Industry Leaders Request Meeting with Biden Administration on Nursing Home Reform

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) has asked for meetings with members of the Biden administration one week after the White House unveiled its sweeping nursing home reform proposal.

The reforms, developed by the Department of Health and Human Services (HHS) through its Centers for Medicare & Medicaid Services (CMS), are aimed at improving the quality and safety of nursing homes, protecting residents and staff and cracking down on “bad actors,” according to the White House.

President & CEO Mark Parkinson, who penned the March 8 letter, said it was “crucial” the government hear directly from nursing home operators and leaders about the progress that has already been made, the ongoing challenges surrounding recruiting and retaining staff and the industry’s plans for the future.

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“We have lost hundreds of thousands of workers since the beginning of the pandemic, and it is not clear that we can get them back, let alone add minimum staffing standards, without significant support from federal policymakers,” Parkinson wrote.

Nursing homes gained 1,600 jobs in February, a modest increase compared to home health and physician offices at 20,000 and 15,000, respectively, according to data compiled by the U.S. Bureau of Labor Statistics (BLS).

The industry has lost 238,000 caregivers since the beginning of the COVID-19 pandemic, BLS data has shown. The skilled nursing workforce is 15% below pre-pandemic levels, and workforce levels within the long-term care industry as a whole are at a 15-year low.

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“Increasing staffing minimums in the midst of this workforce crisis without corresponding resources does little to help residents and would result in nearly every nursing home being out of compliance,” Parkinson wrote. “Facilities, especially in rural communities, would be forced to further limit access to care for residents in order to meet arbitrary staffing ratios or close altogether.”

The Centers for Medicare & Medicaid Services (CMS) is expected to conduct a study to determine the level and type of staffing needed to ensure safe and quality care, and issue those proposed rules within one year.

It remains to be seen whether the White House plans to go through Congress to set a federal staffing minimum or do so through executive branch actions, but Parkinson previously said he believes that the process should go through Congress.

The letter also pushed back on the White House fact sheet and other comments made by the administration implying that nursing home quality has declined.

Parkinson pointed to the association’s work with then-CMS Administrator Donald Berwick 10 years ago in developing the Nursing Home Quality Initiative, and how before the pandemic, SNFs improved in 16 of the 20 CMS quality measures.

Reducing off-label use of antipsychotic medications was one of the goals of the quality initiative, and in the last decade the use of antipsychotics in SNFs has decreased by 40%, the letter stated.

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