AHCA’s Parkinson: Nursing Homes Must ‘Look in the Mirror’ to Improve Care, Infection Control Post-COVID

While emphasizing that the industry is much better prepared to weather a potential revival of large COVID-19 outbreaks in the fall and winter, a top nursing home leader on Tuesday called on operators to use the hard lessons learned during 2020 to improve from within.

“You cannot ignore the fact that probably close to 100,000 people died in long-term care facilities,” American Health Care Association (AHCA) CEO Mark Parkinson said. “And if we don’t use that as a moment of reflection, to not just look at what caused this outside of our control, but look in the mirror and figure out: Are there things that were within our control that could have slowed some of this down? And what can we do to be better in the future? We’re missing an enormous opportunity if we don’t embrace this as a moment of real self reflection and a real opportunity to get better.”

Parkinson’s comments came during a panel discussion with former Centers for Medicare & Medicaid Services (CMS) acting administrator Andy Slavitt, held during the National Investment Center for Seniors Housing & Care’s (NIC) virtual conference. Broadcast journalist Soledad O’Brien served as moderator.


The AHCA head also declared that it would be a “huge mistake” for the space to return to business as usual in the wake of the pandemic.

Slavitt, who held the top Medicare and Medicaid job during the last two years of President Obama’s second term, praised the nursing home space for taking that introspective stance.

“There are other industries, of course, that don’t self-reflect, that go: ‘Phew, we dodged the bullet,'” he said. “I don’t think that’s happening here, and I don’t think that’s a concern here.”


Reform of the post-acute and long-term care industry must come from a mixture of financial and regulatory overhauls, according to Slavitt. In particular, he criticized what he perceived as a historic tendency to implement new rules on the space without regard for what came before.

“At CMS, you only have one instrument; it’s a blunt instrument. Every time you see some bad story, some lowest-common-denominator story, it’s to add that regulation to every single nursing home in the country,” Slavitt said. “And guess what? It stands on top of the last 10 bad stories. These regulations stack on top of one another without coherence, without regard for performance.”

Instead, Slavitt called on the industry to formulate a plan for improvement with specific baseline goals, while also laying out the top government action items needed to achieve those goals — in this case, a combination of increased funding and new regulations that target the areas that matter most to residents and their families.

He compared the ideal framework for finding a nursing home for a loved one to the car-buying process. Nobody has to ask questions about the baseline safety performance, such as whether the brakes work, of any given model. This in turn frees the consumer to make a decision based on the features and factors that truly matter to them.

“If the industry is able to move itself to that point, I think the industry will find a very ready and willing partner in the government,” Slavitt said.

Parkinson specifically zeroed in on infection control, noting that it was a persistent problem in the space prior to the pandemic.

“Instead of having 1,000 different things regulated, let’s figure out the 50 or 75 clinical things that really do matter and focus on them — probably, almost inevitably, put more resources into infection control, more resources into person-centered-type planning and activities,” Parkinson said. “And I think if we have our head in that direction, we can actually come out of this with a net positive.”

The AHCA head touted the progress made on infection control so far, indicating that the lessons learned during COVID can also help operators fight the more familiar flu during future seasons.

Acknowledging NIC’s core audience of investors in senior housing and care properties, Parkinson asserted that the skilled nursing space should still be a target for investment, expressing optimism about the progress of a COVID-19 vaccine, the depth of the government’s support for providers during the crisis, and the necessary nature of nursing home services.

“People don’t move into our buildings because they want to; they move into our buildings because they have to,” he said. “They just can’t be taken care of safely at home anymore. It will be bumpy and it will take some time. But the demographics are compelling. We will win the public’s confidence back, and I think that this will be a good space to be in eventually.”

Slavitt echoed that sentiment.

“This is an industry that everybody cares about. Every Congressperson, every senator, every presidential candidate needs this community to be successful,” he said. “It’s not too big to fail; it’s too important to fail.”

That said, Parkinson did not mince words about the impact of the coronavirus on the people who live and work in nursing homes so far this year. Citing the number of infections and deaths, he described COVID’s impact on the sector as “a nightmare beyond any worst-case scenario we could have ever generated,” and also pointed to the lack of testing and personal protective equipment (PPE) support in the pandemic’s earliest days.

“We were not ready for phase one. For phase two, we’re in better shape,” he said.

Both Parkinson and Slavitt hammered home the need for continued vigilance — primarily the continued wearing of masks in public — to reduce community spread of the virus, which multiple studies have indicated is a key driver of nursing home COVID-19 outbreaks and deaths.

“I don’t doubt that we are more prepared inside nursing homes than we were before, and that is great news,” Slavitt said. “But the better news would be if they didn’t have to deal with the community spread coming into their facilities.”

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