Michael Wasserman, M.D.
I am regularly described as “a critic of the nursing home industry.” A nursing home chain executive once admonished me for using the term nursing home industry. He told me that I should call it the nursing home profession.
The COVID-19 pandemic led to 169,291 more nursing home resident deaths in 2020 alone and has painfully reminded me of the difference between the two terms. I am a critic of the nursing home industry. I am not a critic of the nursing home profession. It’s time to set the record straight.
The people who work in nursing homes are some of the most dedicated, caring and compassionate human beings I have ever worked with. This includes administrators and directors of nursing, and most certainly reflects the daily work of the front-line staff. I often hear the question, “Who would want to work in a nursing home? They are horrible places.” People who say that haven’t spent time with the people who work and reside in nursing homes, or they would know better. So, why am I a critic of the nursing home industry?
If one wanted to approximate the structure and function of a nursing home, including all of the direct care time, in an individual’s home, it would cost more than $20,000 a month. Few can afford this. Even if one could manage to provide the necessary services for a frail older adult to live safely at home, the issue of social isolation is still significant. I have often compared nursing home life to that of college students living in a dormitory. The residents have roommates, eat in a dining hall and participate in daily activities.
Nursing homes do not have to feel institutional, nor do they have to lack in adequate care. They already benefit from incredible, dedicated caregivers. We must ensure that these caregivers exist in sufficient numbers, are treated with respect, and are paid a living wage. There will always be a need for nursing homes, all talk of “hospital-at-home” and such models aside. The issue comes down to how the industry, as a business entity, is structured. Which brings me back to the difference between the nursing home industry and the nursing home profession.
The nursing home industry is composed of different asset-bearing businesses. The first and foremost is real estate. It has become the norm that nursing home real estate assets are held separately from the operations. This allows real estate owners to claim no role or responsibility for the quality of care delivered in nursing homes. It also takes the largest leverageable asset out of the financial equation in relation to day-to-day operations. The nursing home industry …….