COVID-19 reminds us that nursing homes should never be the first option | COMMENTARY

Nursing homes have seen many cases of coronavirus, including deaths.

If recent headlines haven’t scared you, they should. Reports have found that one-fifth of coronavirus cases come from nursing homes and that more than two-thirds of nursing facilities in Maryland have coronavirus infections.

I began my work in nursing homes in 1980, and these facilities have not changed much in the 40 years since. That is not a good thing. Conditions at nursing homes are often crammed and crowded with up to three people in a room. Underpaid staff often receive inadequate training and work in two or three facilities to make ends meet. These factors make moving to a nursing home a less than satisfactory, and even dangerous, health care option if you can find an alternative. And there are usually plenty of options if you plan ahead.


Your first choice should be to stay in your own home. This might require installing a ramp or lift so you can get in and out, and putting in a stair glide, a mechanical device that lets you ride up or down to other floors if your bathroom and living quarters are on more than one level. You can also modify your kitchen to easily reach all cupboards and work spaces.

Providing a spare room for a live-in care provider is also an option that will save money and give peace of mind. There are even some limited funds to help pay for home modifications available through centers for independent living, which work to keep people out of nursing homes. Baltimore County has funding to modify homes even for people who rent.


A second option should be to consider living with four or fewer residents, rather than in nursing homes with hundreds of people. The less crowded environment offers more of a home feel, not to mention it lowers the risk of catching every random flu, cold, or worse, the coronavirus. It also gives space for someone to socialize with when they want, or go to their private room and binge-watch the “Beverly Hillbillies” when they don’t.

The important thing to know about these options is that if you don’t have enough money to pay for your care and medical costs, the state of Maryland and the federal government can provide coverage. How much they will pay for home modifications is far less certain. The more you can prepare your home yourself, the better.

The service delivery system has learned that it’s cheaper and more humane for people to live in the community. For those already in a facility who want to leave, there are programs set up to help with that, but the process takes time. There is work being done by groups like mine to get the state to allow people to temporarily leave and stay with family or loved ones during this pandemic without losing their place on the Medicaid long-term care waiting list for services, but we haven’t yet been successful.

If you are a veteran, Veterans Affairs knows that they save at least $25,000 per year by some estimates if a vet stays in their own home rather than going to a nursing facility. They allow you to hire your own help and will even compensate your spouse to care for you if that is your choice.

In other words, nursing homes should be your last option, and can be if you plan ahead. The bureaucracy you’ll have to deal with is complicated, slow and frustrating. But it is worth it. Fight the American tendency to avoid thinking about, and talking about aging and end of life. Be proactive and give yourself choices.

Contact your local center for independent living about ways to make your house more functional. Let our experience, knowledge and determination help you. We are people with disabilities who have created solutions when others have told us there are none. Living in a Baltimore row home with a stoop and the bathroom on the second floor has its own unique challenges, but, most of the time there are solutions.

It is possible to age well and live your life on your own terms — and somewhere other than a nursing home. For those of us who become disabled, whether because of an injury or aging, there are solutions that increase independence and help us stay in charge of our lives.

To find a listing of centers in Maryland, go to: In Baltimore City, Baltimore County or Harford County, contact the IMAGE Center at or 410-982-6311.


Michael Bullis ( is executive director of the Towson-based IMAGE Center of Maryland, which helps people live in the community rather than nursing homes.