The COVID-19 pandemic revealed and exacerbated several challenges facing long-term care, or LTC, facilities, residents and staff. Despite LTC residents and staff making up less than 2% of the U.S. population, they have accounted for more than one-fifth of the nation’s COVID-19 deaths. Various studies have also found that, since the pandemic, LTC residents face high levels of loneliness and isolation, which can negatively affect their physical and mental health.
Defining Long-Term Care Facility
States license and oversee an array of facilities offering long-term services and supports to patients. These include skilled nursing facilities, assisted living facilities, nursing homes, residential care facilities (or board and care homes), intermediate care facilities for individuals with intellectual disabilities and more.
Patients and families have long preferred home- and community-based services over institutional care, but since pandemic, the number of nursing home residents decreased by 13%. More than 450 nursing homes have closed since 2020. Nursing homes cite financial hardship related to the pandemic and low reimbursement rates for care as factors contributing to financial pressures. A recent report found 81% of nursing homes receive less than the cost of care for Medicaid patients (which accounts for nearly 60% of nursing home funding).
Workforce shortages are creating challenges for LTC facilities. Around two-thirds of nursing homes are concerned their facility is at risk of closing due to persistent staffing shortages. Data suggests nursing homes have lost 241,000 employees—just over 15% of the sector’s total workforce—since the start of pandemic.
There is also a growing trend of private equity involvement with LTC facilities. One study (using Centers for Medicare & Medicaid Services data) found that private equity-owned firms operated fewer than 1% of skilled nursing facilities in 2005; the percentage increased to 9% by 2015. The authors also found private equity ownership was associated with higher charges for LTC services and fewer front-line caregivers, among other differences.
Given these concerns, states are considering various policy levers to ensure high-quality care in LTC facilities, including:
- Improving state licensing and oversight of ownership structures.
- Addressing direct care staffing shortages.
- Bolstering quality reporting, transparency and metrics.
- Enhancing state LTC ombudsman capacity.