Michael Wasserman
Michael Wasserman, M.D.

The California Association of Long Term Care Medicine (CALTCM) applauds President Biden’s ambitious plan to improve the care of our nursing home residents.  

CALTCM is the medical voice of long-term care in California. We advocate for quality patient care and achieve our mission through education and policy. Many of our physicians and other healthcare professional members were on the front lines in nursing homes throughout the pandemic. 

We knew what was coming and did everything possible to develop solutions. Some of these solutions were implemented and made a difference. Others took time to implement and ultimately were responsible for saving lives. One thing is certain: nursing homes could have been better prepared. 

Structural problems in how nursing homes function as a business have existed for years, with many studies demonstrating longstanding inequities and disparities.  “Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” the president’s plan to bring needed change to the nursing home industry, tracks closely with our efforts.

Here’s why we agree with this desperately needed initiative:

A nationwide shortage of nursing staff actually highlights the importance of the clinical need to “Establish a Minimum Nursing Home Staffing Requirement.”  CALTCM published a white paper on nursing home staffing that provides the evidence for this.  We are pleased that the California Association of Health Facilities (CAHF) recently proposed a plan that also supports most of the findings of our white paper. While we do not believe that more studies are needed to demonstrate the need for increased staffing levels, we do support ongoing research into how to optimize care in nursing homes and align staffing best practices.

Nursing homes have a long history of inadequate infection prevention and control. This is why CALTCM recommended requiring full-time infection preventionists in the first weeks of the pandemic. “Strengthen Requirements for On-site Infection Preventionists,” is already the law in California, thanks to Assemblymember Jim Wood’s bill that was signed into law by Gov. Gavin Newsom (D) in 2020. It’s time for this to become a national requirement, and the president is on the right track here.

There is ample historical evidence, particularly from the Department of Health and Human Services Office of Inspector General (OIG) that nursing homes are unprepared for disasters such as a pandemic. The plan to “Enhance Requirements for Pandemic and Emergency Preparedness,” is consistent with CALTCM’s Quadruple Aim for COVID-19 Response, published in April of 2020. We went so far as to publish a white paper and then an article entitled “An Aspirational Approach to Nursing Home Operations During the COVID-19 Pandemic” that promotes the concept of a centralized support and guidance center for nursing homes. Unfortunately, this concept has yet to be implemented. There is so much more that needs to be done to improve the quality of care delivered in our nation’s nursing homes.

In the early weeks of the pandemic, it was obvious to geriatrics and long-term care medicine experts, many of whom were providing care on the literal front lines but were not “in the room” for policymaking discussions, that widespread testing in nursing homes was critical to battling this deadly virus that disproportionately affected nursing home residents. This is why we wholeheartedly support the importance of “Continued COVID-19 testing in long-term care facilities.”

We cannot accept slow turnaround times for tests, nor can we ever accept impediments to testing among nursing home staff and residents. We are entering the third year of the pandemic and this continues to be a challenge.

The positive impact of vaccinations on vulnerable older adults cannot be overstated.  The latest surges in late 2021 and early 2022, while affecting fairly large numbers of long-term care residents, caused much less serious illness and fewer hospitalizations or deaths — especially compared to the absolute devastation of the pre-vaccine winter of 2020. This is largely due to the protective effects of the vaccine and boosters, which have been well accepted among nursing home residents. 

CALTCM has actively promoted the importance of improving vaccine confidence among nursing home staff and residents, an issue which has become even more apparent with the rollout of the booster.  We’ve also recognized some of the structural challenges that have gotten in the way of effective vaccination efforts. There can be no doubt about the importance of “Continued COVID-19 vaccinations and boosters in long-term care facilities.”

There have been many articles regarding the inadequacy of oversight in nursing homes.  This is why we completely support the concept to “Adequately Fund Inspection Activities.” Two of our board members co-authored a paper in 2020 on the need to “upgrade the nursing home survey process.” It is time for the experts in geriatrics and long-term care medicine to work in tandem with the government and advocacy groups to develop a more effective oversight program for nursing homes. While spending more money to increase the number of surveyors, inspections or penalties alone is unlikely to improve the quality of care, we are hopeful that some of the funds earmarked for improving the federal survey process can be devoted to different paradigms more in line with established research on process improvement.

In February of 2021, two members of CALTCM’s Public Policy Committee collaborated with other national experts to develop recommendations to bring transparency to nursing home ownership and finances. We also supported the passage of SB-650, a nursing home transparency bill that was signed into law by Gov. Newsom last fall. The Biden Administration’s plan to “Improve Transparency of Facility Ownership and Finances” and to “Increase Accountability for Chain Owners of Substandard Facilities” are initiatives that we fully support and that California has already implemented. 

Beyond that, California is requiring transparency as to the identity and certification status of all nursing home medical directors, which we hope will move the needle toward higher-quality medical care. In fact, all California medical directors will have to be certified within five years — thereby guaranteeing at least a minimum knowledge base about geriatric medical care principles and the complex regulatory framework nursing homes operate within.  

Tragically, the pandemic only served to highlight decades-old structural faults in the nursing home industry. We are at an inflection point. We cannot allow the nearly 200,000 nursing home resident and staff deaths that have occurred nationally to have been in vain. 

We must learn lessons from the devastation and change our processes in nursing homes to prevent it from happening again. That is why we strongly support the president’s plan for “Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes.”

Michael Wasserman, M.D., is a board member and chairs the Public Policy Committee for the California Association for Long Term Care Medicine.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.