As the country continues to struggle with the ongoing Covid-19 pandemic, it has become increasingly clear that the quality of medical care in nursing homes is of the utmost importance. As a result, President Biden is working on a set of reforms through the Department of Health and Human Services (HHS) to improve minimum staffing requirements in these facilities.
The nursing homes, each year, receive tens of billions of federal taxpayer dollars. But fail to provide standard services to the residents. For example, the Government Accountability Office conducted surveys from 2013 to 2017 through Medicaid and Medicare that encountered a deficiency in the prevention and control of infections and a lack of regular handwashing in more than 82% of the nursing homes.
Such unacceptable conditions have been getting worse because of the hold of private equity firms on nursing homes. The firms have compromised health and safety, putting profits before the benefits of older and disabled residents. Therefore, setting standards of medical care in nursing homes has become a priority.
To understand how Biden’s reforms will work to provide safe and adequate medical care in nursing homes, let’s discuss them in detail.
In collaboration with (HHS) department, CMS aims to fulfill the commitment of utilizing taxpayers’ dollars for the needs of senior and disabled residents. To ensure quality staffing service in all nursing homes, let’s discuss Biden’s reforms in detail:
One of the key areas that the President’s reforms aim to address is the minimum staffing levels in nursing homes. Unfortunately, there are no federal requirements for the minimum number of staff members present in a nursing home at any time. This issue has led to a wide variation in staffing levels across the country, with some facilities providing excellent care and others falling short.
The lack of minimum staffing requirements has been a long-standing concern for advocates of nursing home residents. A lack of staff can lead to many problems, including inadequate care for residents, increased risk of falls and injuries, and a higher likelihood of residents developing bedsores and other health complications. In the worst cases, a lack of staffing can lead to death.
The President’s reforms aim to address these concerns by establishing minimum staffing levels in nursing homes. These levels will depend on the following factors: the size of the facility, residents’ number, and the level of care needed by each resident. The goal is to ensure nursing homes have enough staff members to provide high-quality care to all residents.
Another key component of the President’s reforms would be to increase the accountability of nursing homes when it comes to staffing levels and yearly performance. Improving accountability depends on measures such as regular audits to ensure facilities meet the minimum staffing requirements and penalties for those that fail to do so.
Furthermore, CMS will be funded up to $500 million from congress for supporting inspection activities. The poor performers will be accountable for the financial penalties and get terminated from Medicare and Medicaid if they show negligence in enforcing better nursing facilities for the residents.
CMS will also provide technical assistance to nursing homes to enhance accountability. In addition, CMS, in affiliation with the ‘Quality Improvements Organization, will be helping nursing homes get on-demand training and guidance on evidence-based issues.
Improving public transparency has become an essential priority since corporate owners and medical care operators are held accountable for poor performance. Therefore, CMS aims to improve the transparency of ownership and facilities provided in nursing homes.
In concern to the residents’ health and safety, CMS will create a database to track and identify previous problems faced by nursing homes across all states. Through the provider enrollment database and health and safety inspection, they will compare the performance of operators and owners of all states.
Nursing Home Care Compare is another important initiative taken by CMS to enhance transparency for the public. CMS has published measures to smoothen the decision-making process for families. For instance, they have developed rating sites to help them compare services, packages, weekend staffing levels, and staff turnover.
Through the Care Compare service, they will enforce verified rating data, improve the data’s readability and usability, and present accurate details of facilities to meet minimum staffing requirements.
CMS has created pathways to empower nursing workforces by making training aid affordable and accessible. For example, the center will work with different states to promote and publicize free training campaigns. They have also decided to tie Medicaid payments with clinical staff wages, including extra incentives for specialization and experience in the field.
CMS is also focusing on introducing National Nursing Careers Pathways Campaign while collaborating with the Department of Labor. In addition, they will further collaborate with training intermediaries, registered apprenticeship programs, labor-management training programs, and labor unions to process recruitment for empowering nursing home care careers.
In light of Biden’s comprehensive reforms, CMS launched an approach based on different aspects to identify the type and minimum level of staffing to improve quality and safety in nursing homes. This approach is called a Request For Information, issued to conduct a study at the beginning of 2022.
To help you understand this approach and how it worked for CMS, we’ve explained the RFI in detail below.
CMS issued an RFI approach to seeking public responses regarding improving staffing requirements in nursing homes. The agenda of this approach relied on collecting data through public comments. Gathering data will help in the rule-making of minimum staffing requirements in 2023.
They started this approach in April 2022 and closed the period of public comments in June 2022. CMS received more than 3k comments from providers, advocacy groups, industry researchers, experts, labor unions, family members, and caretakers of the residents. They all voiced concerns about payment, study design, and staffing requirements.
CMS collected data through the RFI approach and staffing study. They collected data the best outcomes for the residents living in the nursing homes. Let’s explore what a staffing study looks like and how to conduct it to benefit nursing homes.
The staffing study will include qualitative and quantitative research to address the requirements of the minimum staffing proposal. CMS will conduct qualitative analysis using primary data, interviews, site visits, surveys, and observation data in nursing homes. On the contrary, quantitative analysis will depend on secondary data. It will include Medicare claims, Minimum Data Set (MDS), and Medicare Payroll-based Journal (PBJ) data.
Launched in August 2022 and expected to continue till December 2022, the staffing study will be conducted. Consisting site visits, literature reviews, cost analyses, and quantitative analyses – all further discussed below.
The contracted researchers will visit 75 nursing home sites to collect data to help develop the minimum staffing requirement proposal. CMS selected nursing homes in 15 states: FL, IL, MA, MD, MO, NC, NY, OH, CA, CO, PA, TX, VA, WY, and WA.
They have selected nursing homes based on the following factors: Medicaid population, national representation, a cross-section of size, rating system, geographic location, and ownership type. This step ensures staffing levels and will focus on the quality and safety of nursing homes.
The staffing study team will work to identify the strength and weaknesses of the existing literature. They will also work on the relationship between minimum staffing and staffing standards.
CMS will perform a quantitative analysis to examine trends in nursing home staffing from 2018 to 2021. They will also identify other staffing levels that will improvise safety and quality for the residents.
CMS will evaluate extra incremental expenses for staffing levels and services needed in nursing homes. It will be associated with the new recruitment of the staff and affording resources to maintain standard services in nursing homes.
In the wake of the Covid-19 pandemic, it has become more important to focus on the quality of services in nursing homes. The President’s reforms are a critical step in this direction. Therefore, CMS will help to ensure that nursing home residents receive the care and support they need to stay healthy and happy. In addition, in Spring 2023, they will issue a minimum staffing requirement proposal to implement better services and staffing levels outcomes.
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