The grim reality of nursing homes under current ACA guidelines

As the number of seniors grows in the United States, more people are ending up in long-term care facilities as they enter the final stage of life. This result indicates that the quality of nursing homes should be relevant to all Americans, as most people will know a loved one that ends up in one, if not themselves. There is often a stigma against aging, and the US healthcare system tends to treat death as the enemy rather than an inevitable part of life. The crux of the problem is that the US chronically ignores and overlooks nursing home residents because people do not want to face their mortality. I noticed this neglect firsthand while volunteering at a local nursing home. Every Friday, I would join a group of Cornell University students in spending an hour with the residents. The environment was very sterile, but the people were colorful, and their conversations were fascinating. I spent most of my time with one resident in particular; she had a vibrant past and a wit that most people are lucky to hold onto in older age. She also tended to be a whistleblower on the conditions she lived in: anything from lack of options in meal choices to the loose following of COVID procedures. What makes addressing mistreatment in long-term care a complicated issue is how understaffed nursing homes tend to be, which creates a constant cycle of burnout and lower-quality care. 

The COVID-19 pandemic was a sobering reminder of how unequipped most nursing homes are to provide adequate care. The pandemic highlighted inadequate staffing, poor infection control, and failures in regulation. A stark statistic that demonstrates this neglect is that nursing home residents accounted for 19% of all COVID-19 deaths in the United States while only making up 0.5% of the overall population. The death rate for nursing home residents was 24 times higher than for people aged 65 or older outside of long-term care facilities. Clearly, something went wrong in the treatment of these patients. If the demographic were to be swapped for children, I wonder how the public response would have changed. One of the main roots of this poor health care is the misallocation of funding. 

Under Section 6104 of the Affordable Care Act (ACA), long-term care facilities have been able to exploit funding. This misallocation of money is largely caused by the overly broad categories of annual expenditures and a lack of administrative eyes on the yearly receipts. Related-party transactions are one of the culprits of this fraud, which allows for nursing homes to hide their profits in third-party expenditures. It is incredible that money-hungry individuals are still taking advantage of vulnerable populations in this modern day under the guise of providing a space that will keep them safe. The New York government implemented a mandatory staffing law for long-term care systems in the COVID-19 era during which these administrators still claimed that they needed more money to run their operations when the truth was that the funding was going straight into their own pockets. Something is sick in the system, but that does not mean we should lose hope for a solution. 

The government can and should make reforms to Section 6104 of the ACA to make financial accounting and reporting more transparent and accurate. If money is what administrators care about, then there should be monetary penalties imposed for lack of compliance with reporting standards. To ensure that records are truthful and correct, it would be beneficial to implement federal monitoring boards who could create a standard of conduct. To increase the accessibility of data, the Centers for Medicare & Medicaid Services should create a consolidated database in an easy-to-digest format and organize it by facility and chain. The reporting should also include disclosure of owners, to highlight possible related-party transactions which were prevalent in 75% of US nursing homes in 2015. The US needs to hold these long-term care facilities to the standards that one would be happy to live in because these places end up being the final home for loved ones and people held dear. This neglect and ignorance is another form of ageism that will not be tolerable as the senior population continues to grow and thrust more people into unjust conditions.