Covid-19 generated much needed attention from policymakers to the issues of nursing home care. In a recent perspective piece in NEJM, Harvard Health Policy PhD student and Ari Ne’eman and Professor of Health Care Policy David Grabowski, PhD suggest that further efforts should be taken to address the needs of people with disabilities. Housing people with disabilities in nursing homes is a short-term solution often driven by social rather than clinical factors. Among these residents are peoples with serious mental illness, who account for one third of long-stay residents under 65 years of age and are comprised of members of ethnic and marginalized communities whose ability to remain in the community is challenged by racial gaps in wealth.

The piece advocates for transitioning care from facilities back into the community via home and community-based services (HCBS), which provide support and assistance outside of institutional settings. HCBS would not only reduce the unmet needs of disabled persons but would also allow family caregivers to re-enter the workforce.

The authors propose that policymakers promote community living and reduce nursing home admissions through a series of suggestions. They first recommend that Congress establish population-specific targets for underserved groups. Next, they advise  reforming the Preadmission Screening and Resident Review (PASRR) program. The authors also promote using a waiver to allow Medicaid funding to finance rental assistance. Quality improvement is also emphasized through enforcement of compliance for HCBS settings.

Although long-term care services have the attention of policymakers, the time is ripe for expanding community-based alternatives. These would not only improve the country’s infrastructure for long-term services and reduce long-term institutionalization, but they would also foster safe conditions for caregiving to allow disabled people to re-enter their communities.