens have left. With all the publicity about terrible conditions in the nation’s nursing homes, owners, states and the federal government are galvanized into self-protective and resident-protective actions. In fact, the latest is an effort across multiple states to grant themselves immunity from Covid-19 civil lawsuits because of a 'shortage of PPE' – unlikely to have been stockpiled just-in-case prior to the crisis and onslaught of publicity. Meanwhile, a wave of nursing home ‘transparency’ directives emerges from CMS, the nursing home regulator. Most important? Identifying which nursing homes had Covid-19 cases. Add to that, state-by-state, the National Guard is being brought in to disinfect nursing homes or assist with Covid-19 testing.

But what is the standard of care and how is it measured? With such visibility, consider that none of these articles examine how nursing homes are measured. Consider the business structure of nursing homes – 70% of them are for-profit, many also under-staffed and under-supplied, and not just with PPE. Multiple of these owners also own the supplier companies that deliver nursing home goods and services which also contribute profit to the owners.  

Heat about transparency, but very little light.  More bad news from a recent survey underpins the staff shortages and problematic infection control procedures. Yet some nursing homes (including personal experience) are well-run – it would be useful if the rating system actually revealed that. At the moment, CMS’ five star rating system has a now-updated annual inspection process to check off whether nursing homes meet the individual elements that make up the rating. This AHCA observation was that the recent revision of the Five Star system would cause a slip in ratings, which might lead to consumer confusion. None of those changes or subsequent noise about nursing homes reflects either actual family satisfaction (see Yelp) or the current Covid-19 nursing home nightmare.  

So where is tech-enabled transparency in all of this? There are numerous reasons why individuals will continue to reside in nursing homes. Maybe technology-based changes could help with management, family visibility/oversight, and tracking of (better) quality measures in between inspections. Take the current data sets about Covid-19 infections, add complaints and other items well-documented over time. Combine staffing information, offer aggregate information about health status of residents, and create predictive analytics about where future issues may emerge. That could help families assess quality and also help management do a better job. Add tablets for residents and support camera-enabled tech for family chats, and consider wearables to better monitor health status. Identify volunteers who would check in online with residents who lack families -- maybe these volunteers would be even willing to come in (when that's again feasible) to be proxy family council members.


Laurie Orlov does a real nice job talking about not blaming but supporting senior care communities with tech-enabled solutions.


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