By Steve Moran

On Monday, March 15, AHCA and LeadingAge announced a sorely needed, long overdue reform agenda for nursing homes, they are calling the “Care for our Seniors Act” (downloadable pdf).

The act has 4 significant pillars:

  1. Enhanced Infection Control policies, including updated practical guidelines and 24-hour RN staffing. 
  2. Action to improve recruitment and retention of staff, including things like loan forgiveness for new graduates who work in LTC, tax credits for licensed LTC professionals, programs for affordable housing and childcare assistance, and increased subsidies to professional schools whose graduates work in nursing homes for at least five years.
  3. Revamping the regulatory system to better serve the needs of residents in these ways:
    1. Move from a punitive to an improvement approach to oversight
    2. Create an effective system to address chronic poor-performing nursing homes that will help them turn around or close
    3. Add customer satisfaction to the scoring of nursing homes (5-star system)
  4. Address the reality that most nursing homes are 40-50 years old with standards and consumer expectations very different from what they are now. Semi-private rooms, as well as 3- and 4-bed wards, are no longer acceptable; and the same is true with bathrooms and showers shared by multiple rooms. The state and federal governments must come up with ways to give residents more dignity and privacy.


All of this is, of course, undergirded by the idea the federal and state governments will need to make a much bigger investment in the industry . . . though that is not quite it. They will have to make a much bigger investment in the oldest and most frail of our people. They are proposing these “investment strategies”:

  1. Enhanced Federal Medical Assistance Percentages (EFMAP): Increased federal Medicaid funds are provided to states to pay for the mandatory nursing facility benefit, with requirements that additional federal funds be used for nursing facility rates.
  2. Federal Framework for “Allowable Cost” or “Reasonable Cost”: Establish federal guidelines for state allowable cost definitions.
  3. Medicaid Rate Adequacy Requirement: Medicaid rates are brought up to equal the cost of care and subsequently updated regularly to keep pace with increases in costs of care.
  4. State Nursing Facility Value-Based Purchasing (VBP) Committee & Required Design Report: States will be required to form and maintain a state, health plan, and nursing facility VBP committee with specific guidelines and deadlines to submit reports. This offers the potential for additional resources.

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What If?

I find myself wondering how much money would have been saved, how many lives would have been saved if the government had done this 5 years ago. My guess is that while we would have still had some deaths in nursing homes, the numbers would have been much, much lower. More importantly, instead of nursing homes being their segment of the crisis they would have served as a vital link in the healthcare system to effectively combat the pandemic.

Well done, AHCA and LeadingAge, we all need to support this effort.

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