The American Health Care Association and LeadingAge Monday released reform proposals for the nursing home industry that address quality of care, workforce challenges, oversight and modernization. The federal government has offered temporary relief to the industry through the COVID-19 pandemic but the proposed reforms aim to enact long-term change.
Through the joint proposal, dubbed the Care for Our Seniors Act, the nursing home advocates are calling on lawmakers to "help resolve systemic challenges."
"The pandemic has been an unprecedented tragedy with long-term care facilities being at the epicenter of the crisis," Debbie Meade, chair of the board of directors of AHCA, said in a statement. "We have seen long-standing challenges exacerbated among our facilities and without serious reform, we risk more crises in the future. The Care For Our Seniors Act pinpoints the biggest issues facing our industry and provides bold, transformative and meaningful solutions that can ensure something like the COVID-19 pandemic never happens again."
AHCA and LeadingAge want to see care quality improve through clearer standards for infection preventionists. They recommended requiring each nursing home to have a registered nurse on staff at all times and mandating that all facilities have a 30-day supply of personal protective equipment.
To address workforce issues, they suggested implementing a plan to attract, retain and train more long-term care workers. The associations also want to establish a resident-driven system by creating a process to turn around or close underperforming nursing homes and by adding customer satisfaction to CMS' five-star rating system.
The groups suggested nursing homes could move toward modernizing facilities by conducting a national study on how to shift to more private rooms.
Advocates say the proposals "will be costly but long overdue" and will require government resources. They suggest increasing federal Medicaid funds, establishing federal guidelines for state funding and creating state-based Nursing Facility Value-Based Purchasing Committees.
"The long-term care system that serves our elderly has been too long ignored in this country. That is untenable and does not reflect who we are as Americans. Now is an opportunity to fund what our country values," Carol Silver Elliott, chair of LeadingAge's board of directors and president and CEO of Jewish Home Family, said in a statement. "Quality care that honors the dignity of each of us must be our top priority; ensuring consistent access and delivery in safe environments must be our shared goal."
David Grabowski, a professor of healthcare policy at Harvard Medical School, said most of the steps outlined in the reform proposal would improve care but noted that "they key is in the details."
"Most importantly, these reforms need to be paired with strong financial oversight and transparency. The proposal mentioned the establishment of a federal framework for state allowable costs. This needs to go further. We need to know how nursing homes are currently spending public dollars, and when additional dollars are necessary, how these will be spent," Grabowski said.
When asked about transparency provisions during a press call Monday, AHCA President and CEO Mark Parkinson said the organizations support transparency but added that concerns about transparency detract from "the real work that needs to be done in terms of providing care."
Grabowski added that the reform proposals fail to address the workforce shortages of direct caregivers and don't offer any solutions for increasing their pay.