The White House on Monday unveiled sweeping nursing-home reforms designed to improve the quality of care, ensure adequate staffing levels and make facility ownership more transparent. President Joe Biden will discuss the measures in his State of the Union address Tuesday night, the White House said, emphasizing the pandemic’s toll on long-term care residents and staff.
The Centers for Medicare and Medicaid Services, the federal agency that regulates nursing homes, will establish a minimum nursing home staffing requirement, beef up a program designed to improve the poorest-performing facilities, and create a new database to track owners and operators across states. The Department of Health and Human Services, along with other federal agencies, will study the role of private equity, real estate investment trusts, and other investors in the sector. President Biden will also call on Congress to provide nearly $500 million to support nursing home health and safety inspections and to give CMS new authority to bar operators from obtaining Medicare or Medicaid nursing-home provider agreements based on the compliance history of their existing or previous facilities.
“This is the biggest news since 1987,” when a federal nursing-home reform law set new standards of care and resident rights, says Charlene Harrington, a nursing home researcher and professor emeritus at the University of California San Francisco. “It’s a comprehensive approach.”
The reforms come as the number of long-term care facility resident and staff COVID-19 deaths topped 200,000 in late January, accounting for nearly a quarter of all U.S. deaths from the virus, according to the Kaiser Family Foundation. Several academic studies have found that for-profit nursing homes, which account for about 70% of all U.S. nursing homes, had higher COVID cases and deaths than their nonprofit competitors. Other recent studies have linked private-equity nursing home ownership with higher rates of negative health outcomes including hospitalizations and short-term risk of death.
“Undoubtedly, there will be challenges ahead” in developing regulations to implement the initiatives, says Richard Mollot, executive director of the nonprofit Long Term Care Community Coalition, “but it is wonderful to finally see meaningful leadership to address widespread and persistent problems in nursing homes across the country.”
For consumers and regulators alike, it’s often tough to decipher exactly who controls a nursing home and to assess the track record of any other facilities under the same ownership. State and federal nursing home ownership data tend to be outdated and incomplete, researchers say, and complex corporate structures obscure ownership links among facilities. During the pandemic, some lawmakers, policy experts and resident advocates have called on the federal government to take on a much larger role in overseeing nursing home ownership.
Ownership “is the foundation of care,” says Tony Chicotel, senior staff attorney at the nonprofit California Advocates for Nursing Home Reform, in part because owners control allocation of critical resources such as staffing levels.
The federal government has historically left oversight of nursing-home ownership changes largely to the states, whose patchwork of rules governing these transactions haven’t kept up with increasingly complex ownership structures and can have major loopholes, such as allowing unlicensed operators to take over and run facilities for indefinite periods. In many cases, states don’t have the resources to size up prospective owners, researchers and resident advocates say.
The nursing home industry said that more funding is needed to boost quality. “Additional oversight without corresponding assistance will not improve resident care,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living said in a statement. The industry can’t meet additional staffing requirements, he said, “when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers.”
The White House action comes amid a flurry of state legislative efforts to shine light on nursing-home owners and their finances. States from California to Florida have recently enacted or are weighing additional financial-reporting requirements for nursing home owners, tighter facility licensing criteria, or other measures designed to clarify who owns these facilities and how they’re spending taxpayer dollars.
CMS will also take steps to ensure that nurse aide training is affordable, the White House said, work with the Department of Labor on a campaign to recruit and retain long-term-care workers, and strengthen requirements for on-site infection preventionists in nursing homes.
“Despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm,” the White House said in a fact sheet summarizing the measures.