National Academies Call for “Fundamental Overhaul” of U.S. Nursing Home System

The COVID-19 pandemic had a significant impact on nursing home staffing, and thus quality, of the U.S. nursing home system, the National Academies found.

Following the devastating impact COVID-19 had on nursing homes nationwide, a private non-profit research organization has released a series of recommendations regarding fundamental changes that are needed to prioritize the quality of care for more than one million nursing home residents across the nation.

Om May 11, the National Academies of Sciences, Engineering, and Medicine published a report in the Journal of American Medical Association (JAMA) which proposed several immediate nursing home reform recommendations at both the federal and private sector levels, aimed at better serving residents and nursing home staff.

With more than 1.4 million residents in over 15,500 Medicare and Medicaid-certified nursing homes throughout the United States, significant attention has been placed on nursing home neglect incidents caused by understaffing, staffing turnover rates and lack of infectious disease protocols throughout the course of the COVID-19 pandemic.

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The list of recommendations includes increasing the minimum nursing staffing standards, which experts claim have played a crucial and tragic role in the high number of COVID-19 deaths at facilities throughout the nation since March 2020. The report calls for nursing home staff to be compensated with competitive wages and benefits, which includes health insurance, childcare and sick pay.

In addition to improved benefits and staffing levels, the report also calls for nursing home staff education requirements, calling for facilities to provide entry-level training and continuing education, at no cost to the employee.

The report mirrors a similar proposal for nursing home reforms announced by the White House earlier this year, indicating that nursing home facilities should adopt room occupancy standards to avoid patients sharing rooms. The report also indicates limiting the amount of patients per room not only increases the quality of life for residents, but can greatly reduce the spread of an outbreak.

To further improve the standard of care and patient safety, the report calls for nursing homes to adopt health information technology that will easily allow the exchange of important clinical data such as patient’s admission, discharge, and other information critical to patients care.

Recommendations outlined in the release also call on the U.S. Department of Health and Human Services (HHS) to collect, audit, and make publicly available detailed facility-level data on the finances, operations, and ownership of all nursing homes through the use of Medicare and Medicaid cost reports and data from the Medicare’s Provider Enrollment, Chain and Ownership System.

Analysts claim that by increasing its financial auditing abilities, CMS will be better able to track staffing patterns, deficiencies, and objective quality indicators by owners and company’s managing nursing homes.

Nursing Home COVID-19 Staffing Problems

Nursing home staffing levels plummeted during the pandemic, due to employees succumbing to Covid-19 or becoming burnt out attempting to provide care for their residents with a greatly decreased staff. Many nursing home workers, seeing the sharp rise in workload without accompanying increases in pay, simply quit for other, higher-paying jobs, leaving those who stayed pulling multiple shifts to try and make up for the staffing deficiency.

In February, the White House issued a press release proposing a series of nursing home reform policies that are designed to ensure patients receive better quality of care through improved staffing requirements.

The release cited a recent survey by the Government Accountability Office, which found 82% of nursing homes lack suitable infection control and prevention protocols, which has directly contributed to more than 200,000 nursing home resident and staffing deaths recorded throughout the course of the pandemic. The White House indicates that if decisive action is not taken now, the nation’s most vulnerable population could be subject to ever-worsening conditions.

Earlier this week, U.S. Senator Bob Casey, chair of the U.S. Senate Special Committee on Aging, wrote a letter (PDF) to CMS Administrator Chiquita Brooks-LaSure, calling for an increase in inspections of what are known as Special Focus Facilities (SFF); those nursing homes and long-term care facilities which have been rated poorly by CMS, saying many of them are not being surveyed as frequently as required by law.

Specifically, the letter states the Aging Committee has identified 15 nursing homes, representing 22% of the 63 facilities currently registered in the SFF program, which have gone six months or longer without a standard inspection. Four facilities have gone at least seven months without inspections, and three facilities have gone eight months, the letter notes.


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