Communities should create solutions that
aren’t just involving geriatricians of the world or
the geriatric nurses and social workers. It’s going to
take everybody pulling together.
– Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN

Grow old along with me. The best is yet to be. The last of life for which the first was made.”

In 1864, as Robert Browning wrote those words, growing old was not regarded the same as it is today. Before nursing homes and assisted living facilities, older adults aged at home alongside their families. Today, most people still age in their communities; but for the aging population that becomes frail, they may need the support from these long-term care institutions. However, the current nursing homes and care parameters for older adults often stigmatized aging and overlooked what people want when they get older.

To counter this, we need a shift in mindset, one that sees older adults as persons with diverse needs, dreams, and aspirations about their future rather than just patients in need of care.

In this episode of This Is Getting Old, join Dr. Stuart Butler and me in rethinking nursing homes and care for older adults.

Part One of ‘Rethinking Nursing Homes and Care of Older Adults’.

The Convergence Report on Rethinking Care for Older Adults

  • History and Background

The Convergence Report on Rethinking Care for Older Adults is released at the end of November 2020. It was supported by the John A. Hartford Foundation, which funds a lot of work in the long-term care area on aging.

The convergence conversation aimed to bring together about 50 people from very different backgrounds and different points of view to see if there are common ground areas. They were asked to brainstorm about the issues impacting today’s nursing homes, what’s going on there, and what could be done differently. They were also asked to explore other ways that people can age outside of nursing homes.

A crucial part of the conversation revolved around the workforce and the caregiving field, the workforce’s nature and how to think about it differently in the future, and the financing of aging in American care and nursing homes.

  • The Findings Of The Convergence Report On Rethinking Care For Older Adults

The resulting main areas revolved around living outside nursing homes, the payment system, and the caregiving workforce.

  • Today’s nursing home system is increasingly out of date and the product of the payment system.
  • The majority of older adults need not stay in nursing homes. There are ways of enabling them to live more successfully in their own homes and their communities. People and institutions can help older adults stay in their own homes, avoid isolation, and be safer.
  • Today, the caregiving workforce is predominantly low-paid, very heavily immigrant—It’s a low-skilled, low-paid workforce.

Only 5% of people over 65 ever end up in a nursing home,
but they account for 50% of the state’s budget.
– Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN

Reimaging Nursing Homes and Other Care Institutions 

  • Alternative Business Models & Payment Systems 

The current payment system for long-term care forces many older adults to go into a care setting, which may not be the right one for them. It may not be ideal and indeed may not make them happy and may cut them off from their family.  If a family  asks, ‘What’s the next best thing for mom?’ The first response right now will be, ‘We need to talk about your finances to figure that answer out.

Exploring The Financing And Workforce Elements

  • Medicare + Medicare

There’s a lot of interest in revamping the rules and the regulations associated with, particularly Medicare and Medicaid, as to what they would cover. Medicare and Medicaid alternative services should be more open to covering home- and community-based services. However, exploring these options has the potential to  save government spending on Medicaid and Medicare in the long term.

  • Role Of Private Health Insurance 

One possible solution for people who do have some savings but are afraid of them being exhausted and then ending up on Medicaid, is providing a so-called “catastrophic backup” to long-term care insurance. The idea is to have legislation that would set this up to stabilize the long-term care insurance industry to make it more viable in the future. When this happens, then far fewer people would fall into this trap of being unable to pay. 

  • Role Of Long-term Care Insurance

The long-term care insurance industry has declined very sharply in the last several years, in part because younger people don’t think of having long-term care insurance. The other thing is people are living longer, and they live longer with sometimes costly illnesses that impact their ability to be independent. So long-term care insurers face these enormous potential costs; so this approach is not working.

Part Two of ‘Rethinking Nursing Homes and Care of Older Adults’.


Expanding the range of older adult-friendly housing and communities

95% of older adults do stay and age in their own homes. Below are some ideas to help people age at home.

  • Design and Collaboration

Architects involved in the convergence conversation think about how to design housing that is safer and more open. These perspectives include looking at group housing, in various forms, and thinking about how multifamily units can be designed so that an older person can have that privacy, and so on.

But more than these essential design features, we also look at how to build social capital  that helps an older adult live in their own home and community, but not be isolated and cut-off from the rest of society.

  • Role of Technology 

There are also a lot of improvements in technology. For instance, monitoring older adults, a doctor, or a nurse in the area can know if that person is getting unsafe in some way like a potential fall, etc. Technology connects health care providers and older adults so that their needs can be addressed.

We’re on the cusp of thinking differently about nursing homes in the future. – Stuart M. Butler, Senior Fellow, Economics Studies


Thinking About The Caregiving Workforce Differently

Workforce Issues: Other Resources to Learn More 

  • LeadingAge Report: Making Care Work Pay 

LeadingAge released a new report, Making Care Work Pay. The report highlights health care professionals as an essential part of the United States’ healthcare infrastructure and accounts for a significant portion of its workforce. Every day, nearly 3.5 million direct care staff operate in residential care centers and private homes to offer care for some of society’s most needy members—the elderly, the disadvantaged, and the mentally impaired.

Given the value of health care staff to our country’s health and economy, health care professionals continue to be undervalued and underpaid. Poor wages and stressful working conditions exacerbate persistent workforce problems. As a consequence, efficiency and care delivery aren’t as good as they should or could be.


  • Milken Institute Center for the Future of Aging Report

(Recommendations to Build a Dementia-Capable Workforce and System amid    COVID-19)

The recommendation aims to endorse the GWEP program’s recent sanction, which authorizes almost $39 million in funding to expand geriatric expertise across the healthcare system over five years. Such action is anchored because, despite the reality that the number of individuals living with Alzheimer’s disease is predicted to increase by 2050, a lack of geriatricians, nurses, and social workers with advanced expertise in geriatrics and complex dementia treatment is on the horizon.

  • Mathematica Report

COVID-19 Intensifies Nursing Home Workforce Issues (Full report available as a downloadable PDF)

Mathematica Report studies show that workforce shortages and turnover also strained nursing homes during the pandemic’s climax. Many nurses and licensed nursing assistants have recently quit the industry due to low wages, inadequate working conditions, and the high risk of COVID-19 contamination at a period when their skills and experience are in high demand.


Thinking About The Healthcare Workforce In Different Ways

  • Improving Training

Improve training for healthcare providers. At the moment, there’s minimal federal training and federal requirements on states that need to be expanded enormously to raise the skill level.

Want to know how your state is doing in terms of long-term care support and services (LTSS)?

Find out from the AARP Foundation Long-Term Services and Supports State Scorecard 2020 Edition

About Stuart M. Butler, Senior Fellow:

Stuart Butler is a Senior Fellow at Brookings. Before Brookings, he spent 35 years at The Heritage Foundation as the Director for the Center of Policy Innovation and, earlier, as VP of Domestic and Economic Policy. He has recently played a prominent role in the debate over health care reform and addressing social determinants of health. Butler is a member of the Health Affairs editorial board, an advisory board member of the National Academy of Medicine’s Culture of Health Program, and the Board President for Mary’s Center, a group of community health clinics.

About The Brookings Institution:

The Brookings Institution is a nonprofit public policy organization based in Washington, DC, whose mission is to conduct in-depth research that leads to new ideas for solving problems facing society at the local and national level and globally.



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About Melissa:

Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN. I am a nurse, nurse practitioner, nurse educator and nurse researcher with over 25 years of experience in the aging and long-term care healthcare space. You can visit my website at to learn more about me, how you can work with me directly,
and/or support future episodes of the podcast. Within the first 18 months of launching this podcast, we reached a ranking of top 10% globally. I have all of you who’ve been with me on this journey so far to thank for that!

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