Financial assistance components include providing student loan forgiveness for licensed healthcare professionals who are new graduates and work in long-term care , as well as providing tax credits for licensed healthcare professionals who work in LTC facilities .
Regulatory solutions include :
• Create a pathway ( including training and testing ) for temporary nurse aides allowed by the current Public Health Emergency ( 1135 waiver ) to become nurse aides
• Review state policies to reduce burdensome regulations and streamline opportunities to enhance the long-term care workforce ( such as providing facilities the flexibility to run their own CNA training programs )
• End ban on CNA training programs after a nursing home receives a civil monetary penalty ( CMP ) or substandard quality of care deficiency , or , at minimum , allow facilities to restart their training program when they demonstrate that they are back in compliance . Currently , nursing homes with these citations face a two-year ban on being able to train CNAs .
• Ensure the Nurse Licensure Compact is available in every state to be able to “ share ” RNs across state borders
• Expedite the progression in licensed practical nurse ( LPN ) to RN bridge programs to increase the number of RNs
• For professional licensing boards , change the reporting for adverse events that can trigger , licensure sanctions , personal CMPs and criminal actions , which is a known barrier to recruitment and retention . These changes would not apply to rare events that are egregious or criminal in nature .
It is proposed that these action steps would be funded by federal and state governments .
3 . Oversight : Improving Systems to be More Resident-Driven
As we know , the purpose behind government oversight of nursing homes is to ensure the safety and wellbeing of residents ; AHCA / LeadingAge assert that “… the current survey and enforcement system treats nursing homes like they are all bad actors , and as a result , the system has been shown to be inconsistent and ineffective . The current process does not drive improved quality of care and quality of life for nursing home residents . The same modes of citation and penalty have been used for decades and have not evolved to reflect the science of quality improvement nor a current understanding of how to effectively use oversight to create change and achieve desired outcomes . Nursing homes , consumer advocates , Congress , and the Centers for Medicare and Medicaid Services ( CMS ) are dissatisfied with both the process and results . The extensive investment of time and funding in the inspection process by state survey agencies , the federal government , nursing home staff , and other stakeholders is not delivering an equal or better return on investment to benefit the residents the system is intended to serve .”
Last year , the National Academies of Sciences , Engineering , and Medicine recognized this suboptimal system and launched a study to revisit the connections between the regulations / survey process and quality .
As AHCA / LeadingAge state , “ The punitive nature of the process drives qualified staff out of long-term care and into other healthcare jobs where the oversight process focuses on supporting a culture of safety and continuous quality improvement . Moreover , excessive fines take away precious resources needed by facilities to make necessary improvements for better resident care . In addition , CMS spends a substantial portion of its survey budget on addressing poor-performing nursing homes , yet the current process and use of resources is not improving resident care among struggling providers . We must foster an approach where providers and regulators have a shared responsibility to do what is best for the residents , recognize good faith efforts , and effectively remedy identified issues .”
AHCA / LeadingAge recommend a three-tiered approach that leverages continuous learning to improve the oversight and enforcement process for better resident care :
1 . Incorporate a good-faith effort evaluation and quality improvement focus on the survey process . 2 . Understand when and how citation and enforcement remedies are helpful in driving compliance and improvement and apply consistently across the U . S . 3 . Align state survey agency performance evaluation with the CMS mission of assuring basic levels of quality and safety for all residents .
It is proposed that these action steps would be funded by current CMS and state survey agency funding , which is a budget-neutral proposition .
4 . Structural : Modernize for Resident Dignity and Safety
Capital improvements to nursing homes have been delayed due to chronic Medicaid underfunding , which also makes the goal of private rooms largely unattainable . As AHCA / LeadingAge explain , “ The current reimbursement system incentivizes providers to put multiple long-stay residents and / or short-stay patients in the same room in order to make ends meet . Residents deserve better , and nursing homes must continue to evolve . These traditional care models for long-stay residents are no longer considered appropriate as a new , welcomed emphasis on person-centered care continues to emerge . One central aspect of this shift is a greater emphasis on residents ’ autonomy , dignity , and privacy . Increased privacy can also enhance the quality of care delivered , especially considering COVID-19 best practices and the efforts to promote infection prevention and control . To date , there has not been an organized examination of the broad range of factors related to different room configurations . Furthermore , there are no data sources on the number of buildings and rooms with more than two residents and no consistent approach to assessing the costs associated with a move to private and semiprivate rooms . Most research in nursing homes on this topic relates to psychosocial outcomes such as preference and satisfaction .”
The proposed solution is to develop a national study that would provide evidence-based data on shifting to more private rooms in nursing homes , especially considering emerging infectious threats . The national study would be framed by two key guiding principles : assess nursing home design to address the COVID-19 pandemic and improve infection control ; and modernize to meet market preferences . As AHCA / LeadingAge note , “ It is vital to understand the role private and semi-private