Transforming Nursing Homes: Advice for Lawmakers

by Published On: Jun 14, 2012Updated On: Apr 02, 2015

Now that Wisconsin’s dramatic June 5 recall election is over, it’s time for Gov. Scott Walker (R) and Wisconsin legislators to get back to the business of running their state. 

I certainly hope the future of long-term services and supports is on the agenda.

I recently had the opportunity to brief Wisconsin lawmakers about some of the issues I believe they should be addressing as they prepare for a 28% increase in their state’s over-85 population. 

But my remarks, offered during a meeting sponsored by the Evidence-Based Health Policy Project, really apply to all states, their legislatures and their regulatory bodies.

Shifting to HCBS

It’s no secret that many states are focusing quite intently on shifting the provision of long-term services and supports away from institutions like nursing homes and toward home and community-based settings. 

This approach makes sense for a variety of reasons. However, our collective enthusiasm for home and community-based services (HCBS) should not cause us to overlook the important role that nursing homes continue to play in communities nationwide.

Nursing homes face both short-term and long-term challenges during this time of shrinking financial resources and increasing concerns about a burgeoning older population. 

Taking deliberate steps to strengthen these organizations – and connect them more closely with other providers of long-term services and supports – is particularly important now. 

We need a variety of providers, working together, to help us ensure that older adults receive the right services, at the right time, in the right place and for the right reasons.

Short Term Challenge: Serving 2 Populations

Economic realities and the advent of health reform have spurred many nursing homes to offer post-acute care as a short-stay option on their menu of services. 

These organizations are also continuing to serve traditional nursing home residents, who typically stay for longer periods of time and are likely to have greater care needs and higher rates of dementia than ever before.

How will nursing homes meet the challenges associated with caring for both of these populations, which have very different care needs and who require a very different workforce? 

Legislators can help, in part by allocating additional funds and supporting regulatory changes that foster the recruitment and training of qualified workers who can provide complex care at both ends of the continuum. 

Long-Term Challenge: Renovation or Reinvention?

Will nursing homes have the infrastructure they need to support future demands for their services? If Wisconsin is any indication, the answer is no. 

The average Wisconsin nursing home is 31 years old – too old to incorporate modern design elements that are cost-efficient and person-centered. 

These aging nursing homes have 2 choices as they prepare for the future:

  1. They can update their infrastructures so they can do their current work more efficiently. 

  2. Or, they can transform themselves completely by moving away from traditional bricks-and-mortar delivery models to serve older adults in community settings and in collaboration with other providers. 

Legislators can help nursing homes choose the second option by introducing much-needed flexibility into the nursing home setting. For example, revised scope-of-practice regulations could enhance the delivery of person-centered care. 

Similar flexibility could help foster the development of models like Greenhouses, where older adults receive nursing care in an atmosphere similar to a small group home. A more flexible view of the continuum of care could erase the artificial demarcations that exist between institutional and community-based care. 

That way, providers and policy makers alike could focus their attention on the consumer, not on the care setting.

A Valuable Asset

Now is not the time to think about thinning the ranks of nursing homes in Wisconsin or in any other state. Instead, our challenging times call for innovative approaches that will help these facilities do their best work in the present and position themselves to help their states meet future challenges associated with an aging population.


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