Nursing Home Improvement Must Go Beyond Increased Oversight

The push to improve the nation’s nursing homes needs to go beyond calling for increased oversight and higher quality resident care as the sector largely remains in the spotlight.

Federal officials should also provide skilled nursing operators ways build up the workforce and take steps to reduce staff turnover, in addition to offering residents and their families alternatives to institutional care settings, according to U.S. Sen. Bob Casey of Pennsylvania.

“We can’t say that … we really care about seniors, we really care about people with disabilities if the people providing the care are making $12 an hour. That’s an insult, not just to the worker and the good work that they do everyday, but it’s an insult to all of us,” Casey said during a virtual discussion on improving long-term care.


The webinar was hosted by the University of Pennsylvania’s Leonard Davis Institute of Health Economics, and comes nearly two months after the National Academies of Sciences, Engineering and Medicine (NASEM) released a landmark report on new proposals to overhaul nursing homes.

Casey highlighted several pieces of legislation — including the Nursing Home Reform Modernization Act and the Nursing Home Improvement and Accountability Act — as ways he hopes to create meaningful change in the way the skilled nursing sector operates.

At the moment, however, both bills are effectively stalled in Congress.


Casey also stressed the need to take steps to reduce turnover and ensure the staff-to-resident ratio is within a range that would ensure better care.

While it’s been long understood that nursing home staffing shortages were an issue long before March 2020, they’ve continued to get worse over the course of Covid, according to Jasmine Travers, webinar panelist and assistant professor of nursing at NYU Rory Meyers College of Nursing.

Travers called the COVID-19 pandemic the “9/11 moment for nursing homes,” highlighting the current staffing crisis as the biggest obstacle currently facing the industry.

“We have a greater demand for nursing home staff than we have supply, so that’s something that we’re going to need to work on as well,” she added.

The Nursing Home Improvement and Accountability Act of 2021, which was introduced by Casey and others in the U.S. Senate, would allocate $50 million to the U.S. Department of Health & Human Services (HHS) to conduct studies every five years to determine minimum staffing levels.

“Part of that, of course, is the workforce. You’ve got to lift up these workers, and that means wages,” Casey said.

This idea echoes that of President Biden’s nursing home reform, which has called on CMS to conduct a study and proposed a federal staffing minimum in the next year.

When it comes to efforts to increase staffing, Travers also highlighted the need for adequate training as the care needs of residents become increasingly complex.

Better oversight, more care options for residents

Expanding the Centers for Medicare & Medicaid Services’s (CMS) Special Focus Facilities (SFF) program in particular has also been a focus of Casey’s over the last several years.

Back in June 2019 Sens. Casey and Pat Toomey, also of Pennsylvania, released a previously undisclosed list of more than 400 nursing homes under consideration for placement on the SFF program.

Casey said during the webinar that while the program’s goals are “worthy,” it is not covering enough of the facilities that have demonstrated a record of poor performance.

National leaders should also allocate greater resources toward providing additional care options outside of the traditional institutional settings for residents and their families, according to Casey.

For many families, having their loved ones be cared for in a nursing home “works out just fine” but that is not always the case, he said.

“We’ve got to make sure that we not only do better oversight and improve the care in nursing homes … but also provide more options,” Casey added.

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