Now is the Time to Reimagine and Reinvest in America ’ s Nursing Homes
By Holly Harmon , RN , MBA , LNHA , FACHCA
The COVID-19 pandemic exposed and exacerbated systemic issues in America ’ s long-term care system , such as workforce shortages and chronic underfunding . More than 5 million seniors and individuals with disabilities each year rely on the round-theclock care and enriching social environment in long-term care facilities . They deserve the highest quality care , and long-term care profession officials are calling for meaningful , bold reforms .
The American Health Care Association , along with LeadingAge , have proposed the
Care For Our Seniors Act to address some of the long-standing issues in America ’ s nursing homes and continue our ongoing effort to improve the overall quality of care and services . There are four main principles that encompass these bold reforms – Clinical , Workforce , Oversight , and Structural . Many of their elements are designed to directly improve infection prevention and control .
To enhance the quality of care and services in nursing homes , the clinical principle outlines the need to develop robust standards for infection preventionists ( IPs ), require that each nursing home have a registered nurse ( RN ) on staff 24 hours per day , and require a minimum 30-day supply of personal protective equipment ( PPE ) in all nursing homes .
While some nursing homes have designated one or more part-time , specially trained IPs , others have full-time IPs , or have the position fulfill a broader role , with duties such as staff educator or supervisor . Prior to COVID-19 , nursing homes already experienced a nationwide shortage of RNs and other challenges in recruiting qualified staff , including IPs . The pandemic has only exacerbated these workforce challenges . The increased demand for resources and dedicated , specially trained IPs – which are most often fulfilled by an RN – have strained nursing homes .
We have proposed creating an enhanced standard for staffing infection preventionists in each nursing home where the amount of time required for an IP is correlated with meaningful clinical and environmental factors . To effectively implement these changes , proper funding and key steps to increase workforce availability are necessary .
RNs play a critical role in ensuring nursing home residents receive the highest quality care . They help oversee and manage duties of other clinical staff ( e . g ., licensed practical nurses and certified nursing assistants ), prepare care plans for residents , monitor their health , communicate with physicians , and interact with families of residents , among many other duties . Research has consistently found that as resident acuity increases in nursing homes , a greater presence of physicians , nurse practitioners or RNs results in better resident outcomes and increased satisfaction .
Therefore , the Care for Our Seniors Act supports enhanced staffing for each nursing home to have a RN on staff 24 hours a day and provides recommendations on how to effectively implement this including key steps to increase the availability of RNs in nursing homes and proper funding to fulfill this enhanced staffing requirement .
During the pandemic , worldwide supply chain issues combined with soaring demand among every industry and individual left many nursing home providers scrambling to acquire and afford precious PPE . An adequate supply of PPE improves infection control outcomes and has the potential to reduce mortality rates associated with infection outbreaks .
The Care for Our Seniors Act proposes to require each nursing home to have a minimum 30-day supply of PPE for average conventional use , which will be supported by ongoing federal and state stockpiles .
Real , long-lasting transformation that will truly protect our residents requires a considerable investment in the long-term care profession . Nursing home providers embrace meaningful changes that can help our residents , our staff and our country . But it won ’ t be possible without a commitment from policymakers to provide necessary and consistent funding support .
For too long , nursing homes have faced chronic Medicaid underfunding and unfunded government mandates , leaving many unable to afford enhancements in their care delivery , workforce and infrastructure . COVID-19 has exacerbated these economic challenges . Nursing homes have spent tens of billions responding to the pandemic , specifically PPE , testing , additional staff and bonus pay . Coupled with significant losses due to fewer new residents , the nursing home industry expects to lose $ 94 billion over the course of the pandemic ( 2020-2021 ).
As a healthcare provider that relies almost entirely on government reimbursement ( Medicare and Medicaid ), nursing homes cannot make substantial reforms on their own . They need the support of federal and state policymakers and resources .
We must not let something like the pandemic happen in longterm care ever again , and we must prepare for a growing elderly population . We need to and want to do better .
AHCA / NCAL is eager to work collaboratively with the Biden Administration and Congress to implement significant meaningful reforms that will protect and improve the lives of our nation ’ s seniors .
Holly Harmon , RN , MBA , LNHA , FACHCA , is the vice president of quality , regulatory and clinical services for the American Health Care Association ( AHCA ).