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What a year it has been. It is probably safe to say that there may be no single impetus for change in the senior care industry other than COVID-19. There is no sector of senior healthcare or senior housing that has not been affected by the pandemic. Big and small changes are coming to the senior care industry.

Nursing Homes

No other area of the senior care industry has been hit as hard as nursing homes. Almost 50% of COVID cases and deaths are in nursing homes, and after a brief reprieve, there is another surge in cases. Unfortunately, long-standing problems in the nursing home industry have been exposed at the cost of lost lives. Here are some of the issues and proposed solutions.

Problem: Poor Infection Control

The US Government Accountability Office found that “prior to the COVID-19 pandemic, we found that most nursing homes were cited for infection prevention and control deficiencies (82% of those surveyed from 2013-2017). About half of these homes had persistent problems and were cited across multiple years.” It should come as no surprise that during the worst virus of the modern age, these deficiencies have caused untold death and suffering.

Problem: Inadequate Staffing

Nursing homes have the sickest and most medically complex residents requiring intensive staff time. Nursing homes are understaffed due in large part to the low Medicaid reimbursement rate. Since most nursing homes are for-profit, and most residents are on Medicaid, profit guides much of the decision-making. Cutting staff increases profit.

Problem: Poor Pay and Benefits

When the care staff are paid low wages, there are going to be staff shortages. Most nursing home staff don’t have compensated sick time, and may not have health insurance. Frontline care staff often work at more than one facility to make ends meet, leading to increased infection control issues.


There are several ideas and solutions to current nursing home problems that are very encouraging. Some of these are suggestions from industry experts, and others are proposed legislative changes:

  • Realign Medicaid payments to approximate costs
  • Encourage policies that increase the number of clinicians on-site
  • Improve wages and benefits for nursing home staff
  • Establish minimum nurse and nurse aide staffing standards
  • Provide better oversight and transparency for nursing homes
  • Invest in Medicaid home and community-based services. In other words, keep people out of nursing homes by offering home-based services.
  • Offer a public long-term care benefit

Assisted Living

The assisted living industry has no federal oversight. Oversight and management are left to the states. The result of this during the pandemic has been a patchwork of restrictions. COVID cases are in almost every assisted living community across the country. According to an AARP report, “Essential coronavirus-mitigation strategies, such as testing, PPE supply, and staffing, have rolled out inconsistently across the states.” The assisted living industry has been hit hard by COVID as well, and here are some of the consequences.

Problem: Admissions

Some state health departments dictate that admissions be placed on hold until the community is free of infections. As a result, the assisted living industry has suffered significant adverse financial consequences. Moreover, families are reluctant to place a loved one in assisted living due to visitation and activity restrictions and fear of infection. More assisted living are offering rent concessions. There is disagreement about how long it will take the assisted living industry to recover.

Problem: Residents Leaving Assisted Living

More families have taken their loved ones out of assisted living due to virus concerns and visitation restrictions. For many of these families, this has placed an increasing burden on family caregiving.

Problem: Staffing

Staffing is not a new problem for the assisted living industry. According to Senior Housing News, the turnover rate is at about 29%.


With a vaccine in sight, the assisted living industry should recover, but it will take time. At the time of this writing, most communities have the PPE and testing that they need to curb the virus, which will be essential to recovery until a vaccine is widely distributed.

  • Pay staff better and offer opportunities for growth and advancement
  • Put safety protocols in place for any future virus outbreaks
  • There are discussions of a nationwide, consistent oversight of assisted living, but don’t expect any significant changes soon.

Home Care

Home care services hit a bit of a lag during the beginning of the pandemic but have recovered nicely due to the increased need for home services. The home care industry is responding to several of the changes already mentioned: more people remaining in their homes, people leaving assisted living, and adult day services closing due to the pandemic. Challenges in the home care industry continue to persist, but changes are coming.

Problem: Staffing

Home care has always struggled with staffing. The industry competes with all other sectors of senior care to recruit and retain good staff. As people age and continue to want to remain in their homes, more home care aides are needed. The Bureau of Labor Statistics reports that the need for home care aides will grow by 34% by 2029.


The home care industry is working to increase pay and benefits for their frontline staff. Bonuses, increased opportunity for skill-building, flexible scheduling, advancement, and health benefits are all on the table. Home Care Assistance highlights their caregivers and gives national recognition to those staff.

Problem: Infection Control

One of the initial deterrents to people asking for home care in the early days of the pandemic was the fear of infection. The industry responded with the increased use of PPE and safety protocol policies.


Expect that infection control and safety protocols will become standard operating procedure for home care companies. Home Care Assistance leads the way with specific safety procedures and protocols for all staff across the country.

Continuing Care Retirement Communities (CCRC’s)

Just like the rest of the senior living industry, CCRC’s have suffered setbacks. Reportedly, the independent sector of CCRC’s has held up well during the pandemic. But the industry has sustained losses like everyone else. Companies have been able to draw on cash reserves and government programs to stay solvent. They are also responding to the need for more health services in the home by increasing home health, hospice, and private nursing on-site.

A Senior Care Industry in Flux

Despite all the predictions and the changing nature of the senior care industry, one thing is certain; things will improve. Sometimes it takes a catastrophic event to shake up an industry, and COVID-19 is that event. Everyone in the senior care industry is improving their care, attitude, and responding to seniors' unique needs during this challenging time.

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About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of Choose Your Place: Rethinking Home as You Age (November 2020) and of Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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