The CMS is proposing rules aimed at dramatically improving the quality of care Medicaid and Medicare beneficiaries are receiving in nursing homes.
An estimated 1.5 million beneficiaries are receiving treatment at more than 15,000 long-term care facilities or nursing homes around the country that participate in the Medicare and Medicaid programs.
The 403-page proposed rule released Monday contains numerous proposals to reduce unnecessary hospital readmissions and infections, increase quality of care and introduce new safety measures.
“Today's measures set high standards for quality and safety in nursing homes and long-term care facilities,” HHS Secretary Sylvia Mathews Burwell said in a statement. “When a family makes the decision for a loved one to be placed in a nursing home or long-term-care facility, they need to know that their loved one's health and safety are priorities.”
President Barack Obama announced the new rules Monday at the White House Conference on Aging.
Some of the specific changes include making sure that nursing home staff members are properly trained on caring for residents with dementia and in preventing elder abuse. Other changes include improving care planning, including discharge planning for all residents with involvement of the facility's interdisciplinary team and consideration of the caregiver's capacity, giving residents information they need for follow-up, and ensuring that instructions are transmitted to any receiving facilities or services. Lastly, the CMS is looking to strengthen the rights of nursing home residents, including placing limits on when and how binding arbitration agreements may be used.
The CMS is the leading payer in the nation for long-term care services. Approximately 64% of nursing home residents have their care paid for by Medicaid, another 14% are covered by Medicare and 22% have another payer, according to the American Health Care Association, a nursing home trade group.
If finalized, the proposals would cost the nursing home industry $729 million in the first year the rule is in effect and $638 million in year two, according to the CMS.
The cost sent a shudder through the industry Monday.
"We would oppose such a large unfunded mandate, especially given the overall narrow margins of 1% to 3% that MedPAC calculates for skilled-nursing-care centers,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, said in a statement.
Advocates had mixed reactions. The Long Term Care Community Coalition was happy to see HHS takes some steps to improve the care of residents in facilities but was disappointed that the agency didn't go farther to push for mandatory staffing minimums. Burnout is common at these facilities.
"For residents, in terms of staffing, this is a case of 'the more things change, the more they stay the same," said Robyn Grant, director of public policy and advocacy at National Consumer Voice for Quality Long-Term Care. "With increasing care needs and greater numbers of profit-driven nursing home corporations, residents can't afford for things to stay the same," she added. "The agency's stated goal is to improve quality care. The most important step it can take to achieve that goal is to implement stronger staffing requirements. Consumer Voice will continue to advocate for these improvements.”
Richard Mollot, executive director at the organization, added that he also wanted more controls to ensure that senior citizens are not unnecessarily prescribed anti-psychotics, which has been a problem at nursing homes.
"When anti-psychotics are used long term, there is an increased risk of death,” Mollot said.
Comments on the rule will be due Sept. 16.