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It is time for a discussion about end of life care homes



Adapt is pushing for nursing homes so residents can walk by themselves and find safer homes in the community. “If the local care facility were on fire, we would hurry to get people out. If a hurricane came, people would be asked to evacuate and get to safety. But what is happening is […] We watch people die in these facilities and we don’t do anything about it, ”says Darling.

The organization also has a more ambitious goal: Adapt has long called for the removal of most long-term care facilities. They argue that long-term care facility residents often end up there not because they want to, but because they have no other viable options. Very often there is a higher risk of illness. Even before the pandemic, between 201

3 and 2017, 82 percent of U.S. nursing homes were listed at least once for lack of infection prevention or control, according to the US Government Accountability Office. And it’s not just the “bad apple” nursing homes that have been hit hardest by Covid-19. Data suggest that nursing homes with low ratings as determined by the Centers for Medicare & Medicaid Services are doing well just as good (or bad) like everyone else.

Instead of accommodating people in gatherings, Adapt and other activists argue that better results can be achieved by supporting people in homes with small groups of two to four, or, even better, by supporting them on the spot. Mike Ervin from The progressive, pointed out to me that most of the data indicate that home care is cheaper in the long run than nursing homes. For example, the Money Follow The Person program has shown that overall Medicare and Medicaid spending decreases by an average of 20 percent when someone moves from a care facility to the community. Even if it wasn’t cheaper to deinstitutionalize, Ervin argues that it would still be the right thing to do. “What if it were more expensive? That doesn’t mean that they deserve to be locked up because something costs more money. “As disability advocate Alice Wong recently wrote,” Freedom to live in a community is a human right. “

The concept of accommodating aging and disabled people in largely private facilities like this has not been around for too long. By the mid-20th century, older people were more likely to spend their final days in “rest homes” such as the Winchester Home for Aged Women in Charlestown, Massachusetts. These tiny facilities generally housed 30 to 50 people, often with similar economic and social backgrounds, and were generally run by philanthropists. Nursing homes as we know them today only really started in the 1950s, when the Hill-Burton Act allowed public funds to be used to build them. Between 1960 and 1974, the country’s spending on nursing homes increased by 1,400 percent. An article from 1969 in Barrons noticed the boom:

Lately… [a] The stock market seems to be seizing on a kind of frenzy when these magic words are simply mentioned: “convalescence care”, “extended care”, “continued care”. All euphemisms for the services provided by nursing homes represent the hottest investment around today … “Nobody,” said a new underwriter recently, “can lose money in this business. There is simply no way.”

Today, the home nursing home industry is huge. According to the CDC, there were 15,600 facilities in 2016, of which about two thirds were profit-oriented. According to a market research company, global long-term care business will be worth $ 1.7 trillion in 2027. In the United States, nursing home lobbyists have already begun looking for immunity to lawsuits related to Covid-19, and billions of federal funds have called for funding and resistance to additional oversight and regulations that may be imposed on them.

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As stories of nursing homes emerge around the world that falsify their response to the coronavirus, Adapt and other advocates hope this could be a moment to consider how the industry could be improved. The organization hopes that Congress will consider incorporating the disability integration law – which protects the right of disabled and older Americans to live in the community – into future Covid 19 relief laws.

As we face a long and uncertain road to recovery, it is unlikely that nursing homes will be completely safe for residents or employees in the near or even medium term. And as we saw in the current outbreak, only one infected person is required to decimate an entire community. “Even if it is not widely distributed in public, it will still be a problem for us in nursing homes,” says Darling.




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