Long-Term Care Special Edition August 2021 | Page 25

increased demand for resources and dedicated , specially trained IPs , which are most often fulfilled by a RN , have critically strained nursing homes … The COVID-19 pandemic requires us to reflect upon whether the current regulation is adequate to ensure staff with expertise in infection prevention and control are effectively used in nursing homes .”
The proposed solution , according to AHCA / LeadingAge , is to create an evidence-based standard for staffing IPs in each nursing home where the amount of time required for an IP is correlated with meaningful environmental factors . Additionally , AHCA and LeadingAge recommend :
• The amount of time required for an IP is adjusted based on each facility ’ s bed count , demographics of the facility ’ s surrounding area , individual factors contributing to infection control risk levels , and corporate or other support resources .
• Flexibilities for smaller and rural facilities .
• A diverse group of professionals be allowed to serve as an IP with training as described in current regulation .
• A phased-in requirement to give nursing homes time to recruit and train without threat of penalty for noncompliance .
• The IP is recognized in the CMS Payroll-Based Journal as a role centered around resident care .
Implementation would include :
• Loan forgiveness for RNs in long-term care and to other professionals ( such as those with a public health degree ) who serve as IPs in nursing homes
• Offer grants to pay for initial and ongoing continuing education units / training for IPs
• Provide tax incentives or accreditation recognition for professional schools whose graduates work as an IP in nursing homes
• Require states to incentivize enhanced infection prevention through state quality payment programs
• Create national database of IPs for networking and recruiting
• Provide value-based purchasing incentive for nursing homes with a full-time IP on staff
• Ensure the Nurse Licensure Compact is available in every state to be able to share RNs across state borders
• “ Train the Trainer ” supports from state public health officials to help nursing home providers adapt to IP turnover or other emergent issues
It is proposed that these action steps would be funded by Medicaid payment policy .
The second component is a new federal requirement that each nursing home have a RN on-staff 24 hours a day .
Implementation would include :
• Policies increasing nurses in nursing homes also need to incorporate strategies to attract more nurses to work in long term care . Prior to implementation of such a requirement , several steps are needed to achieve RNs being available 24 hours a day in nursing homes , including financial incentives to RNs and students in RN training , as well as to schools / universities and nursing homes .
• National campaign to recruit RNs into nursing homes , including showing the value of nursing homes and calling to serve LTC populations , as well as highlighting the incentives available to RNs who pursue careers in nursing homes available to new graduates as well as experienced RNs
• Level the playing field for RNs in nursing homes by aligning reporting of nurses to their licensing board for adverse events to be consistent in all settings .
• Support state-based efforts such as creating and funding an emergency workforce , available from local and state sources , to deploy to nursing homes in need to maintain requirements .
It is proposed that these action steps would be funded by Medicaid payment policy and Medicare rates .
The third component is adequate personal protective equipment ( PPE ), which , as we know , improves infection control outcomes and has the potential to reduce mortality rates associated with infection outbreaks .
The proposed solution is to require every nursing home to have a minimum 30-day supply of PPE for average conventional use . Nursing homes may also employ conservation strategies , if needed , to extend use of PPE – an effort that must be supported by ongoing federal and state stockpiles of PPE that is in acceptable condition for healthcare use . This 30-day minimum supply includes gloves , gowns , goggles / face shields , facemasks and N-95 masks , as well as alcohol-based handrubs and disinfecting supplies .
Implementation would include :
• The federal government must prioritize nursing homes for allocation of PPE .
• Allow adequate timeline to secure necessary PPE for initial minimum supply .
• Offer waivers to facilities when supply is not available outside of facility control , such as notifying state or federal agency when PPE supply is below 30 days and not able to replenish .
• Federal and state governments provide credible PPE wholesale supplier registries that are made available to the public . Providers need access in order to meet any PPE stockpile requirement .
• Through registries , federal and state agencies monitor for price gouging of required PPE and disinfection supplies .
• Maintain national and state stockpiles for additional support and established direct pathway for nursing home providers to request and receive timely supplies .
It is proposed that these action steps would be funded by federal and state governments .
2 . Workforce : Strengthen and Support Frontline Caregivers
Workforce recruitment and retention is one of the most pressing challenges confronting long-term care facilities . As AHCA / LeadingAge observe , “ Long-term care was already dealing with a workforce shortage prior to COVID , and the pandemic exacerbated the crisis as staff members got sick , had to isolate , or lacked childcare options . At the same time , already thinly stretched staff members had to do more than ever before , as residents required additional one-on-one care to help prevent spread of the virus as well as fill the void of loved ones who could not visit in-person .”
The multi-phased approach includes incentives necessary to attract , keep , and develop long-term care staff by leveraging federal , state , and academic resources — a key first step to increase workforce availability , AHCA / LeadingAge emphasize . Strategies address challenges including financial assistance for potential and current caregivers , training , educational opportunities to develop their skills , and streamlined pathways for professionals to build a career in long-term care .
www . healthcarehygienemagazine . com • aug 2021 • LTC Imperatives Special Issue
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