Evidence Base for the Future of Nursing Homes: Special Issue

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

In the July 12, 2022 edition of Innovation in Aging, you’ll find this interesting article – same title as this blog.  It’s an interesting read.

“After decades of exposés, special commissions, and advocacy, the moment has arrived to commit to making the residential nursing home a good place to live (National Academies of Sciences, Engineering, and Medicine, 2022). The modern American nursing home, an unexpected creature of the Medicaid and Medicare programs, has evolved to provide neither a comfortable, functional “home” nor reliably excellent “nursing” (Grabowski, 2022). The COVID-19 pandemic has amplified the impact of nursing home shortcomings with respect to safety, clinical quality, racial and ethnic disparities in care, mental health, and resident well-being. The horrendous death toll for nursing home residents and staff, 15.4% of U.S. deaths by April 2022 (Centers for Disease Control and Prevention, 2022; Centers for Medicare and Medicaid Services, 2022), has shocked the nation, as have reports of devastating resident isolation and staff despair.

Sadly, these shortfalls come as no surprise to researchers, advocates, and policy makers who have been grappling with them for decades (Fashaw et al., 2020; Harrington et al., 2019; Hawes et al., 1997; White House, 2022; Wiener et al., 2007). But although previous research has uncovered what does not work in nursing homes, policy and practice have not been able to solve the problems of inconsistent clinical quality, disparities in care, high cost, and poor quality of life. Because these deficits seem so intractable and are sometimes seen as inherent in the nursing home setting itself, avoidance of the nursing home has become the main strategy of policy makers and consumers alike: in partnership with Centers for Medicare and Medicaid Services, state Medicaid programs have worked diligently to “rebalance” toward community living and away from residential long-term services and supports (Bernacet et al., 2021; Eiken et al., 2018; Kaye & Harrington, 2015), and consumers express strong preferences for care in community settings rather than in a nursing home should they become disabled. In a recent survey conducted by AARP, only 2% of people age 50 and older would prefer to receive care in a nursing home (Harrell et al., 2014; see Kasper et al., 2019).

Unfortunately, community living is not optimal for everyone. Given the current state of housing inequity, uncertain capacity of family carers, and home care workforce instability, some individuals with substantial functional limitations are likely to find that a nursing home, or a setting that has many nursing-home-like features, is their best choice (Bishop & Stone, 2014). By shining a spotlight on nursing homes, the pandemic compels us to ask: If we can see what is wrong with nursing homes and accept that we will need nursing-intensive residential services for the foreseeable future, what should be done? The time for simply exposing quality and access problems is long past. Families, payers, and governments must act to make good nursing home care available to those who need it.

This Special Issue of Innovation in Aging seizes this pivotal moment. It showcases empirical research for an evidence base to make the nursing home care of the future a preferred setting for older adults with functional deficits. The articles contribute to an agenda for policy and practice to improve the quality of nursing home care. Quality in the nursing home setting is multidimensional, and the articles address quality in several ways. Three articles (Bowblis, 2022; Kishida, 2022; Sharma & Xu, 2022) focus on adequacy and stability of staffing, a basic requirement for structural quality. Another group (Carnahan et al., 2022; Cross & Adler-Milstein, 2022; Davitt & Brown, 2022; Hass et al., 2022; Ninteau & Bishop, 2022) discuss aspects of clinical care that should be targets for improvement and regulation. And a third group (Grabowski, 2022; Morris et al., 2022; Shippee et al., 2022) take us beyond what is currently measured and regulated to investigate factors affecting meaning and quality of life for nursing home residents.”

[Note: I’ve bolded the verbiage in the paragraph directly above to further whet your interest in reviewing this special issue. Please review the information cited – you’ll have access to those links, in parens, within the editorial itself. Certainly, food for thought.]

The editorial goes on to discuss these topics:

  • Managing and Regulating to Support a Stable Nursing Staff
  • Improving Clinical Quality
  • Advancing Equitable Access to Resident Quality of Life