The pandemic damaged views on nursing homes to the extent that a vast majority of older Canadians are more likely than before to shun nursing homes after observing the initial wave of COVID-19 outbreaks and substandard living conditions in some institutions.
According to the Center for Retirement Research at Boston College, more than 70% of those surveyed reported being less inclined to enter a nursing home after the pandemic, while a quarter reported no change in their long-term care plans.
“We expected to see some aversion to nursing homes, but we were surprised by the magnitude of it,” said Minjoon Lee, a visiting scholar at the Center for Retirement Research and an associate professor of economics at Carleton University in Ottawa, Canada. “I would expect to find similar attitudes in the U.S.”
In many countries, including Canada and the United States, COVID deaths were heavily concentrated among older people. Early in the pandemic, many of these deaths occurred in nursing homes.
For example, by May 2020, more than 90% of the COVID deaths among individuals ages 70 or older in Québec were in nursing homes, while in Ontario, it was more than 70%.
Also, many nursing home workers left during COVID due to the more challenging conditions, which meant the remaining nursing home residents faced an increasing health risk and worse living conditions amid less support.
These issues received widespread media coverage, so they were very visible to the public and may have a lasting impact on individuals’ choices between entering a nursing home or receiving care in their own home, researchers found.
According to the survey, nursing home aversion was widespread across demographic groups. The survey respondents were between the ages of 50 to 69 without any limitations on activities of daily living. In total, 3,004 respondents completed the survey.
“This is very alarming news for the nursing home industry. For people, the impact of the pandemic will be persistent,” Lee said. “I don’t see an easy solution to this if I’m a nursing home manager.”
While respondents were concerned about nursing homes, some are also aware that planning to use home care instead may require more money. More than a quarter of the respondents reported being willing to save more postpandemic.
For this group, the survey further asked whether they would save more to avoid entering a nursing home when they need long-term care and 83% said yes.
The survey also asked whether the pandemic changed their opinion on a home care subsidy. The result confirms that the pandemic strengthened support for such a policy. About 40% reported that they are more in favor of a home care subsidy compared to before the pandemic, and only about 10% are less in favor postpandemic.
If individuals are mainly responsible for covering the risk of needing late-life home care, it could pose an excessive burden. Therefore, those who plan to use home care may support new public policies to subsidize home care.
To explore this issue, the survey asked: “Suppose the government was to propose a policy to increase the access to home care for people needing help with activities of daily living…to reduce their likelihood of going to a nursing home, but would increase taxes to finance this policy. What…would be your opinion…?”
The results show strong support for such a policy. About 70% agree with the home care subsidy funded by higher taxes, with 20% strongly agreeing. Only 12% strongly disagree with such a policy.
The United States has had similar experiences with nursing homes during COVID and also tends to more readily subsidize institutional care over home care.
As a result, the survey results likely apply to the U.S. context as well, suggesting that policies aimed at making home care more affordable might better meet the preferences of older Americans in the wake of the pandemic, researchers said.