By Steve Moran
In Joe Biden’s 2022 State of the Union address, he announced broad sweeping changes for nursing homes that include much bigger sticks and the promise of better carrots. AHCA/NCAL and LeadingAge see these changes through completely different lenses, with LeadingAge finding a pony in the poop and AHCA only seeing poop.
Undergirding much of what is happening is that, since ownership of nursing homes by “private equity firms” has rapidly increased, the quality of care in those nursing homes has decreased markedly compared to other types of for-profit entities. This is not a for-profit vs. not-for-profit debate, which I have written critically about in the past. It is about a particular type of ownership group that fundamentally only cares about money.
The fundamental premise of the reforms is that “every person, every resident should be treated with dignity and respect” and that “no healthcare facility will be causing patient harm.” Highlights:
- Set minimum staffing requirements such that every resident will receive high-quality care.
- Poor-performing nursing homes will be held accountable for unsafe care and immediately improve or be cut off from taxpayer dollars.
- Improve public disclosure so that consumers will be able to make better decisions.
- Reduce resident room crowding with the goal of getting to single occupancy rooms. The initial effort will be to get rid of three- and four-person bedrooms.
- Provide financial incentives for high-performing nursing homes.
- Increase spending on inspection activities in order to “crack down” on unsafe homes.
- Expand financial penalties and other enforcement sanctions, particularly focused on chronically poor performing facilities. This will increase accountability for chain owners of substandard facilities.
- Create pathways to good-paying jobs, with the free and fair choice to join a union.
- Make nurse aide training more affordable.
All of this will, with necessity, come with improved reimbursement for good operators.
Time for Reform
I get, sort of, AHCA’s unhappiness about this bill. But what it appears to do for the first time, is really tackle the problem of too many mediocre, poor, and terrible operators. These operators have, for too long, justified doing horrific harm to frail older people by blaming the government for inadequate funding. While I am not disagreeing that, for too long, funding has been inadequate, in every single state where crappy operators exist, there are others, serving similar populations, that do a good job of serving the residents they are supposed to be protecting.
I am often frustrated that senior living advocacy groups are unwilling to step up to the podium and call out and condemn operators that are doing real harm to people.
I particularly want to applaud Katie Smith Sloan and the LeadingAge staff and board of directors for being bold enough and brave enough to stand proudly in favor of these reforms.