It was estimated that 23 percent of all COVID-19-related deaths in the U.S. since the start of the pandemic were in nursing homes. And this percentage has gone down over time. In the early days of the pandemic, about 50 percent of the COVID-19-related deaths were in long-term care facilities.
The heroism of the nurses and staff caring for the aging, disabled and others needing long term care, especially during a pandemic, cannot go unnoticed. But these statistics have raised alarm bells about the safety and security of seniors and others needing long-term care.
In the State of the Union address on March 1, President Joe Biden made small mention of his plans for making long term care facilities, like nursing homes, safer. He said: “And as Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up. That ends on my watch. Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and that they expect.”
These brief remarks alluded to a broad strategy to improve the quality of care for seniors, people with disabilities and others living in nursing homes. The plan, explained in a fact sheet from the White House, seeks to ensure nursing homes and long-term care facilities have sufficient staffing, are held accountable for improper care and provide better information about conditions so people can make informed decisions about where they want to be.
A central part of the plan is setting required staffing levels at long-term care facilities to ensure adequate care around the clock. Skilled nursing was one area of healthcare that saw the biggest drop in employment during the pandemic, with about 8.4 percent of skilled nurses leaving the industry.
Advocates for long-term care and skilled nursing facilities argue for increased Medicaid funding, rather than putting more oversight staff. Without proper financial support, long-term care facilities can’t provide needed services or keep staff, Beth Martino, senior vice president of public affairs at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said in Skilled Nursing News.
Long-term care facilities struggle with staff retention, Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit aging service providers, told Keiser Health News. Setting minimum staff requirements, without also increasing Medicaid funding to these facilities won’t make keeping employees any easier.
The White House included a provision for the Centers for Medicare and Medicaid Services (CMS) to develop a template for states to request Medicaid funding for clinical staff wages and benefits in the plan. This may include additional pay for experience level or specializations.
If the administration accomplishes its goals for nursing home reform, this would be the largest increase in nursing home-related spending in four decades. A lot of the money – almost $500 million – would go towards funding for nursing home inspections. But, the question remains, where will this leave long-term care two, three or five years from now?
“Despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm … Without decisive action now, these unacceptable conditions may get worse,” the White House said in the fact sheet.
Other key elements of the reform, aside from staffing requirements, include reducing room crowding for facility residents, increasing performance incentives for skilled nursing facilities, and reinforcing safeguards against unnecessary medication and treatment. The Biden administration also plans to increase oversight over long-term care facilities and put measures in place to increase facility transparency. This will allow for those needing care, and their loved ones, to make informed decisions about their future.
As for next steps, the Biden administration has tasked the CMS to conduct a study on long-term care facility staffing and publish proposed regulations within the year.
