Time for a Change: The COVID-19 Nursing Home Disaster and the Urgency of LTSS Reform*

The horrific death rate of nursing home residents due to COVID-19 has exposed the nation's long-standing failure to effectively manage public policies toward long-term services and supports (LTSS). Government agencies’ dereliction in the enforcement of quality standards in nursing homes has been most visible. But equally important are provider payment policies that discriminate against people with low incomes, dependence on under-paid direct care workers or unpaid family caregivers, and—most broadly— underfinancing of LTSS that leaves people of all ages at risk of impoverishment and inadeqate care. These risks will only grow as the population ages. The Biden Administration and the Congress have an opportunity to capitalize on heightened public awareness with significant policy and management reforms. In the short term, that means not only the exercise of federal oversight authority to assure quality but also the enhancement of federal funding (through Medicaid) made contingent on adequate wages and support for direct care workers and auditable delivery of quality care—whether delivered in the nursing home or in the community. Over the longer term, enactment of a national program of social insurance is essential to address the LTSS risks and uncertainties facing people of all ages and assuring that, regardless of the state they live in, people receive the care they need.