A blue-ribbon panel from the National Academy of Sciences, Engineering and Medicine has released a scathing report on the state of nursing homes in the United States. Operators, owners, regulators and payers are all failing patients and residents, the report said.
“The way the United States finances, distributes and regulates care in nursing home settings is inefficient, inefficient, fragmented and unsustainable. Immediate action is needed to initiate fundamental change,” according to the 605-page study.
Some reform, some research
The report suggests certain reforms, particularly in terms of staff compensation and training, supervision and transparency of ownership. Nevertheless, in many cases it calls for new research and further research for more fundamental reforms, including the development of new models of care and financing.
For the first time since 1986, this report provides a comprehensive overview of the National Academies Nursing Homes. That report identified significant issues, including “the neglect and abuse of residents, low quality of life, excessive costs, inconsistent (or lacking) supervision, and the need for high-quality outcome data.”
Thirty-six years later, the new report concludes, “Despite significant steps to improve the quality of nursing home care [1987 legislation]The current system often fails to provide high-quality care and undervalues and prepares nursing home staff for their critical responsibilities. ”
I have to go far
Less polite: Although there has been some improvement in the quality of care, nursing facilities still have a long way to go if they can provide their patients and residents with the care they deserve.
One of the report’s most important recommendations is a call for a fixed percentage of Medicare and Medicaid payments for direct care services. Since these federal payments represent almost all nursing home revenues, such a move would likely increase compensation for care workers.
By limiting the revenue that can flow to other costs, including investors’ returns, these targeting benefits will make them less attractive to profitable operators and owners. Whether nonprofits can fill the void is an open and important question.
Personnel reform
The report also recommends a number of changes to nursing home staffing. It calls for registered nurse coverage 24/7, a full-time social worker and an infection control and prevention specialist.
A Challenge: The report also calls for new incentives for smaller homes. But a full-time nurse, infection-control professional, and social worker cannot be affordable for a small home with only 10 residents.
The group also called for a new look at the minimum stuffing requirements. The current federal guidelines are decades old and have never been implemented In this case, a careful study of the 2022 staff needs would be worthwhile.
Long-term care financing
When it comes to financing, the panel indicates significant changes without specific recommendations.
For example, it called for the use of “detailed and adequate nursing home financial information” to determine whether state Medicaid payments for long-term residents are sufficient to finance high-quality care. This is an important first step, but even then, the amount of money they pay for long-term care entitlements will leave states with a lot of shaky homes.
The study recommends “studying how to design such facilities to move toward a federal long-term care facility” and creating state public insurance displays.
I am pleased that the committee has recognized the final requirements for a universal long-term care facility, but this issue has been well studied. There is a lack of political will to work, not a lack of information.
And while state demonstrations may be conducive to many delivery reforms, a social insurance program by state is more efficient at the federal level than at the state level. The Washington State experience is a good example of a single state solution problem.
Some of the recommendations in this report are new. Many, in fact, were recently advised by the Biden administration. And mostly controversial for years. The 600+ page report of the National Academy is rarely read. But it will probably encourage regulators and lawmakers to work to the end before turning nursing homes into an epic market failure.
