Call for holistic nursing home reform, a ‘wake-up’ call for lawmakers

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A landmark report on U.S. nursing homes released Wednesday is expected to serve as a “sharp wake-up call,” encouraging lawmakers to invest as they try to fix what a National Academies committee has called an “unsustainable” system.

That’s according to LeadingAge President and CEO Katie Smith Sloan, one of many observers who said Wednesday’s report from the National Academies of Sciences, Engineering, and Medicine Committee on the quality of care in nursing homes highlighted the inability of the existing payment system to support Quality Care.

“As policymakers consider how to implement the report’s recommendations, they must back their actions with sufficient funding to make change a reality,” Sloan said. “Without that, the work of the committee will be useless.”

The groundbreaking 600-page study is the first time in more than 35 years that the Academies have assessed the challenges facing nursing homes. The final set of recommendations, solicited by Congress, largely shaped the nursing home reform legislation included in the Omnibus Budget Reconciliation Act of 1987 (OBRA).

While this investigation was not undertaken solely in response to COVID-19, committee members acknowledged that the pandemic has brought renewed attention to “the long-standing shortcomings that continue to plague nursing homes,” said said President Betty Ferrell, RN, director of nursing research and education and professor at City of Hope Medical Center in Duarte, Calif.

Among the objectives defined by the committee are ensuring that the workforce is well prepared and compensated appropriately; create a more rational and robust financing system; and increase transparency and accountability of finances, operations and ownership.

Health economist R. Tamara Konetzka, Ph.D., of the University of Chicago served on the nursing home committee. She told LeadingAge members on a conference call on Wednesday that the committee had intentionally offered its measures as a set of interconnected changes — and that implementing one, such as increased staffing, without implementing another, such as funding reform, would not work.

Regarding manpower, the committee called for 24/7 staffing of registered nurses and a full-time social worker in all nursing homes. Members also suggested that leaders seek funds to seek minimum and optimal staffing levels, an initiative independent of the White House’s own proposal on the subject.

“Nursing homes themselves are probably unable to solve the short-term workforce problem,” Konetzka said. “Even if they’re mandated to just increase the roster, I think we’re all in agreement that it’s not really going to happen until we see that fundamental change.”

But she argued that a holistic approach to reform that addresses the macro-economics of skilled nursing would take the sector to a place “where we can pay people more, where we can invest in career ladders and retention. and training, so that we have a more abundant, also more highly qualified and autonomous workforce.

More conclusions and recommendations

The committee also recommended that policymakers, heads of state, and Congress work together to reform how long-term care is paid for by assessing the adequacy of Medicaid payments, exploring more initiatives to value-based purchasing for long-term care and moving toward a long-term federal policy. care delivery.

Regarding transparency, the researchers recommended making facility-level data on the finances, operations, and ownership of all nursing homes publicly available and ensuring the ability to assess data on common owners. nursing homes.

“Accountability of care homes must be strengthened through the implementation of evidence-based oversight,” Sloan added, embracing the recommendations. “Our country needs an effective regulatory system; it can be done, if we harness the science of quality improvement, supporting and rewarding high quality care.

The American Health Care Association/National Center for Assisted Living said Wednesday that policymakers must first invest in “this chronically underfunded health sector and support provider improvement on the metrics that matter to residents.” ” in order to bring about real improvements.

“Providers are dedicated to learning from this pandemic, renewing our commitment to our seniors, and providing solutions that will improve the quality of care in nursing homes across our nation,” the AHCA/NCAL said in a statement. communicated to McKnight Long Term Care News. “With the right resources and support, we can transform our nation’s retirement homes.”

holistic approach

All of the recommendations will require more resources, Konetzka acknowledged.

Even adding transparency measures and directing money more directly to care would not meet the real needs today, she said, noting that the report repeatedly calls on Congress to to intervene. She said further investment will be needed to move the system from one that targets “basic compliance” to one that seeks high-quality, person-centred care.

Konetzka also said better understanding where Medicaid dollars are going through transparency efforts is only the first step in aligning future payments to cover the cost of care.

“Even though there’s a need for more transparency, we have plenty of evidence that Medicaid rates are probably too low, probably across the board,” she said.

The report recommends that federal officials review Medicaid rates to ensure they are adequate and adjust them to cover the cost of care through short-term increases. But it’s the committee’s longer-term solution to overtaking Medicaid that excites many, and it’s the creation of what Konetzka called “perhaps another Medicare.”

“Long term, we really want the federal government to sponsor research that can design a system where we have some kind of federal long-term care benefit rather than all these state Medicaid systems, and this federal long-term care benefit. long term would cover not only the impoverished people, but a more widespread benefit.

Committee chair Ferrell said in a webinar on the report’s findings on Wednesday that she believes “people at all levels of health policy, government and communities understand” the committee’s recommendations. She said members were “very, very hopeful to see this report implemented”.

Fellow committee member David Grabowski, Ph.D., a Harvard health policy expert, called the recommendations “an unprecedented opportunity.”

“I think there’s a momentum that we haven’t had before towards this goal, but the work can’t stop now,” he said during the webinar. “We have to keep moving forward with this.”

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