The call for improving the U.S nursing home system has been stronger than ever, in response to high mortality rates of senior residents and severe staff shortages aggravated by the COVID-19 pandemic.

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The American College of Physicians (ACP) made detailed recommendations about how to reform the system of long-term services and support, in a position paper published in the Annals of Internal Medicine on Monday.

From financing and staffing, to improving care quality and accessibility, the ACP reckoned that the challenges the system faced during the COVID-19 pandemic can be major areas to start with.

“We saw the devastating effect the virus had on residents in nursing homes, both because of their age and the higher risk associated with congregate living situations,” said ACP President Ryan D. Mire in a statement.

The ACP position paper echoed an appeal made in April by the National Academies of Sciences, Engineering, and Medicine for improving nursing home service quality.

No group suffered more during the pandemic than residents in American nursing homes. Nearly 154,000 of them had died from COVID-19 by July 3, according to the Centers for Disease Control and Prevention.

American nursing homes were ill-equipped to control infections. About 82 percent were cited for infection prevention and control deficiencies from 2013 to 2017, the Government Accountability Office reported in May 2020.

At the early stage of the pandemic, however, many nursing homes were required to admit “medically stable” COVID-19 patients from hospitals. The move seeded infections which spread rapidly afterwards.

Rivera’s 78-year-old mother died at a nursing home in West Islip, New York after contracting COVID-19 in April, 2020. She was one of many seniors in the state who lost their lives in nursing homes during the pandemic.

Rivera and her sister Vivian Zayas founded Voices for Seniors to advocate for protective legislation and reform related to the elderly and nursing home residents.

“It’s by passing the legislation that we need, so that this never happens again,” said Zayas.

Some families of elderly residents who died from Covid-19 have already brought negligence and wrongful death lawsuits against the facilities.

The plaintiffs largely accused nursing homes of failing to properly curb the spread of the infectious disease, identify infected residents and treat their illnesses.

All these have mounted further pressure for reforming the troubled nursing home system in the United States.