Long-Term Care Leaders Push For More Accountability, Better Pay For Nursing Homes

As the Nursing Home Improvement and Accountability Act makes its way through Congress, two leaders in the long-term care industry this week said enhanced funding to support staffing in nursing homes is sorely needed coming out of the pandemic and that more transparency for where that funding goes would be welcomed.

Mark Parkinson, president and CEO of the American Health Care Association, and Richard J. Mollot, executive director of the Long Term Care Community Coalition, were guests Monday on NPR podcast 1A, produced by WAMU in Washington, D.C., where they discussed pushing for nursing home reform during a pandemic.

“I think we’re all on the same page here,” Parkinson said. “We all want much better outcomes and great care in facilities and I think we all agree that the problem right now is on the staffing side. Not enough staff and underpaid.”


The act was introduced in August and seeks to bolster Medicaid funding to improve staffing for nursing homes and looks to establish better transparency, accountability and oversight at these facilities.

A section in the act stipulates that states may receive increased funds to improve nursing facility staffing, including by improving wages and benefits. A condition of these federal dollars is that states must regularly update Medicaid payment rates for nursing facility services and must report certain information to the Centers for Medicare & Medicaid, including wages and benefits provided to nursing facility staff.

Mollot said among his biggest policy priorities for long-term care is to see more accountability and “reasonable limitations on profits” as well as more transparency about how federal funding is allocated.


“What we’ve seen is an increasing corporatization of the nursing home sector because there’s so much money to be made and so little accountability for where that money goes,” he said.

The bill seeks to enhance funding through Medicaid to support staff improvements and increase wages and looks to improve data collection and reporting requirements for nursing homes.

“To just throw money at the problem has never worked. We would like to see accountability, we’d like to see some kind of reasonable limitations on profits and to know where the money goes,” Mollot added. “Right now we don’t have a good or accurate sense of where the money goes that goes into nursing homes.”

He said the increased involvement from real estate investment trusts and private equity in the SNF market and increased for-profit investment in the sector has made it a much more sophisticated industry and thus better oversight is needed.

The act also says that every five years Congress must conduct a study on the appropriateness of establishing minimum staff-to-resident ratios in skilled nursing facilities with recommendations.

“We need to immediately establish minimum staffing standards,” Mollot said. “It’s not a place that should be operated like a warehouse. Nursing homes are not supposed to accept or retain residents for whom they don’t have enough staff or supplies to provide appropriate care with dignity.”

Some states have to have a certain number of registered nurses, licensed practical nurses and certified nurse aides in the facility per resident per day but there is no national mandate, Mollot added.

For Parkinson, the primary problem for nursing homes is the “chronic” underfunding of Medicaid.

“The bad stories you hear are typically in the states that made the deliberate policy decision to underfund nursing homes,” he said. “There’s still a long way to go [for nursing homes] and there’s still a long way to go in large part due to staffing and the underpaid of staffing.”

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