Professor Nina Kohn: Long-Term Care After COVID—A Roadmap for Law Reform
(Bill of Health/Harvard Law Petrie-Flom Center | June 2, 2021) Between May 2020 and January 2021, 94 percent of U.S. nursing homes experienced at least one COVID-19 outbreak. And nursing home residents — isolated from family and friends, dependent on staff often tasked with providing care to far more residents than feasible, and sometimes crowded into rooms with three or more people — succumbed the virus at record rates. By March 2021, nursing home residents accounted for a quarter of all U.S. COVID-19-related deaths.
The poor conditions in nursing homes that have been exposed by the pandemic are symptomatic of long-standing problems in the industry.
Fortunately, as I discuss in-depth in a new essay in the Georgetown Law Journal Online, there are a series of practical reforms that could readily improve the quality of nursing home care, in large part by changing the incentives for nursing home providers.
A key problem exposed by the COVID-19 pandemic is the danger of chronic understaffing in nursing homes. Low staffing levels — and especially low levels of nursing staff — predict facilities’ inabilities to control COVID-19 outbreaks and avoid fatalities.
The dangers of understaffing were an open secret long before the pandemic. Even before the pandemic, researchers had shown that most facilities lacked the staff necessary to avoid systemic neglect. Likewise, pre-pandemic nursing homes’ inspection reports provided ample evidence of facilities lacking the staff needed to care for residents (such as those needed to help residents eat without choking, maintain mobility, or simply stay clean. ProPublica’s database of nursing home inspection reports, for example, turns up scores of cases of residents with maggot-infested wounds and skin in the two years preceding the pandemic) …