Nursing Homes Must Advocate for Better Regulations, Payments After COVID. They Also Need a Plan to Improve

COVID-19 has dealt a devastating blow to skilled nursing providers that makes some kind of dedicated assistance at both the state and federal level imperative. That was apparent in the pandemic’s early days, when outbreaks would sweep through facilities like wildfire through dry grass, as SNF executives and politicians noted.

But that assistance has to go beyond simple funding support.

For one thing, SNFs have already benefited from multiple rounds of funding from the federal government. Providers received money from general distributions from the CARES Act Provider Relief fund sent out to both Medicare and Medicaid providers, as well as distributions targeted to SNFs of $4.9 billion and about $2.5 billion. In some states, they’ve received some level of Medicaid assistance in the form of the 6.2% increase in the Federal Medical Assistance Percentage (FMAP) match that was part of the Families First Coronavirus Response Act.


At best, those funds appear to have kept the lights on. This is no small consideration, given that many of the patients living in SNFs cannot easily go home, or have nowhere else to go.

But as providers see light at the end of the tunnel in the form of viable vaccines for COVID-19, they need to commit to going beyond keeping the lights on. The end of November marked 100,000 COVID-19 deaths in long-term care facilities, by one count, and that does not count the death toll stemming from other causes exacerbated by the pandemic.

Providers have to do more in the face of this kind of devastation. They have to make their case not just for their essential role, but pledge to learn from the tragedies when they lobby for needed federal support — and mean it.


Many providers will rightfully point out that costs of staff and personal protective equipment (PPE) have skyrocketed over the course of the pandemic. There’s no question that the financial picture for the foreseeable future is intimidating at best and ugly at worst.

But the necessity of federal and state support should not mean that providers sit back and wait on the government’s largesse. By all means, they should lobby for aid to stave off closures and failures. But SNF operators should also — on their own initiative — start the hard process of self-examination. And they should commit to meaningful improvements in operations and practices without waiting for the government to mandate those improvements.

An obvious place to start is infection control. While it’s certainly true that COVID-19 is a uniquely challenging virus to contain, it is disingenuous to suggest that even perfect infection control practices are powerless to stop it.

At the Andbe Home in Kansas, to name one example, every single resident and multiple staff members became infected with COVID-19; when the facility was disciplined, state and federal regulators pointed to failures in mask-wearing and quarantine practices. While there is no surefire way to keep COVID-19 out of a facility, sgood infection control practices can help curb the severity of its impact.

It may not be feasible to appoint an infection preventionist in every SNF in the country right away, but providers should start thinking now about how they can commit to improving infection control in their facilities and form concrete pledges related to it.

Another place to start might be wages; over and over again, operators argue — again, with some justification — that they have limited leverage to raise staff wages given low Medicaid rates. Given that most SNF residents are covered by Medicaid, this is no small consideration.

But think about how the pharmaceutical and scientific worlds put all of their resources toward the discovery of a vaccine. Obviously SNFs cannot drop everything about running a facility to tackle the multifaceted economic dimensions of living wages, but industry leaders could put their heads together to brainstorm some ways to make better wages and benefits a priority.

Forget trying to prepare for the fickle tastes of baby boomers for a year and instead focus all efforts on how to ensure that frontline caregivers have a living wage, a meaningful sense of purpose and development, and respect in their place of work.

Even if there’s a ceiling to what operators end up being able to feasibly pay — there almost certainly will be — they should make it clear to both legislators and their own workers that improving the conditions for frontline staff is a top priority. That means going to actions and not just words of praise.

Those are just two examples on the provider side. Regulators could commit to reexamining how they enforce rules, and which regulations are the most critical to ensure that residents are safe and receive the best care possible.

The federal government could ensure that state governments have the resources in manpower and funds to conduct better inspections, while states could look at ways of addressing the issues of reimbursement and setting up partnerships locally to bolster workforce development.

But regardless of position, stakeholders in the SNF world need to look at what lies within their power as they try to pick up the pieces from COVID-19. Some readers — such as those at CMS or at major operating chains — will have more in their control than others.

Whatever their position, everyone in the SNF world needs to go beyond reacting. For too many months in the pandemic, providers have waited to react to the government, and the government in turn is too often reacting to incidents in nursing homes that become bad enough to create some press.

Both sides have to cut the cycle short and take action to acknowledge the problems and build solutions to fix them — without waiting for someone else to make the first move.