Long-Term Care in a Post-Pandemic World

Christine Benz: Hi, I'm Christine Benz for Morningstar. The pandemic has had a devastating effect on people in long-term care institutions. Joining me to discuss the implications of the COVID-19 crisis for long-term care is Carolyn McClanahan. She's an MD and a financial advisor, and she's one of our speakers at the Morningstar Investment Conference.

Carolyn, thank you so much for being here.

Carolyn McClanahan: Oh, it's an honor to be with you always. You're always fun and talk about a lot of great stuff.

Benz: Well, you do as well. We're excited to have you here and excited to hear from you at the Conference. Wanted to talk about the pandemic's effect on long-term care. Long-term care is going to be the focus of your remarks at the Conference. Let's talk about what we've seen through this COVID period. It's had a devastating effect on people in long-term care facilities. Can you summarize what's gone on there?

McClanahan: Well, we've known for a long time that it is not good to warehouse a bunch of older people that have not great immune systems. And so when a virus hits, it generally hits everybody in the facility. I remember 20 years ago, when I was a practicing physician, during flu season, we'd get tons of elderly people admitted to the hospital from flu. And so coronavirus was the flu on steroids. It was devastating to the long-term care community. We had 136,000 deaths of patients and of caregivers within these facilities--proving yet again that maybe we need to rethink how we take care of older people in the future. One point I do want to make is people just think of everybody as going to nursing homes. In reality, only 5%-10% of people actually are in nursing homes or assisted living facilities. Most people currently receive home care. And the problem is there's just not enough services to keep supporting those people. So that needs to change.

Benz: I wanted to ask about that, because it seems likely that this experience of COVID-19 will hasten what was already very much a trend toward people preferring care in their homes. I assume that you think that'll just continue to gather steam.

McClanahan: Oh, absolutely. I think one of the things that we saw is that now people see the huge danger of a lot of people put together in a home. And so we're going to see more care moving toward either small residential care communities where you're only having, like The Golden Girls, a few people living together, more people trying to age in place at home, more communities that are spread in their population. So younger people living with older people. And you know, one of the other travesties we saw is we already knew that home care professionals, home health aides and all that, are totally underpaid, we have a shortage of them, and they were first-line workers, they don't receive benefits. Their average pay is like $11 an hour. So that's something we need to fix. And thank goodness we do have legislation pending now that could address a huge part of that.

Benz: I wanted to talk about that because home-based care is more people-intensive. So we had this caregiver shortage before; if we have more and more people receiving care in-home, what do we do to address that?

McClanahan: There are more organizations that are developing home- and community-based care options like adult day facilities, that allow for people to have socialization but still maintain--live at home during the night. And other in-house services for people. The problem is how do we pay for it? Right now there's legislation pending. There was a bill put forth last month called the Better Care Better Jobs Act by a few senators that would help improve how much Medicaid pays for in home care. It'll improve the pay and benefits for people who provide home care, provide training programs. So it's a huge deal. And that bill has actually mostly been incorporated in the current Budget Reconciliation Act that just passed the House this week. We'll see what happens whether it passes the Senate. And I don't think that part will be horse-traded away because people see just a huge need for us to improve how we take care of people who are homebound and elder people when they can no longer care for themselves.

Benz: Yeah, I think almost every family, every individual has been touched in some way by this topic. Carolyn, important topic, important guidance from you. Thank you so much for being here, and I look forward to hearing from you at the Conference.

McClanahan: Thank you so much. I'm looking forward to it.

Benz: Thanks for watching. I'm Christine Benz for Morningstar.