The sometimes wretched the state of care in American nursing homes gained national attention in 2020 as COVID-19 swept through facilities across the country, starting with the Seattle Retirement Home where nearly 40 people died and many more became seriously ill.
Now President Joe Biden proposes to act. And he’s not waiting for Congress to give its approval.
During Tuesday night’s State of the Union address, Biden formally announced a new initiative to more aggressively regulate nursing homes. The main goals are to ensure that all facilities are adequately staffed and to strengthen the nursing workforce while spreading more information about the operations and finances of nursing homes – which, according to Biden, is essential at a time when investors are acquiring so many facilities.
“As Wall Street corporations are taking over more retirement homes, the quality of those homes has gone down, and costs have gone up,” Biden said Tuesday. “It ends on my watch.”
The initiative hasn’t garnered a ton of attention outside of the healthcare business media, which isn’t surprising given everything else in the news and the fact that the discussion about the Biden’s domestic agenda continues to focus primarily on Democratic efforts to push through components of their Building back better agenda.
“This is … the most significant set of changes proposed in home nursing since the Nursing Homes Act 1987.”
– Toby Edelman, Center for Medicare Advocacy
But with these initiatives languishing, as leaders to negotiate with Sen. Joe Manchin (DW.Va.) on a possible deal, regulatory action offers a safer way forward. And while there’s only so much Biden can accomplish on his own, experts and advocates who follow the nursing home industry say his initiative could offer the deepest reforms to homes. nursing for decades, dating back to historic Ronald Reagan times. law that created the first national standards of care.
“This is arguably the most significant set of changes proposed to nursing home care since the Nursing Homes Act 1987,” Toby Edelmanlead attorney at the Medicare Defense Centertold HuffPost.
Why defenders are thrilled
It’s not hard to see why these defenders are so enthusiastic. The pandemic has exposed issues they’ve been crying out for for decades, such as high rates of pressure sores and infections, not to mention reports of neglect and abuse.
Sometimes these calls have led to action — as they did in 2015, when the Obama administration announced it would strengthening surveillance nursing homes through a combination of stricter safety requirements, more frequent inspections and more training for workers. But the Trump administration reversed many of those changes and reduce penalties as part of its broader agenda to reduce regulations affecting the healthcare industry.
One provision of Biden’s platform aims to restore Obama-era enforcement reforms. Another part of Biden’s proposals would require collecting and publishing more information about exactly who owns and runs nursing homes and how they manage their finances.
“We can’t meet the need for additional staff…when we don’t have the resources to compete with other employers.”
– Mark Parkinson, American Health Care Association/National Center for Assisted Living
According to an analysis of Economic and Policy Research Center.
Advocates worry that investment firms and other for-profit owners are underfunding care in order to line their pockets, given academic studies linking for-profit status to poor quality and investigative articles highlighted poor care and safety breaches in such facilities.
But proving the relationship between profit and care is difficult without detailed financial information, and that information is hard to come by as owners have become adept at disguising their dealings and management through layers of corporate intermediaries. Just making this information more widely available could make a big difference, say advocates like Richard Mollotgeneral manager of the Long Term Care Community Coalition.
“You have a much more sophisticated corporate environment than 35 years ago,” Mollot told HuffPost. “There are forensic accountants and lawyers who have spent a lot of time connecting the dots here and there, but we don’t have a national system in place to really know what’s going on.”
Why defenders are particularly happy with staff ratios
A promise to improve staffing levels may be the most concrete and consequential part of Biden’s plan.
Research has repeatedly linked lower staffing levels to lower quality care, although it is enough to capture the relationship of a visit to a facility where harassed workers commute between residents in the need. Under these conditions, it is difficult, if not impossible, for staff to follow recommended routines, including hand washing, which in a nursing home environment can significantly increase the spread of disease.
It’s a big deal in normal times and even more so during a pandemic, which is why a 2020 Connecticut Nursing Home Study found that establishments with fewer employees had higher death rates from COVID-19.
“Especially in a time of increasing acuity, with increasingly needy residents, facilities are understaffed, and the pandemic has only amplified that,” David Grabowskiprofessor of health policy at Harvard Medical School, told HuffPost.
Two decades ago, a study commissioned by the federal government of nursing homes recommended setting minimum staffing requirements, which would mean, roughly, that each resident would receive at least four hours of personalized attention from trained staff per day. The federal government never acted on it, and research from the Long-Term Care Community Coalition suggests that around three-quarters of nursing homes would not meet this threshold today.
“You have a much more sophisticated corporate environment than 35 years ago.”
– Richard Mollot, Long Term Care Community Coalition.
Under Biden’s plan, the Center for Medicare and Medicaid Services (CMS) would have a year to re-examine the matter and then create a staffing need, as some states have since done on their own. Although Biden did not specify what the standard will be, advocates and scholars noted that the language of the initiative released by the White House ahead of the State of the Union address is stronger than a proposal. Legislative of similar design which appeared in several versions of the Build. Back Better legislation.
“It looks like an attempt to do through regulation what they might not be able to do through legislation, and it seems to go a bit further too,” MaryBeth Musumeciexpert in long-term care Henry J. Kaiser Family Foundationtold HuffPost.
Why the nursing home industry is not at all thrilled
To meet a new need for staff, nursing homes would have to spend more money on salaries for their workers, especially now that they are competing for labor with retailers, restaurants and businesses. other employers offering even higher salaries. The national trade group representing long-term care facilities says this would be a big problem, as facilities are already overstretched and don’t have enough money to cover the extra expenses.
“We would like to hire more nurses and nurse aides to meet the growing needs of our residents,” said Mark Parkinson, president of the American Health Care Association/National Center for Assisted Living, in a written response to the Biden’s proposal. “However, we cannot meet additional staffing needs when we cannot find people to fill vacancies or when we do not have the resources to compete with other employers.
Nursing home operators are also wary of more regulations that involve new steps to show compliance, whether that means filling out forms or taking the time to accompany inspectors. Operators say many of these rules don’t actually lead to better quality care.
“Facilities are understaffed, and the pandemic has only amplified that.”
– David Grabowski, Harvard Medical School
Some advocates and researchers are skeptical of the industry’s arguments. They say there is already a lot of money in the system and that many facilities could easily afford higher salaries if only their owners did not profit so much.
Others think the industry arguments about underfunding have more merit, pointing to notoriously low payments for Medicaid, the joint federal-state program that is the single largest funder of nursing in the United States. They agree that regulations can force operators to spend more of their time. income to cover salaries, but they believe that ultimately it would take a substantial increase in federal funding to pay for the kind of high-quality care that most Americans would want for themselves or their loved ones.
One place where both sides agree is on the importance of what happens next. So far, the agenda is just a set of pledges that the White House has distributed electronically. As administration officials translate these proposals into actual regulations and rules, they will come under pressure from industry lobbyists to keep the new standards low.
Historically, these lobbyists have won more battles than they have lost, thanks in part to the many legislators and officials with whom they have influence. But with such a clear and prominent call to action from the President and the ever-growing number of 200,000 COVID deaths in long-term care facilitiesthe chances of meaningful action appear to be as strong as they have been in a long time.