The coronavirus pandemic and the fast-moving federal response to it is upending long-standing rules and practices for caring for older adults. Some changes will be incredibly disruptive, while others may increase support for vulnerable seniors. Here are some of the ways they are affecting how we care for our parents.
No more nursing home visits. Just a week ago, the Centers for Medicare and Medicaid Services (CMS) announced that nursing homes, skilled nursing facilities, and assisted living facilities (ALFs) should discourage visits and screen visitors. That has now changed. Last Friday, at the urging of the nursing home industry, CMS required facilities to temporarily ban all family and other non-medical visits, except when a resident is dying. It also is prohibiting group activities and communal dining.
In effect, it means that residents of nursing homes and patients in skilled nursing facilities are in lock-down. These steps may significantly reduce their risk of contracting COVID-19, the disease caused by the novel coronavirus. But it also means they’d be more lonely and bored, and more likely to become depressed or anxious. And, just as troubling, they’ll have no family members around to advocate for them. While residents still can communicate with loved ones by phone, Facetime, or Zoom, families will effectively be blind to the quality of care their parents or spouses are receiving.
The federal guidance applies only to nursing facilities. CMS does not regulate ALFs. However, some states and many ALFs are adopting similar visitor prohibitions.
Waiving the three-day rule. Medicare only pays for rehab or other care in a SNF for patients who have first been admitted to the hospital for at least three days. At the same time, CMS has been pushing hospitals to discharge people quickly or treat people as observation patients, where time does not count towards the three-day rule. Thus, these patients are responsible for all the costs of their post-acute care.
CMS has now temporarily waived that rule for patients who are affected by COVID-19. Thus, Medicare will pay for their SNF care, up to the normal limits. What does affected mean? CMS says it includes those discharged from a hospital to make room for more seriously ill patients, or those who “need SNF care as a result of the emergency.”
Patient advocates and the nursing home industry have been lobbying Congress for years to reverse the three-day rule, but to no avail. This regulatory change is only temporary, and applies only to some patients, but advocates hope it will be the first step toward permanent change.
Senior centers and adult day programs are closing. These critical supports for frail older adults are being temporarily shuttered to increase “social distancing” The fear: Older adults who spend time together in centers will increase their risk of contracting COVID-19. Thus, local governments are closing the centers they run and urging (or ordering) private operators of day programs to shutter their facilities.
Without these programs, older adults risk social isolation and may not receive needed exercise or meals. Some are at least trying to deliver meals to their participants. The closures also will increase pressure on family caregivers, who rely on these programs for much-needed respite.
While the closings are supposed to be temporary, they will put the organizations that operate them in severe financial risk.
More food aid. The House-passed Families First Coronavirus Response Act provides $250 million in extra funding for home-delivered meals through Senior Nutrition programs. The meals would go to low-income seniors who are home-bound and have disabilities and multiple chronic illnesses; as well as their caregivers. This also may help those who lose access to meals from senior centers and adult day programs. The bill still must be approved by the Senate and signed by President Trump.
Medicaid. The same legislation also would temporarily increase federal funding for Medicaid, the leading payor of long-term care services for fail older adults and younger people with disabilities. More funding should help keep those programs operating despite the increased financial stress from COVID-19.
Worsening the shortage of personal care aides. The pandemic will increase demand for aides even as it shrinks the supply. There already is a severe shortage of aides. Coronavirus will make it far worse.
Demand will rise. In facilities, more robust infection control will take more time and require more staff. The no-visitor rules in nursing homes will encourage some families to keep loved ones at home, which will require more home care aides. Decisions to close senior centers and adult day programs will mean more families will need to hire personal care aides, though some family members who lose their own jobs may take up some of that slack.
This is happening at a time when personal care aides already are in short supply. Now, aides will have to take time off to care for their own children since so many jurisdictions are closing schools and childcare programs. Some aides will inevitably get sick themselves or stop coming to work because they fear becoming ill.
Finally, President Trump’s immigration policy, especially his “public charge” rule, will keep potential aides out of the US labor force. That rule prohibits immigrants from getting green cards to work in the US if they are likely to require government support. And because aides are paid so little, many rely on Medicaid or Food Stamps (SNAP).
Eventually, the coronavirus pandemic will wane. But in profound ways, it may already have changed the way we care for our parents.