Improving Nursing Care Could Start with Enforcing Existing Laws, Not Passing New Ones

The thorny relationship among the skilled nursing industry, consumer advocates, and regulators could be actively thwarting efforts at improving nursing home quality, one expert argued.

“In making their respective cases, stakeholders have expressed divergent views about the current state of nursing home quality and, more specifically, the effectiveness of regulatory oversight efforts,” David Stevenson, an associate professor of health policy in the Department of Health Policy at Vanderbilt University School of Medicine wrote in a Thursday blog post in Health Affairs. “These disagreements arguably limit policymakers’ ability to engage others in constructive dialogue in considering potential reforms and to assess whether they are needed at all.”

When it comes to evaluating reforms that could improve the oversight system and keep residents safe, one argument is that regulators need to first implement and enforce existing standards and processes. Given recent lapses in regulatory oversight and the variations between states in terms of processes — as detailed by the Department of Health and Human Services (HHS) Office of Inspector General — Stevenson said this argument has some merit.


“Yet, the recurring failures in the U.S. nursing home regulatory system and quality of care over many years also beg the question of how we might do better,” he added. “They should compel us to consider the limits of regulation and whether alternate or hybrid strategies could yield better results.”

Part of those new initiatives could include analyzing existing data in new says, Stevenson suggested.

“With enhanced data monitoring capabilities, perhaps the regulatory process could more effectively leverage existing data (for example, complaints, daily payroll-based staffing data, and minimum data set assessments) to identify potential problems in real time and to target oversight efforts on the worst performers,” he wrote.


In general, instead of viewing each other as enemies, Stevenson wants provider groups, watchdogs, and the government to see each other more as partners than adversaries fighting over the future of the industry.

“Ultimately, nursing home providers, resident advocates, and policy makers must be willing to engage in discussions about how best to assure quality of care,” he concludes. “Wherever possible, these efforts should be guided by evidence, a commitment to transparency, and a clear-eyed assessment of the strengths and limitations of different approaches.”

Written by Maggie Flynn

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