By Melinda Young
When the COVID-19 pandemic hit in 2020, nursing home admissions plunged nationwide by about 20%. But the greatest decrease was seen by a nursing home care transition program designed to help veterans.
The Veterans Health Administration’s (VA) community nursing home program reported a readmission decrease of more than one-third from April 12, 2020, to Dec. 26, 2020, when compared with the same period in 2019, according to the results of a recent study.1
The results highlight a national problem with nursing homes that began before the pandemic, but has reached a crisis point since then, says Portia Y. Cornell, PhD, MSPH, lead study author and an assistant professor of health services, policy, and practice at Brown University. Cornell also is a health science research specialist at the Providence (RI) VA Medical Center.
“Our nation’s nursing homes are in trouble,” Cornell says. “They’re doing their best, but staff are burned out. They’re having trouble fully staffing nursing homes.”
To fix this problem, the nation will have to find a way to make sure nursing homes have the resources they need, including enough money to pay employees competitive wages. “It was a fragile system. In a lot of ways, it’s cracked under pressure, but we can’t abandon the system,” Cornell says. “We need to find a way to hold them accountable for quality care.”
A first step is to increase payments to nursing homes so they can pay staff a living wage. “We need to do better for older adults in this country, and one piece of that is to do better for nursing homes,” Cornell notes.
Cornell and colleagues focused on transitions to nursing homes during the first months of the pandemic, but the data also show nursing homes have not bounced back since the COVID-19 vaccine was approved.
“The short-term problems with the pandemic were infection control and COVID outbreaks, and now it’s turned into long-term problems of staff burnout and overall quality,” Cornell says.
While the early 2021 numbers for nursing home admissions improved over the April to September 2020 numbers, the last half of 2021 is not much better than the last quarter of 2020. “Even a whole year out after the pandemic became a national emergency, there’s still a much lower rate of admission to nursing homes,” Cornell adds.
Staffing is the biggest culprit in the crisis. “VA coordinators struggle to find nursing home beds,” Cornell laments.
It also is possible this shift away from hospital-to-nursing home transitions could be a long-term trend. Case managers and transitional care coordinators are finding new and creative alternatives to nursing home care. (For more information, see story in this issue on possible solutions to the nursing home bed crisis.)
“I suspect that another thing that may be going on is we’re seeing a shift in long-term care that may never go back to normal,” Cornell explains. “Case managers and discharge planners are finding ways and services to send veterans home, and there’s a slight shift in preference in trying to put together a plan for home care.”
It is possible nursing home use will never return to what it was before the pandemic as more people find services they need to stay home. “This is part of an ongoing study we had been doing to understand the community nursing home program at the VA,” Cornell says.
The program pays for long-term care in community nursing homes for veterans. Typically, the nursing homes are certified for Medicare and Medicaid and are privately owned. While veterans also could stay in VA-operated community living centers or state-operated veterans homes, these were not included in the study.
Cornell and colleagues wanted to know if the broader national trend of a decline in nursing home admissions and nursing home bed occupancy were reflected in the VA’s data about transitions from their hospitals to private nursing homes.
“We incorporated some questions and dialogue in talking with social workers and discharge planners on what they were seeing on the front lines,” Cornell explains. “We found that in that period right after the pandemic was declared a national emergency, nursing home admissions were 35% lower than the same period in 2019. The 35% was just among VA patients who needed long-term nursing home care and were eligible under the VA.”
Nationally, there was a 19.6% decrease in total nursing home admissions. “It is not totally unexpected. We’re all aware of what was going on in nursing homes in 2020,” Cornell says.
Investigators found several reasons for the decline in care transitions from VA hospitals to private nursing homes in the pandemic era:
• There were fewer available nursing home beds. VA nursing home planners, discharge planners, case managers, and community nursing home coordinators all said there were fewer nursing home beds available. Data confirmed this.
“Beds are a challenge,” Cornell says. “Some nursing homes had quarantines and had to reduce two-bed units to private rooms to isolate patients from one another, and they had problems being fully staffed.”
Nursing homes banned new residents during active COVID-19 outbreaks. Also, nursing homes attempted to isolate patients to protect them from infection. This meant they turned two-bed units into private units.
“There was a point where nearly all the nursing homes the VA contracted with were not accepting new patients because of outbreaks,” Cornell says.
• Veterans’ hesitancy and fear of nursing home care. “Our coordinators found that a lot of people really didn’t want to go to a nursing home if they could avoid it,” Cornell says. “They were worried about COVID-19, and some veterans and their family members canceled their [scheduled] nursing home care.”
They did not want to take a chance the veteran would contract the virus in a nursing home, so they would use home care or hospice care at home instead.
• Veterans left nursing homes. Some patients who already were in nursing homes left the facilities and opted for VA home care services.
“Some were even turning down home health, and other veterans didn’t want anyone coming into their homes,” Cornell says. “I think some veterans were ready to come home, and the pandemic was the extra push for them and their families. But it’s also possible that some veterans were trying to cobble together services, and it was a challenge.”
REFERENCE
- Cornell PY, Magid KH, Corneau E, et al. Decline in veterans’ admissions to nursing homes during COVID-19: Fewer beds, more fear, and finding alternative care settings. J Am Med Dir Assoc 2023;S1525-8610(22)00999-9.
The Veterans Health Administration’s community nursing home program reported a readmission decrease of more than one-third from April 12, 2020, to Dec. 26, 2020, when compared with the same period in 2019, according to the results of a recent study.
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