Long Term Care After Covid-19

Connecticut has one of the highest death rates of nursing home residents in the United States. Over 28,000 in the US and based on news reports nearly 500 in Bristol alone. This is a tragedy resulting from avoiding long term care policy changes. It is unacceptable. Grandparents or parents dying without the comfort of their loved ones is extremely agonizing to the person dying and their families.

Nursing homes as we know them simply cannot cope with the wildfire spread of a virus like Covid-19. Nearly every resident is at the age and physical condition where they are prime targets for the virus. The close living spaces make distancing extremely difficult. And lack of testing and personal protective equipment makes such close living ripe for disaster.

Although Connecticut has been ahead of the national curve in providing funding for
home care, nursing homes have still been a huge part of care using licensed Medicare and Medicaid facilities to give care based on a medical model. With Covid-19, nursing homes are understandably reluctant to take in people who have been discharged from a hospital. Coupled with that, nursing home regulations have been declining over many years, even though our elderly population is rising. The cracks in the system are now plain to see. What are some solutions? In the near future, financial help must be provided to nursing homes, and the federal government has provided some aid. In the long term, policies to enhance homecare are crucial.  Connecticut recognized this years ago and is one of the states that has provided funds to pay for long term care at home, either by home care companies or family members themselves. Medicaid will pay a licensed company up to $5945 per month for home care. In some situations that could result in a live-in aid. The Adult Family Living Program will allow payment to family members, to get paid up to $2000 per month which is a tax-free stipend. A different program called the Personal Care Assistant program can pay up to $5945 per month for a person chosen by the family to give care. That person is paid through a company called Allied Community Resources. But that is not solving the entire problem, because many family members either do not live nearby or can’t afford to give up their jobs. That means some type of residential options must be available.

What is needed is a much smaller scale of self-contained housing without the crowding of large institutions. This gives separation for a future health crisis. In the Netherlands there is a model of such small-scale, long term care called “Dementia Village.” People live in the equivalent of small three or four family units and the caretakers can manage several units. This helps contain the spread of infections, viruses, and disease. This model has been extremely effective in protecting the elderly from Covid-19. In the near future we will have a virtual meeting with Eloy van Hal, the founder of “Dementia Village”, to learn how that model could deliver safer and better care. Just throwing money at a problem or piling on more regulations is not the simple answer. Connecticut has been a leader in providing for home care. But it is painfully obvious that nursing homes as currently configured cannot be the major answer. Hopefully, as we emerge from the virus affecting us, the overall strategy, regulations, and funding will change to provide a wider range of in-home care and institutional care with much less reliance on nursing homes.