Testimony and questions at the recent congressional hearing on nursing homes’ performance in Covid-19 showed that the system is in desperate need of reform, and that the time for reports and study is over, according to LeadingAge President and CEO Katie Smith Sloan.
“We need to start looking ahead,” Sloan told Skilled Nursing News. “My hope is that this will be perhaps the trigger for another set of hearings … we lived through Covid and a lot of things went wrong. Where do we go from here, and how do we make sure that we’re well prepared for both the demographic changes and the potential of another pandemic?”
The Congressional Select Subcommittee on the Coronavirus Crisis, chaired by Rep. James Clyburn, delved further into the impact of Covid-19 in nursing homes during the hearing.
An accompanying report on for-profit nursing homes called out such ownership for their lack of resources in the early months of the pandemic, and murky corporate structures that helped companies obscure profits and avoid legal and regulatory accountability.
In a response to the congressional report and hearing, Sloan, while acknowledging the country’s 15,000 nursing homes are not all the same, said it’s high time to fix a broken system of financing, oversight and support for nursing homes.
Actionable items in NASEM
Specifically, Sloan believes Congress needs to take action on suggestions in the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report, on how the industry is managed in terms of finance, regulations and corporate structures.
“This is a once-in-a-lifetime opportunity that we have,” said Sloan. “We have the credibility and thoroughness with which the National Academies committee went about this. That’s in many ways exactly what we need to bolster our advocacy for real change.”
The report runs to hundreds of pages. It includes seven recommendations, with different “lever points,” as Sloan called it, for Congress to take action along with other federal agencies, while some actions must be taken at the state level.
Some recommendations include transforming the way nursing homes are paid, while more modest change pathways suggest financial incentives to nursing homes for adoption of electronic health records and health information technology.
The study was undertaken by the Committee on the Quality fo Care in Nursing Homes and sponsored by The John A. Hartford Foundation and other organizations. Work was conducted by17 committee members across the long-term care space, who held six public information gathering sessions to consider their recommendations.
LeadingAge in June received $1 million to advance NASEM report directives, eventually forming the Moving Forward: Nursing Home Quality Coalition headed by Alice Bonner, senior advisor for aging at the Institute for Healthcare Improvement.
Bonner served as a witness at the congressional hearing.
Skewering for-profit misses broader issues, but transparency levels playing field
Regardless of ownership, all operators are saddled with the same broken system, the same challenges and struggles, Sloan said of the congressional report focused on for-profit failures in the early days of the pandemic.
While for-profit nursing homes make up about 75% of the sector, focusing on one side of the coin detracts from discussions needed to fix the broader nursing home system, she said.
Still, “the least” organizations can do is to be transparent about ownership, corporate structures and provider relationships.
“We’ve supported transparency forever and not-for-profit organizations, we file 990s every year,” said Sloan. “We’re under public scrutiny all of the time and have been forever. We feel as if the playing field needs to be level, particularly when you’re entrusted with federal dollars and state dollars to do the right thing.”
In terms of company structures, Sloan said she wasn’t sure what the magic formula would be to perfectly manage nursing homes.
But, she has noticed a lot of mergers and acquisitions in the last decade – small companies are getting bigger and it’s harder to be a successful standalone nursing home.
“How big do you need to be and how complex do you need to be? I can’t answer that question. But how the company is organized and how it relates to its various subsidiaries or entities … I think that’s probably the most important thing from a transparency point of view,” added Sloan. “Where are decisions made? Where does the buck stop?”
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