Released in April of 2022, “The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff” contains decades of ideas, information, and historical accounts in what is likely the most comprehensive study of the nursing home industry published since the 1980s. The 600-plus page report from the National Academies of Sciences, Engineering and Medicine’s Committee on the Quality of Care in Nursing Homes examines how the United States “delivers, finances, measures, and regulates the quality of nursing home care.”
The initial reaction to the report has been largely focused on the negative, as the findings depict an industry struggling to serve the elderly under stressful and financially inadequate conditions, not to mention a global pandemic. As a report looking for deficiencies in an industry that deals with the end of life, its findings are often grim, and it ultimately concludes that the seniors housing and care industry needs dramatic reforms. Betty Ferrell, one of the report authors and chair of the Committee on the Quality of Care in Nursing homes, put it simply: “The way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable.”
Ferrell’s blunt message has its place, and seeing how the national media likes to focus on the negative aspects of the senior living industry, this report gave them plenty of fodder for their coverage. Although some of the criticism is warranted, what those in the industry also know is that there are countless success stories of residents receiving excellent care and housing. For the purposes of this discussion, we acknowledge the severity of the report’s findings, argue that the positive aspects of our industry continue to get scant attention, and aim to move past the pessimism and focus on the report’s case for reform.
Building Momentum for Reform
The first nine chapters of the report provide a vast examination of the nursing home industry, including a look at its history, quality measurement and improvement, care delivery, workforce, environment and resident safety, payment and financing, quality oversight and regulation, and information technology. The final chapter of the publication arrives at seven overall goals and recommendations targeted at healthcare providers and organizations, researchers, and policy makers.
Although the complexity of the nursing home industry and breadth of participants make significant reform an enormous endeavor, the report could spark discussion that leads to real change if any of the recommendations and proposals are enacted – in part or in full. Even if they are not immediately enacted, the report could help build momentum for major reforms in the future.
Intriguing proposals detailed include:
- Addressing inadequate Medicaid funding by creating a more robust financing system
- Identifying care delivery models that reduce care disparities and strengthen connections among the nursing homes, communities, and the broader healthcare/social services sectors
- Implementing financial incentives for health information technology adoption
Although many of the recommendations in the report would require Congressional actions, such as funding approvals and expansion of agency authority, some can and likely will be implemented by U.S. Centers for Medicare & Medicaid Services (CMS) and other government agencies fairly quickly. By law, CMS and other federal government agencies must solicit public comments for a proposed rule or regulation, thus active participation by the industry during those comment periods will be important to voice concerns and shed light on potential negative impacts of proposed rules and regulations.
Even if the report’s recommendations are not quickly enacted, the most likely scenario, it can still be quite impactful because its findings will likely be referenced for future legislation and administration agendas for years to come. In fact, many of the proposals in the Whitehouse’s February “2022 Fact Sheet: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes” are closely correlated with the report. Because a lot of the ideas in the report have been around for decades and congressional inaction is the norm, it is has become increasingly easy to dismiss calls for industry reform such as those found in the report. However, with the staffing crisis, occupancy challenges, and attention the current Whitehouse administration is giving to the industry, nursing home owner/operators would be wise to pay attention to the report’s calls for reform at this time, despite the disillusionment that may be many peoples’ initial reaction. Real change is typically a slow process, but if there was ever an environment suitable for an acceleration of reform efforts, the seniors housing and care industry in the post-pandemic era is surely it.