01/03/2026
Sanctuary for Longevity Project: "The first coronavirus outbreak in the occurred in a nursing home near Seattle, in late February. Since then, the country has endlessly revised its hot spot map. Yet the situation in nursing homes and assisted-living facilities has only gotten worse: More than 120,000 workers and residents have died, and residents are now dying at three times the rate they did in July.
In the U.S., long-term care facilities account for 5 percent of all coronavirus cases and almost 40 percent of total deaths.
Long-term care continues to be understaffed, poorly regulated and vulnerable to predation by for-profit conglomerates and private-equity firms. The nursing aides who provide the bulk of bedside assistance still earn poverty wages, and lockdown policies have forced patients into dangerous solitude...
Joe Biden is about the age of the average nursing home resident. Over the summer, he announced a $775 billion proposal to provide care for children, seniors and people with disabilities. The plan, though notional at this point, would eliminate the 800,000-person waiting list for long-term care under Medicaid and pay for 150,000 new community health workers for seniors. It could also help transform millions of low-wage, high-turnover, often transient gigs into stable careers.
But to prevent another disaster on the scale of the coronavirus, the Biden-Harris administration (and state and local regulatory bodies) should go further.
C.M.S. must ensure that the $264 billion paid by Medicaid and Medicare to long-term-care providers actually goes to caregiving, instead of shiny new buildings or executive pay. It can do so by placing caps on how much money is earmarked for profits and bureaucracy, imposing strict accounting requirements and conducting regular audits. Even Mr. Parkinson, the A.H.C.A. president, acknowledged that any increase in Medicaid funding should come with “some accountability to make sure it goes to patients.”
C.M.S. should also regulate assisted-living facilities that serve Medicaid and Medicare patients, just as it does nursing homes. (At present, these facilities are overseen by state agencies, with wide variation.)
Then private-equity firms might have less incentive to enter this field, and patients and workers would know, once and for all, whether businesses are telling the truth when they say they’re operating on “a razor-thin margin.”
To improve residents’ quality of life, the government should mandate that long-term-care facilities have appropriate staffing. We can do this by requiring a minimum amount of nursing time for every resident — 4.1 hours per day, experts say. A bill to this effect was introduced in Congress in 2019.
And certified nursing assistants must be paid a living wage — in most places, $20 or more per hour. A recent study found that such an increase would finance itself by elevating the standard of care. With stable, better-paying jobs, nursing-home staff members could also avoid working in multiple facilities, helping reduce the transmission of the coronavirus and other, future viruses.
In addition, Mr. Biden must reverse Mr. Trump’s laissez-faire approach to this sector. Both C.M.S. and the Occupational Safety and Health Administration should be given the resources they need to inspect, investigate and fine providers for health and workplace violations. The incoming administration must also strengthen workers’ rights to organize and protest unsafe conditions under the National Labor Relations Act, as it has already promised to do.
Most important, we must transform the way we think about long-term care — treating it not as human warehousing or the duty of underpaid women, but as an integral part of our medical system.
All of these changes are possible — and modest, really, given the magnitude of the emergency. By 2050, 19 million people will be 85 or older, and many will require help to live with comfort and a modicum of dignity. What we really need, for all Americans, is single-payer health insurance that covers quality long-term care. But short of that, Mr. Biden and Kamala Harris have a chance to make amends for the deadly failures of the current administration."
