1. More will age at home

With about 40% of Covid-related deaths in the U.S. occurring in long-term-care facilities, the disease has exposed “how shockingly inadequate our care infrastructure and systems are” and “how essential access to home care is,” says Ai-jen Poo, an advocate for caregivers.

That recognition should have two different but beneficial effects: fewer but better nursing homes, and more resources to help people age at home.

As the government raises regulatory standards on nursing homes, industry watchers are saying 30% or more could file for bankruptcy, according to Sarah Slocum, co-director of the Program to Improve Eldercare at Altarum, a nonprofit health-care consulting group.

“You will see a lot more focus on aging at home and figuring out how to shift the financial incentives to make that work” says Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania. (After Dr. Emanuel was interviewed for this article he was appointed to President-elect Joe Biden’s task force on coronavirus.)

Community-based programs will expand, including the Program of All-Inclusive Care for the Elderly, a Medicare-sponsored service that is currently helping 50,000 people with such needs as medical services, day care, home care and transportation. The program costs Medicare and Medicaid an average of about $7,000 per person a month, versus $9,000 per person for nursing homes, according to Altarum.

Pinchas Cohen, dean of the Leonard Davis School of Gerontology at the University of Southern California, predicts that federal or state governments will expand programs, including one under Medicaid, that pay some family caregivers, typically an adult child. Generally, the amount depends on an assessment of the elderly individual’s needs, as well as the average wage for a home care aide in the state and geographic region in which one lives.

Cut Off

Nursing home residents reported dramatic swings in types and frequency of visitation as a result of the pandemic in an online survey conducted this summer.

Ms. Poo says that the pandemic has shone a light on the inadequacy of the average $17,000 annual income of home health aides, many of whom are working “without health care, hazard pay or child care.”

The trend toward more aging at home will also favor smaller elder-care arrangements like the nonprofit Green House Project, which was started by Dr. Thomas and promotes senior living in small, homelike cooperative settings. Some 300 such homes in dozens of states house up to 12 residents and typically feature open floor plans, large dining-room tables, fireplaces and porches. Data gathered by the University of North Carolina and the Green House Project show 94% or more of the homes certified to provide skilled nursing care remained virus-free through Aug. 31.

A movement away from nursing homes might prompt Americans to also rethink other forms of age-segregated housing, including 55-plus communities, predicts Marc Freedman, president of Encore.org, a nonprofit working to bridge generational divides.

Age segregation “has not prepared us well for living longer lives,” says Mr. Freedman. With relatively little day-to-day contact between younger generations and elders, “each life stage we move into we are utterly unprepared for.”

Age segregation, he says, encourages a view that an aging population is “a problem to be solved” rather than “a repository of social, intellectual and community capital.”

Average home healthcare aide salary? $17k a year. Cheapest federal program for home healthcare? $7k a month. 30% of nursing homes filing for bankruptcy.