Facing more scrutiny and tougher standards, nursing homes plead for more help

President Biden is aiming to improve nursing homes in the wake of the COVID-19 pandemic, but advocates for long-term care facilities said they need more support and not more regulation.

Seniors have been most vulnerable to COVID-19 and nursing facilities have been hotbeds for spread of the virus, particularly in the early stages of the pandemic.

In his State of the Union address, Biden derided “Wall Street firms” who have taken over nursing homes and imposed higher costs while quality plummeted.

“Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect,” Biden said.

The Biden administration outlined several steps this week to bolster oversight and spur improvements of nursing homes. The steps include a minimum nursing home staffing requirement, more funding for inspection activities, bigger financial penalties and more scrutiny of “the poorest performers,” the White House said.

The American Health Care Association, which represents nursing homes, said long-term care facilities have been battered financially by the pandemic. In a statement, Mark Parkinson, president and CEO of AHCA, said in a statement, “Additional oversight without corresponding assistance will not improve resident care."

“To make real improvements, we need policymakers to prioritize investing in this chronically underfunded health care sector and support providers’ improvement on the metrics that matter for residents,” he said.

The nursing home group issued a report Wednesday which found that 32 to 40 percent of residents (up to 417,000 residents) are living in nursing homes that are considered financially “at risk.”

Nursing homes have been the target of heavy criticism from lawmakers and industry watchdogs. About 200,000 of America’s COVID-19 deaths have occurred in nursing homes and long-term care facilities, and nursing homes have been faulted for not taking appropriate steps to protect patients.

For years before the pandemic, critics and lawmakers have said regulators haven’t done enough to improve conditions in facilities caring for some of the most vulnerable Americans.

The nursing home industry made substantial gains in the care of residents in the years before the pandemic, reducing hospital readmissions and cutting the use of antipsychotic drugs, Parkinson said.

“It’s time to stop blaming nursing homes for a once-in-a-century pandemic that uniquely targeted our residents and vilifying the heroic caregivers who did everything they could to protect the residents they have come to know as family,” Parkinson said. “Together, we should focus on meaningful solutions that can attract and retain the frontline heroes we need and strengthen delivering the quality of care and services that our nation’s seniors deserve.”

Parkinson also noted long-term care facilities are struggling to fill existing openings, making the proposal of higher staffing standards more problematic.

“We cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers,” he said.

Katie Smith Sloan, president and CEO of LeadingAge, which represents non-profit aging providers, said in a statement she welcomed the Biden administration’s focus on long-term care. But she called for more resources.

“Mission-driven providers like LeadingAge members are committed to providing quality care and community services for older adults," she said, "but the threshold question is when will the government finally adequately fund these critical supports for millions of older Americans and their families?”

An analysis published on Health Affairs Forefront called for more transparency in the ownership of nursing homes, noting that 70% of those facilities are privately owned.

The government should also allow consumers to compare the quality of nursing home companies that own nursing homes to allow evaluations as a chain, and not just the individual facilities. The authors also argued for an interagency task force to focus on the homes that need the most improvement.

David C. Grabowski, a professor at Harvard Medical School and an author of the study, hailed the Biden administration’s plans to improve nursing homes as “great steps,” The Washington Post reported.

But he also said it’s important for those facilities to get the funding they need to hire people to meet those staffing levels.

The AARP welcomed the Biden administration's plans to raise the quality of the nation's nursing homes. AARP CEO Jo Ann Jenkins said the organization has been drawing attention to problems in nursing homes for years.

“The COVID-19 pandemic exposed the chronic, ongoing issues with our long-term care system and emphasized the need for reform. It is a national disgrace that more than 200,000 residents and staff in nursing homes and other long-term care facilities died," Jenkins said in a statement.

Lawmakers have pushed measures to improve nursing home oversight.

In a bipartisan effort, U.S. Sens. Bob Casey Jr., D-Pa., and Pat Toomey, R-Pa., introduced legislation last year to expand oversight for some of the nation’s most troubled nursing homes.

The bill targets the government’s Special Focus Facility list of homes that persistently fall short in quality. While several hundred homes are candidates, only 88 facilities are actually placed on the list, which leads to more inspections and oversight. The legislation would expand oversight to the hundreds of candidates for the list.

Supporters of the bill include the AARP and the Alzheimer’s Association, among others.