Dueling Opinions: What’s challenging the nation’s nursing homes?

In late February, the White House released an outline on proposed nursing home reforms, including minimum staffing requirements and other goals concerning quality, safety and oversight.

Like hospitals, nursing homes have been hammered by workforce issues during the pandemic. What are some changes that could help with staffing?

Brian Perry: There’s been a lot of reporting on the nurse staffing agency problems the industry is having and the high costs. That’s been an incredible challenge. Nurses are leaving for myriad reasons. … And when you realize there aren’t enough seats in nursing schools to train the nurses we need, there also aren’t enough instructors to teach those nurses where seats are available.

Susan Reinhard: We do believe front-line workers in nursing facilities need better pay, which would help, but we also think, particularly around Medicaid payment, that we shouldn’t just raise the rates. When states do raise the rates, they should make sure the bulk of that funding goes to direct care, that it goes to paying the workers, for infection control, for direct care services.

As more care continues to shift from hospitals and nursing facilities to home-based services, what do you see as some pros and cons?

Perry: So many of the patients we care for in our nursing homes are Medicaid patients who maybe don’t have the community support that’s needed. They don’t have a safe home to go to, if they have a home at all. There are so many social structures that we believe need to be put in place to ensure that we can greatly expand home care.

Reinhard: I started my career as a visiting nurse, so I’m very pro home care in general. But there are concerns about shifting very complex care into the home, when there’s a lot that needs to be done for these patients. Our concerns over all of this have to do with the family caregivers in particular. Do they have the proper training and resources?

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Medicaid is the largest payer when it comes to nursing homes. What are some policy issues you’re focusing on?

Perry:There’s continued underfunding in that program from governors across the country. Some states are doing fairly well. Alabama comes to mind, but we don’t operate there. California has been a state that has valued their Medicaid program and pay a decent rate. But there are others where we lose $40 to $50 a day on a Medicaid patient. … This should be a nonpartisan issue.

Reinhard: We’re doing a lot of work around training and safety issues. And the president’s proposals include that. One issue is how much training caregivers should be allowed to get online. We’re looking at a lot of issues, state by state, trying very hard to make sure we get more workers. But we need to ensure they are prepared workers and that safety and quality continue to be priorities.