Spotlight on Nursing Home Care

Abstract

Nursing homes often receive unfavorable press, [1,2] and this trend has intensified because of their involvement in multiple horrific COVID outbreaks [3,4]. On the one hand, high morbidity and mortality in nursing homes during the pandemic, apart from being a serious problem in itself, exposed ongoing inadequacies in the provision of quality care, which external supervision addressed only partially [5]. Running an effective nursing home is an expensive enterprise, which, unfortunately, is frequently underfunded [6,7]. Even with adequate funding, it is a complex endeavor at which it is not easy to excel [8]. On the other hand, as nursing homes are repositories for people with high morbidities whose health will invariably worsen over time, we may conclude that unmet expectations and unfortunate outcomes are not always preventable or the result of poor care. Nursing home care is not a government priority in the U.S., [9] and probably not in other Western countries either. This is unfortunate for many reasons, not least because of the likelihood that some of us will eventually end up in one. I believe that, while some criticism is justified, as nursing home care is sometimes suboptimal, in other cases there is inappropriate malignment. This paper will analyze how a nursing home works and attempt to distinguish between preventable and unpreventable poor outcomes.