Pandemic Brings Opportunity To Reexamine Care For Seniors

A woman walking along a brick path with a walker, wearing a bright blue jacket and a face mask.
The McGregor Foundation's PACE program provides senior enrollees with rides to medical appointments. [FamVeld / Shutterstock]

The coronavirus pandemic has hit elderly populations particularly hard, especially those in nursing homes and long-term care facilities.

In the height of the COVID-19 pandemic, vacancies in nursing homes and long-term care facilities were on the rise as patients sought to avoid the virus. But many struggle to afford the same level of care from home.

The pandemic has given new momentum to a local program helping older residents stay in place.

The option to stay home was important to Cleveland-area resident Brenda Brown when she received a positive cancer diagnosis 14 years ago. She enrolled in the Program for All-Inclusive Care for the Elderly (PACE) through the McGregor Foundation.

“I was very ill at one time and unable to really take care of myself, and it was kind of hard for the family to give me the care that I needed,” Brown said.

Through PACE, patients receive care and transportation to in-person appointments with eye doctors, dentists, general practitioners and other medical specialists. The program aims to provide a way for people to stay in the community and still receive medical care for whatever they need.

During the pandemic, Brown said, she’s been able to receive all the care she needs remotely.

“If I'm sick and I can call them and they’ll send a nurse to the house,” Brown said. “If the nurse thinks that I need to go to the hospital, they send me to the hospital.”

Without programs like PACE to provide full comprehensive services, just one accident or medical issue can result in moving into a long-term care facility, said McGregor Foundation President Ann Conn.

“They don't have the overall system to support them,” Conn said, “when really they just needed to make sure they got those preventive services to keep them stable in the community.”

The PACE program is for patients enrolled in Medicare and Medicaid, Conn said, so it provides an option even for those at low-income levels. And for those who are interested in transitioning to live-in care, Conn said, the program offers ways to help make that move simpler.

A report from the Center for Community Solutions (CCS) found about 97 percent of enrollees in the McGregor PACE program were satisfied with the service. The report also found expanding PACE to other areas of the state could be beneficial for a vulnerable demographic.

The need for these programs is more evident now, said CCS Executive Director John Corlett, as 54 percent of all coronavirus-related deaths were from long-term care facilities.

“I think what kind of crystallized things for us last year was the horrible toll that COVID took on older adults who lived in nursing homes or assisted living facilities,” Corlett said.

Moving into a nursing home or assisted living facility can mean giving up certain freedoms and losing some social connections, Corlett said. Community-based care programs are a possible solution for those who wish to stay independent and involved, he said.

Occupancy is down for a few reasons, Corlett said. The first is that fewer people are getting outpatient surgeries that result in the need to recover in a skilled nursing facility, he said, and the second is concerns about safety. The shift offers an opportunity to reexamine the current system, he said.

“Rather than trying to fill nursing homes back up, we should be boosting support and resources for home- and community-based services for the elderly and for persons with disabilities,” Corlett said.

Long-term care has shifted over the last 20 years to favor at-home care, said Bob Applebaum, director of the Ohio Long-Term Care Research Project at the Scripps Gerontology Center at Miami University. The high vacancies in nursing homes were exacerbated by the pandemic, he said, but they might start to level out as family members return to work.

“That's going to place pressures on families to not be able to care as much at home,” Applebaum said. “I do think that facilities will bounce back to some extent.”

Right now, nursing home occupancy is hovering around 70 percent, Applebaum said, the lowest he’s seen in his 35 years of research. The state has an adequate supply of beds to meet the demand, he said, so there’s the potential to expand in-home care options and give people choices to let them figure out what works.

“More and more people are choosing the community-based alternative for care, and that's great,” Applebaum said. “But most importantly, we want people to be able to choose and to plan where they want to live.”

The PACE program is currently limited to the Cleveland area, Conn said, but they’d like to expand to cover additional cities.

“We've seen quite a bit of interest from individuals, obviously, when there were restrictions on visitation for nursing homes and assisted living,” Conn said. “If people could stay in their homes, that's where we want to stay.”

Last week, the Centers for Medicare and Medicaid Services released guidance for states to apply for more than $400 million for home and community services like those from PACE. That funding could help to provide more support to people like Brenda Brown.

When the pandemic is over, Brown said, she plans to take advantage of another important local asset: a community center, where she and other PACE participants can gather, even while she continues living at home.

“I enjoy the fellowship, and I do miss it,” Brown said. “I'm looking forward to being back with my friends at the center. I miss them, and I'm sure they miss me.”

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