The COVID-19 pandemic highlighted nursing home safety and infection control as critical public health issues. A new report authored by HMA colleagues found compelling evidence that single rooms in nursing homes have numerous benefits for both public health and residents’ experience. The authors conclude that transitioning from multi-resident rooms to single rooms should be a component of person-centered nursing home reform. The report calls on stakeholders to come to the table to discuss options and strategies for long-term care redesign and transformation.
The report, Fundamental Nursing Home Reform: Evidence on Single-Resident Rooms to Improve Personal Experience and Public Health, was developed for a Michigan-based long-term care provider and owner of skilled nursing facilities.
The pandemic’s outsized impact on nursing home residents and staff drove the need to reexamine the physical environment of nursing homes, including room occupancy and its relationship to infection control, health outcomes, quality of life, and overall resident and staff safety. Based on a comprehensive review of the literature and recent lessons from the COVID-19 public health emergency, the HMA team’s findings included:
- Numerous studies over decades concluded that single occupancy rooms decrease the risk of acquiring and spreading infections in hospital settings
- Long-term care facilities’ experience with COVID-19 increased awareness of the risk of infection in multi-resident rooms, and a recent study of nursing homes in Canada found that lower room occupancy was associated with lower COVID-19 infection rates and mortality
- Single resident rooms are associated with improved sleep patterns and reduced agitation and aggressive behavior among people with dementia in long-term care facilities, and fewer medication errors and adverse outcomes in hospitals
- Single-occupancy rooms allow greater flexibility in adapting care as the patient’s/resident’s condition and acuity change, therefore requiring fewer patient transfers
- Single resident rooms in nursing homes enhance residents’ sense of home, privacy, and control
- Studies conducted in long-term care facilities and hospitals found higher resident/patient satisfaction and family preference for single-resident rooms
- Hospital nursing staff view single rooms favorably on multiple dimensions; further study is needed to better understand the association between nursing home staff satisfaction and room occupancy
The HMA team provides guidance and recommendations to explore options for converting multiple to single occupancy rooms in licensed/certified skilled nursing facilities. Funding for reconstruction and new operating and capital costs is a key consideration, and creative strategies and funding sources should be explored. Nursing home owners and administrators should engage federal agencies that help finance nursing homes and improve public health, as well as other key stakeholders including nursing home residents, advocates, and staff. All of these stakeholders have an interest in discussing costs, benefits, and options for promoting, incentivizing, and financing movement toward a healthier and safer nursing home environment.
HMA colleagues Sharon Silow-Carroll, MBA, MSW, Deborah Peartree, RN, MS, Susan Tucker, CPA, and Anh Pham conducted the research and analysis and prepared this report. An appendix prepared by the national accounting firm Plante Moran provides estimates of new costs and other considerations related to transitioning to single-resident rooms, based on data from two Michigan-based multi-facility long-term care organizations.