Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis

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Nursing homes have been caught in the crosshairs of the coronavirus pandemic. As of early May 2020, Covid-19 had claimed the lives of more than 28,000 nursing home residents and staff in the United States. But U.S. nursing homes were unstable even before Covid-19 hit. The tragedy unfolding in nursing homes is the result of decades of neglect of long-term care policy.

Beyond the pandemic, we will have to transform the way we pay for and provide long-term care. First, Medicaid programs need to invest considerably more in care in all settings, including home-based settings as Medicaid shifts a larger share of care into them. Second, because caregiving at home is not feasible for many care recipients and families, we also need safe, affordable residential options. Better residential options can help ensure that the tragedy currently unfolding in nursing homes never happens again. Finally, we believe that the United States needs to reconsider our piecemeal approach to paying for long-term care. Existing programs, such as Medicare and Medicaid, would have to fundamentally change the way they pay for long-term care to meet the needs of our aging population. We can look to other countries for more coherent financing systems.

More funding alone is not the answer. Nor is more regulation a sufficient response. Rather, we need a combination of funding, regulation, and a new strategy that fully supports a range of institutional and noninstitutional care.


Health care policy, nursing homes, long-term care, COVID-19 deaths, Medicaid, Medicare, home healthcare, risk of closures, comprehensive funding, social insurance program, long term services & supports, caregiver, reform

Publication Title

New England Journal of Medicine

Publication Citation

383 N Engl J Med 903-05 (Sept. 3, 2020).