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Patricia Sadoski: Health care for seniors in the U.S. is broken

Fines for nursing homes that don’t meet standards threaten to make the problem worse.

(John Minchillo | AP photo) In this April 17, 2020, photo, a patient is loaded into an ambulance by emergency medical workers outside Cobble Hill Health Center in the Brooklyn borough of New York. More than 9,000 recovering coronavirus patients in New York state were released from hospitals into nursing homes at the height of the pandemic under a controversial order that was scrapped amid criticisms it accelerated outbreaks, according to records obtained by The Associated Press.

Health care for seniors in the United States is broken. If you are a senior or love a senior who might need a nursing home or are unable to live alone safely any longer, you may rely on a nursing home for your last months or years. Or you might need a nursing home because dementia has become the hurdle to your elderly parent’s remaining in the home. Our current system in the United States is severely “wounded” and almost on life support. Its regulatory oversight and reimbursement structure is uniformly ineffective and inefficient.

To fully understand the oversight of this profession, one needs to understand the funding. Approximately 57% of persons in a nursing home are funded all or in part by Medicaid, a state funded program. About 14% is reimbursed through Medicare, a federally funded program. The remaining 29% are paid by managed care programs, insurance and individuals paying privately.

As the primary source of funds are through state and federal programs, oversight is standardized and regulated. There is a standard of care that is expected of these facilities and the oversight is managed by each state. Oversight includes safe practices, building safety and requirements and staffing standards. Whether a nursing home is a for-profit or a not-for-profit, the basic standards are the same. In the United States, 67% of nursing homes are for-profit entities.

Staffing nursing homes requires licensed nursing supervision and certified nursing aides, to be in the facility 24 hours a day. Therapists as well as food service workers, activity specialists, social services and housekeeping services are among other positions often found in a licensed nursing home. Much of the care of the senior is provided by certified nurse’s aides.

For those who may be unaware of what it takes to be an aide in a nursing home, I will inform you. They need to know how to communicate kindly and effectively, how to physically move a person in a safe and comfortable manner, and how to bathe, assist with meals and dress a person who can’t dress themselves. And they need to have a basic understanding of how to prevent the spread of disease as we discovered with the pandemic. It is often emotionally and physically exhausting. However, the rewards this hard compassionate work provides to these dedicated workers is valued and loving friendships that can only come through service.

Think for a minute how the COVID-19 pandemic has altered your personal life over the last two years. The nursing home profession has evolved, too. Nursing homes are where some of our most vulnerable adults live and are dependent on others for their care. Nursing homes desire to have adequate staff and strive to find those who can assist in the day-to-day care of their residents.

Prior to the worldwide pandemic, it was difficult to effectively and efficiently staff nursing homes. Since the pandemic, the nursing homes have not been exempted from the significant staffing crisis that plagues our nation. Many nursing homes struggle to appropriately staff and to safely cover the resident needs. Some close beds so their limited staff is not overwhelmed.

Now in an effort to “push for better care and oversight,” the federal entities are proposing steep fines for institutions that do not meet the minimum requirements. The penalties, if instituted, will put many facilities out of business further compounding the need to care for the aging population. This is wrong!

Would it not be better for all concerned to look at the industry as a whole and revamp it? Improve the reimbursement structure so nursing facilities can adequately recruit qualified individuals to care for our vulnerable seniors. With the proper attention given to this, more individuals will want to choose this profession as a career. This will also positively impact the quality of care and quality of life nursing home residents receive. Let’s give higher status to our seniors.

Let’s support nursing homes in their efforts to create places of safety, positivity, warmth and understanding. Where we give back to our seniors and honor them for a life well-lived.


Patricia Sadoski, Logan, is a retired nurse and senior advocate.

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