It is time to seriously review how we provide residential services for the elderly who need nursing care. Some group home models of care for people with developmental disabilities might provide some guidance.
However, in some states, the deinstitutionalization of people with developmental disabilities has stalled, and during the COVID-19 pandemic, people with disabilities who continue to reside in large facilities, like the elderly in nursing homes, are paying the price.
Many of today’s large residential facilities for the elderly or the disabled, no matter how fancy, are not working, at least not for the benefit of their residents. There are two important things we expect of these facilities: to keep their residents safe and to maintain their quality of life. Many large, single-building residential models have failed at both.
These are not new enlightenments brought on by COVID-19. But the pandemic has certainly brought to light, in the most tragic of ways, the poor care many of our nation’s elderly and disabled receive in many of these facilities, as they are currently designed. I’m sure there are exceptions, but they are rare. While many of these problems have been brought to light by COVID-19, these residential facilities have a long history of understaffing, poor care, and a lack of meaningful oversight.
In my field of disability care, we have a long and sad history of institutionalization. In response to public attention to these issues, residential services for the developmentally disabled transitioned from large institutions to smaller institutions during the 1970s and 1980s. I worked in one of these smaller facilities in Virginia. It was new and considered, in 1975, a model for the deinstitutionalization movement. With 180 beds, it was a far cry from the 5,000 bed Lynchburg Institution where many of the residents came. It was a start in the right direction.
Even better than its smaller size, and the more important variable in providing quality care is the fact that the facility was broken up across a single campus with 20, individual 8 and 10-bed homes. Each home had private bedrooms, shared bathrooms, a living room, a dining room, a kitchen, and a backyard. The shared campus included trails, a gym, and medical facilities. This was a giant leap forward in the history of residential care for people with developmental disabilities. In many states, however, while they closed their large institutions, they simply moved residents to smaller institutions with many of the same challenges.
In the evolution of residential care for people with disabilities, group homes replaced these smaller facilities. In Maryland, group homes have 3 to 4 residents per home. Why, people asked, did people with developmental disabilities need to be located and segregated onto a single campus? They didn’t, it turns out. Today, Maryland operates group homes built within regular neighborhoods. Instead of a centralized gym and medical center, the residents in these homes use the community medical and recreational facilities in their neighborhoods.
Many people might argue that this type of structure would not work for the elderly population. I remember people making the same argument about people with severe disabilities. They needed too many services, including medical services, they argued. In fact, the group home model has been very successful, if appropriately managed and staffed. By and large, they have kept their residents safe and improved their quality of life.
During this pandemic, group homes for people with disabilities in Maryland have suffered significantly fewer COVID-19 outbreaks than nursing homes or larger residential settings for the disabled. In Maryland, there have been about 200 positive cases and 20 deaths among the thousands of residents with disabilities living in group homes. In states where people with disabilities are still kept in large residential facilities, similar to nursing homes, COVID-19 has been devastating. In Texas, for example, a 400-bed facility for adults with developmental disabilities has reported over 100 residents and employees infected. Similar situations are reported in other states that still maintain the single large facility model of care and have not transitioned to the group home model.
The primary variable with spreading infections seems to be the grouping of many high-risk individuals within one building with shared staff and medical care. Outside of hospitals, which provide more specific services that demand centralized care, the service model of congregating large groups of vulnerable people into single facilities has not been a model of success. COVID-19 has brought to the public attention what many Americans had already observed: In most cases, the nursing home model is not working for our elderly or our disabled populations.
It is time to consider alternatives.
Tom Zirpoli is the program coordinator of the Human Services Management graduate program at McDaniel College. His column appears on Wednesdays. Email him at tzirpoli@mcdaniel.edu.