But Americans with family members in nursing homes believe they deserve praise in this crisis and more funding in the future

By John Ashford, Chairman and CEO, the Hawthorn Group and Joe Perkins, President and Senior Consultant, Matrix LLC

Facing unprecedented peril to their health, way of living and economic future, Americans struggle with whom to blame for the COVID19 virus. Nursing homes and assisted living facilities are a prime target, yet people who have actually experienced and observed the struggle of administrators and staff members to cope with the disease give them high marks.

The challenges facing nursing homes stem from long before COVID-19. In one state, New Jersey, the average daily Medicaid rate a nursing home received from the government was $208.64 compared with a projected actual cost of $255.76, according to a 2017 survey. That’s a daily loss of $47.12. Who can sustain a business like that? And the $208.64 comes with three meals a day with medical care. How many hotels could one have found in New Jersey with three meals a day at that rate? Maybe a free breakfast at Motel 6?

Many nursing home residents would remember the plate spinner on the Ed Sullivan Show, but may not remember his name — Erich Brenn. He would start spinning one plate and then add one after another, trying to keep all spinning without suddenly all falling off.

That’s where nursing and assisted living homes have been. Trying to juggle low government reimbursement rates, high real estate and insurance costs, and increasing daily costs.

Now they suddenly face an unknown, frightening disease with devastating effects on both residents and caregivers. With enormous new costs, decreasing numbers of new residents due to COVID-19 fears and staggering fatalities in some cases.

We polled 1,677 voters in seven states with a wide range of political affiliations and state funding policies — Alabama, Connecticut, Michigan, Pennsylvania, Missouri, Florida, and New Jersey.

While the polling indicated deeply conflicting attitudes toward nursing homes, one outcome was clear — the nursing home industry is at a knife’s edge. Public opinion is still unformed. There is a mix of anger and sympathy. But opinion will move in one of two opposite directions — toward an understanding that nursing homes faced an impossible situation and need more help, or that they are fundamentally to blame for deaths under their watch and must face regulations that will have a transformative and potentially harmful impact.

Most assuredly, there are some long-term care facilities that do an excellent job while the performance of others may be questioned. But the COVID-19 pandemic has proven that even the best practices in nursing home care cannot cope with the insidious threat of the virus. A vital industry, underfunded from the beginning, is facing an uncertain future.

The industry must define its future agenda and make reforms, or government will do so in its place.

In our polling, 55% of those polled in the seven states have a more negative opinion of nursing and assisted living homes than they did before the pandemic. Forty-one percent believed nursing homes and long-term care providers are to blame for COVID-19 outbreaks within their facilities, and yet a sizable minority (59%) believed such outbreaks were inevitable with so many high-risk individuals confined into relatively small spaces.

But most interesting, the more experience people have with nursing homes, the more positive they feel. Those polled with a family member currently in a nursing home are much more positive in their perspective. They are twice as likely to have a positive attitude toward them. (23% vs 45%).

And as state and federal governments relook at liability limitations for nursing homes and their insurers, a strong majority — 62% — of those polled who have recently visited a nursing home believe they should not be held legally liable for COVID-19 outbreaks in their facilities.

Clearly, familiarity with nursing homes means coming to know the staff and administrators who have worked hard and risked their health and lives to serve their residents. People with elderly parents in such homes see for themselves the dedication of the staff members who provide care.

When faced with sharply divided opinion and potential regulation that could do great harm, what should the nursing home and assisted living industry do?

  • First, build an understanding of what nursing home caregivers face everyday coping with the COVID-19 virus. We rightfully applaud and sing out for the hospital caregivers and first responders every evening.

Nursing home caregivers also show great caring and bravery in their work every day. Against enormous odds, they go to work every day, feed and care for elderly residents at risk, and return again the next day. They are heroes and deserve our recognition.

  • Second, recognize that many nursing homes were not adequately prepared for the COVID virus, along with governments, hospitals, and virtually everyone else. Make an ironclad commitment to have the needed protective equipment, testing procedures, and training to be prepared for a new surge of the virus over the winter or the next pandemic, whenever it hits us.
  • Third, demand adequate funding to provide superior care. If there were ever a time to reconsider antiquated funding formulas, it is now. Identify those who understand the challenges nursing homes face and build their support. Force government to be part of the solution and not the problem. The last thing the industry needs is additional regulation that increases costs, throws more facilities into bankruptcy, and interferes with the delivery of care. Step up now or others will.

Crises define us. We learn and change, or we withdraw and allow things to get worse. Nursing homes have paid a price during this crisis in many ways including public opinion. But these caregivers have a reservoir of goodwill that they can build upon for change that will benefit us all.


Author bios

John Ashford

Once a country-and-western disc jockey, John Ashford is Chairman and Chief Executive Officer of The Hawthorn Group, L.C., the international public affairs company he founded nearly 30 years ago.

Ashford is a graduate of Missouri Valley College (B.A., magna cum laude, 1971) and received his Masters in Public Administration from Harvard University’s John F. Kennedy School of Government (1991).

A specialist in crisis management, his public affairs clients include international industry leaders in healthcare, higher education, energy, manufacturing, finance, and consumer products.

Joseph W. Perkins, Jr., Ph.D.

As President and Senior Consultant of Matrix LLC, Dr. Perkins has played a major role in Alabama elections and issues of public policy for more than 30 years, managing more campaigns during that span than any other individual

in the Southeast. A recent Atlantic Monthly article referred to Perkins as one of the few political consultants to have defeated Karl Rove. Additionally, Perkins directed the first successful effort to elect an African-American to statewide office in Alabama. He is often called upon to advise universities and companies on crises with a potentially profound impact on their future.