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Thursday, April 15, 2021


Solomon Center Roundtable Explores the Future of Long-Term Care in the U.S.

Yale Law School Windows

On March 11, 2021, the Solomon Center for Health Law and Policy hosted a virtual panel, “Long-Term Care Post COVID-19: Extinction, Transformation, or Business as Usual?” The event discussed the pertinent topic of the fate of long-term care in a post-pandemic world.

The panel featured Shawn Bloom, president and CEO of the National PACE Association (NPA); David C. Grabowski, Professor of Health Care Policy at Harvard Medical School; Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL); and Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care. Nina A. Kohn, David M. Levy Professor of Law at Syracuse University College of Law and Distinguished Scholar in Elder Law at the Solomon Center, moderated the event.

Kohn kicked off the discussion by posing the question to each panelist of what long-term care in the United States should look like in five years, and what it will actually look like in five years. Bloom highlighted the benefits of aging at home through community supports such as senior-designated housing.  Grabowski concurred with Bloom’s sentiments about the importance of implementing policies to support aging at home and blending housing with healthcare for seniors. Both panelists agreed that if more resources are invested into community-based care, then it will become a reality in five years. Parkinson emphasized that residents in long-term care facilities should be prioritized going forward, a lesson learned from the pandemic. Parkinson stressed that long-term care facilities should have improved infection control capabilities and increased registered nurse staffing levels. Smetanka emphasized the need for industry investments and identified the current pandemic as a window of opportunity for significant change to the system, specifically focusing on what the consumers want. These consumer desires include affordable care, access to quality care, and expansion of community-based services. The panelists’ overarching response was the need for necessary investments into the long-term care industry.

Kohn approached the topic of staffing concerns in long-term care, referencing a recent Politico piece written by Grabowski. The panelists agreed on the significance of increasing staffing ratios, however, there were varying opinions on the specificities of the types of staff as well as the avenues to achieve amplified staffing levels. Smetanka underscored the need for better training, wages and benefits, and working conditions for front-line workers to attract individuals into the field. Grabowski and Bloom echoed this idea, that the issue stems beyond minimum staffing levels, and while they need to be increased, the quality of the workers is vital. While Parkinson shared similar opinions, he cautioned against increasing staffing requirements without first considering external factors, including low unemployment rates and minimal margins of long-term care operators.

It is a common argument that poor quality of care is an outcome of low Medicaid rates. The panelists were asked to choose between additional funding to the sector or augmented control on where current financing is being spent. The majority of the panelists agreed that both choices are necessary, but there were polite disagreements on which choice should be weighed heavier. While funding is necessary to advance the long-term care industry, oversight of how money is spent is also a priority.

A concluding discussion question asked what a long-term care system would look like if we could start from scratch and build from the ground up. Bloom illustrated his vision as a value- based payment system with a strengthened continuum of care structure for seniors. Grabowski homed in on the operations of long-term care facilities and advocated for smaller facilities with individualized care, such as the Greenhouse Model. Parkinson also emphasized the Greenhouse Model and person-centered care, and agreed with Bloom that to accomplish a personalized care system, reimbursement methods need to change. Smetanka depicted her vision as concentrating on patient choice of where seniors want to live, the type of care they receive, affordability of their care, and community integration.

The panelists then answered questions from the audience regarding modeling long-term care facilities that maintained high quality care during the pandemic, resident care experience surveys to encourage consumer choice, and investments in training for caregivers. It is hoped that this will be the first of many discussions on improving the future of long-term care at Yale and beyond.