Long-term care industry facing changes as pandemic pushes more families toward home care

After more than a year battling the deadly coronavirus pandemic, long-term care facilities may be seeing a change in the industry as consumers shift away from nursing homes and assisted living facilities, according to a new study published by an industry research group.

Widespread distribution of the COVID-19 vaccine has reduced the spread of the virus in nursing homes and other long-term care facilities, with infection rates dropping sharply. But the legacy of the virus -- which to date has killed more than 182,000 long-term care residents and staff nationwide -- may be fundamental changes to the business of long-term care.

Research by The Associated Press National Opinion Research Center shows that, more than a year into the pandemic, 88% of Americans say they would rather care for elderly relatives in their own home instead of moving them into a facility.

"COVID raised the fear that people already had of nursing homes and exacerbated that in terms of, are people going to want to even think about going there or placing an older relative there?" Dr. Robyn Stone, co-director of the LeadingAge Long Term Services and Supports Center at the University of Massachusetts, told ABC News. "And because of that, we are seeing a lot of providers developing models where aides actually go into people's homes."

According to the study, more people are showing a desire to "age in place" -- regardless of their background. Results appear to be consistent across all races and ethnicities, as well as in suburban, urban and rural environments, the study says.

Some long-term care advocates told ABC News that, even before the pandemic, the industry was looking for ways to improve its business model.

"The pandemic has only accelerated pressures to improve the outdated financial and operational models of nursing facilities, which are not working," said Terry Fulmer, president of the John A. Hartford Foundation, a nonprofit that works to improve care for older adults.

Fulmer says that the pandemic has highlighted the benefits of home-based care, which she predicts will mean fewer nursing homes in the future.

"The shift to delivering more long-term services and supports in the home will only continue, and it is highly likely we will see new and creative business models supported by technology," Fulmer said.

At the same time, the study found that families are concerned about how to pay for at-home long-term care services.

Surveys over the last few years have shown Americans feeling consistently unprepared for the costs of long-term care, the report said. And with a move toward at-home care services, more families are now looking for the government to help low-income seniors receive care at home, according to the study.

"The question is, will these new models just be available to people who can pay?" Stone said. "Many of these models are being developed in the private sector -- so will nursing facilities become homes just for the really disadvantaged?"

President Joe Biden's proposed infrastructure plan includes a massive $400 billion investment to help pay for in-home care under Medicaid, a move that would make community and home-based services more accessible and affordable. The American Health Care Association, which represents nursing homes and assisted living facilities across the county, has been lobbying for more government support, saying that the pandemic has taken a heavy financial toll.

In March, the AHCA, along with the National Center for Assisted Living, released a report estimating that the long-term care industry is expected to lose $94 billion over the next two years. Mark Parkinson, AHCA's president, warned that as many as 1,000 facilities may close if no additional help from the federal government is provided.

"In some cases, the long-term care facilities have run out of money," Parkinson said.

William Dombi, president of the National Association for Home Care & Hospice, a nonprofit organization that supports home care, said that if long-term care facilities shift their focus to offering more in-home services, they could end up competing with already-established home-care programs.

Regardless, said Dombi, change in the industry is inevitable.

"The demand for home care services is rising and that's because of the COVID-19 pandemic," Dombi said. "Obviously someone's home is safer than congregate care in a nursing facility, and families are realizing that."