The American Health Care Association ( AHCA ) and LeadingAge assert that as nursing homes emerge from the pandemic , lawmakers must commit to substantive reform and support for the industry , and earlier this year have proposed the Care For Our Seniors Act – a reform package that will support better pandemic management and strengthen overall care in nursing homes .
• decision-making is only possible when the workforce feels safe , prepared , and respected for the meaningful work they do . They need to work in facilities compliant with Occupational Safety and Health Administration ( OSHA ) regulations ; they need timely access to the right training , equipment , and technology ; and they need to be compensated at a level commensurate with the intensity of the care they provide . These needs must be accompanied by a multi-faceted financing approach that involves securing and distributing federal emergency funding relief and longer-term appropriations , reforming Medicaid and Medicare reimbursement rates , and allocating wage pass-throughs . Employing effective processes requires that oversight bodies at federal and SLTT levels deliver clear , concise , timely , transparent , and evidence-based guidance and instruction for compliance , as well as streamline reporting requirements . Moreover , nursing home owners and administrators , along with their oversight bodies , share responsibility for ensuring that required processes for operation are implemented and continuously improved as new learnings emerge about the pandemic . As such , CMS actions in response to the pandemic should have the intention of increasing organizational capacity so that nursing home staff fulfill their responsibilities related to the care and protection of residents . Increasing organizational capacity can involve both effective oversight and enforcement but also leveraging the resources and insights gleaned from a national level perspective of the pandemic and disseminating them to others at the ground level .”
In the wake of the COVID-19 pandemic , authors of a commentary call for nursing homes to match patients with appropriate care models , increase training and payment for staff , and investigate better financing models .
As Fulmer , et al . ( 2020 ) observe , “… there is agreement that , in general , America ’ s nursing homes are not designed , operated , or funded to deal effectively with infectious disease epidemics , and their staff are often too few and inadequately paid , protected , and trained . While knowledge related to caring for residents during COVID-19 accrues , nursing homes will continue to apply multiple strategies to meet the many different requirements for care of their older residents … As the primary financiers for short- and long-term nursing home stays respectively , the payment rules of Medicare and Medicaid will play crucial roles in realizing a new vision for the appropriate services and settings for the care nursing homes currently provide .”
The American Health Care Association ( AHCA ) and LeadingAge assert that as nursing homes emerge from the pandemic , lawmakers must commit to substantive reform and support for the industry , and earlier this year have proposed the Care For Our Seniors Act – a reform package that will support better pandemic management and strengthen overall care in nursing homes . The package consists of four policy areas :
• Clinical improvements to enhance quality of care : Enhance the quality of care in nursing homes by developing robust standards for infection preventionists , requiring that each nursing home have a registered nurse on-staff , 24 hours per day , and requiring a minimum 30-day supply of personal protective equipment in all nursing homes .
• Workforce improvements to strengthen and support our frontline caregivers : Strengthen and support our frontline caregivers by implementing a multi-phase tiered approach to attract , retain and develop more long-term care professionals leveraging federal , state and academic institutions .
• Oversight reforms to make systems more resident-driven : Establish a more resident-driven system that is focused on improvement to ensure nursing homes are compliant and providing high quality care . This would include implementing a process to help turn around or close facilities that are chronic poor performers and adding customer satisfaction to the government ’ s five-star rating system to help guide potential residents and family members .
• Structural modernizations focused on resident dignity and safety : Modernize nursing homes by conducting a national study on how to shift to more private rooms , which promote resident privacy , autonomy and dignity , as well as support infection control best practices .
As AHCA / LeadingAge state , “ Implementing these reforms requires a commitment from federal and state lawmakers to properly fund nursing homes – particularly ensuring that Medicaid reimbursement rates cover the actual cost of care . With most nursing homes already operating on razor-thin margins , the cost of making improvements will not be possible without financial assistance . Long-term care was forgotten at the beginning of the pandemic , but it cannot be forgotten now . Lawmakers have an opportunity to put America ’ s seniors and frontline caregivers first .”
Let us review each tenet of the Care For Our Seniors Act , as it establishes a comprehensive blueprint for improvements in long-term care .
1 . Quality of Care
The first component is an enhanced infection preventionist . As we know , effective infection prevention and control programs can decrease infection rates and HAIs , improve attention to hand hygiene and transmission-based precautions , improve employee health , and reduce hospitalizations and adverse events among nursing home residents . As AHCA / LeadingAge explain , “ While some facilities have designated one or more part-time , specially trained IPs , others have fulltime IPs , or have IPs 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