What Is the President Proposing to Help Nursing Home Quality?
White House officials outlined more than 20 separate actions aimed at improving nursing home quality, many of which have been advocated by consumer groups and resisted by the industry.
Nursing home residents have represented a disproportionate share of COVID-19 pandemic deaths. In response, the Biden administration has been developing home- and community-based care as an alternative to traditional nursing facilities.
Minimum Staffing Requirements
The centerpiece of the nursing home plan focuses on establishing minimum staffing levels. The administration directed the Centers for Medicare and Medicaid Services to conduct a study on staffing and publish proposed regulations within one year.
Experts identify staffing levels as the most critical factor determining nursing home quality. Many facilities currently lack adequate numbers of nurses, nursing assistants, and other direct care personnel. The coronavirus pandemic accelerated worker departures from the industry, even as facilities increased wages.
Congress has been debating legislation requiring minimum staffing standards for Medicare and Medicaid-accepting facilities. The proposal was originally intended for inclusion in the president’s domestic agenda bill but has stalled. The administration is now pursuing regulatory approaches to mandate these changes.
Additional Facility Requirements
The plan includes a push toward private rooms for residents, directing federal regulators to examine phasing out multi-bed arrangements housing three or more people.
Despite tens of billions of federal taxpayer dollars flowing to nursing homes annually, too many continue providing substandard care causing avoidable resident harm.
Enhanced Oversight and Enforcement
The plan allocates an additional $500 million for nursing home inspections – nearly a 25 percent increase. States typically conduct these inspections following Medicare guidelines.
The administration plans to restructure the special inspection program for low-performing facilities, increase penalties for non-compliance, and potentially suspend Medicare and Medicaid payments when necessary.
Private Equity Concerns
More than half of American nursing homes are owned by for-profit companies. The administration is examining the growing trend of private equity acquisition of facilities. Private equity investments in the sector grew from $5 billion in 2000 to over $100 billion by 2018.
Too often, private equity models prioritize profits over people – particularly dangerous when addressing vulnerable seniors’ health and safety. Federal agencies will examine private equity’s role in nursing home operations and inform the public when corporate entities underserve residents’ interests.
The private equity industry counters that investor ownership improves management through standardized procedures and administrator evaluation.
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