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Eldercare needs a reboot

A corridor of a nursing home prior to

A corridor of a nursing home prior to the pandemic. Credit: Newsday/Jessica Rotkiewicz

As we emerge from the pandemic, many of us wish to return to the way things were "before."

But in some cases, we must make sure we don't revert to pre-pandemic ways. Among them: how we treat our elderly, how nursing homes and adult care facilities handle patient care and staffing, and how the state oversees and regulates those entities.

The COVID-19 pandemic has been especially brutal for New York's most vulnerable, especially those living in nursing homes. More than 15,000 nursing home residents died of the virus. Those who remained spent months and months isolated and alone. The pandemic shed new light on preexisting problems, from staffing to infection control.

But while the spotlight has been trained on nursing homes, the discussion must more broadly encompass how to care for our elderly in their own homes, too. President Joe Biden's proposal to devote $400 billion to expanding access to at-home care and improving wages and job quality for home health care aides is an important piece.

Nursing homes and similar facilities won't disappear. But they'll have to face structural and cultural issues head on if they hope to address the enormous vacancy rates and broader financial strain they're now facing. Statewide, the nursing home vacancy rate jumped to 21.3% this February, compared with 7.3% in February 2020, and it's unlikely to rebound quickly. Increasing costs and lower Medicaid reimbursement rates are added factors taking their toll.

Some nursing homes are doing their best under difficult circumstances, providing excellent care and service to their patients. But other facility owners need to overhaul how they do business to give families reasons to entrust loved ones to them.

State reforms could help, but they won't go far enough. This year's state budget includes a profit cap and new requirements on what share of a facility's revenue must go to resident care. To address the staffing issue, the State Senate and Assembly approved a so-called "safe staffing" bill that would set a minimum standard of 3.5 hours of direct care per nursing home patient per day by a mix of licensed nurses and certified nursing assistants. It's a bill nurses and their unions desperately want, but administrators worry about the financial burden. It will require proper workforce development and training.

There is a more immediate concern. Islandwide, less than 60% of nursing home staff are vaccinated. In some facilities, barely a third of employees have gotten shots, though they were among the first eligible. This is a management and union issue. Low rates of vaccination will further hurt business.

That's unacceptable, and no one — including Gov. Andrew M. Cuomo and the powerful health care worker union, Local 1199 of the Service Employees International Union — seems to be treating the issue with urgency. Perhaps Cuomo should refuse to sign the bill until staff vaccination rates rise. Would that push the union to advocate? Would it give staffers an incentive to roll up their sleeves?

It's worth a shot.

— The editorial board