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While our publisher is on a brief sabbatical, in lieu of our regular “From the Publisher” column we will be having guest writers. This month’s guest column is written by Howard Gleckman, a senior fellow at The Urban Institute and president of the Jewish Council for the Aging of Greater Washington. He is the author of Caring for Our Parents.

We are beginning to see what may be the end of the worst pandemic in a century. Many of us are visiting friends again. We are seeing children and grandchildren — and parents and grandparents — for the first time in more than a year.

But the scars remain. COVID-19 has illuminated the deep flaws in the way we care for older adults. The question now is: How will we respond to these painful lessons?

In Maryland, 87 percent of those who died from COVID-19 were age 60 or older. More than half were 80-plus. It was the same story in Virginia, where 90 percent of those who died from COVID-19 were over 60.

Tragically, vulnerable nursing home residents suffered the most. While, overall, about 1 percent of those diagnosed with coronavirus died, about one of every six nursing home residents who caught the virus passed away.

And keep in mind that these death rates represented only those who died directly from the disease. Many more likely succumbed to loneliness and depression that were directly caused by the COVID-19 lockdowns in facilities and by self-isolation of those living in the community.

What can we do to make sure this never happens again? Here are a few possible solutions:

Build a support system for as many older adults as possible to live at home. Not everyone will be able to stay at home as they age, but many can.

I’ve estimated that as many as 20 percent of those living in nursing homes have no clinical need for skilled nursing care. They are there because that is where Medicaid pays and because they lack those supports for remaining home.

Congress has increased the federal contribution to Medicaid’s home-based care program for frail older adults and younger people with disabilities by nearly $12 billion for the next year. And the Biden Administration wants to raise the federal payment by another $400 billion over eight years.

These dramatic increases promise to make Medicaid home care far more robust. But individual states will decide how to spend the money. And they have varied widely in how they use Medicaid long-term care dollars.

For instance, Maryland covers about 44,000 people in its home-based Medicaid program, while Virginia covers about 51,000. Maryland spends an average of about $44,000 annually on each enrollee while Virginia spends about $34,000.

However, Maryland focuses two-thirds of its spending on people with intellectual and developmental disabilities. Virginia, by contrast, spends four-fifths of its Medicaid home care dollars on seniors and other adults with physical disabilities.

And boosting Medicaid will help only some frail older adults. Many seniors will never be poor enough to qualify for Medicaid yet cannot afford the staggering costs of long-term care. For example, in Maryland and Northern Virginia, home care aides cost $25 or more an hour, or at least $100 a day for a four-hour shift.

For those families, we need to build a robust infrastructure of care, including more home-delivered meals, transportation, adult day care, case management services, and caregiver training and respite care. Without those services, many people will have no choice but to move to a facility.

For those who do live in nursing homes and other long-term care facilities, we must vastly improve infection control. Keep in mind that COVID-19 was not the first deadly virus to rage through senior communities. Every year, thousands of residents die from seasonal flu.

Staff need to be better trained and better paid. They need masks, gloves, and other personal protection equipment. They need access to rapid and accurate testing, and they need to be encouraged to be vaccinated.

Finally, there is a growing body of evidence that under-staffed facilities were more likely to suffer outbreaks of COVID-19. Thus, we need to increase staffing levels and reduce turnover.

All of this will cost money and will require state and local governments to give priority to the needs of older adults.

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