James M. Berklan

Anybody who has ever said nursing homes don’t get much attention can dial back that rhetoric after the last couple of days.

The funnel cloud churned by Team CMS Verma has done nothing if not put nursing homes on a pedestal. And you know what they say about targets posted on high perches.

First came Wednesday’s release of the Coronavirus Nursing Home Quality and Safety Commission report. With 25 commissioners from virtually every point on the long-term care compass — from nursing home operators to their mistrusting consumer advocacy counterparts — you knew from the start this was going to be an unwieldy polyglot of ideas and conclusions.

While there were no reports of chairs being thrown at meetings (which weren’t held in person come to think of it … but you get the idea), there were certainly differing arguments made. Some would say the 27 recommendations is a healthy number. Others might say it amounts to 27 cooks in the broth.

In the end, the report appeared to hold its sponsor’s feet intriguingly close to the “get your act together” fire. Interestingly, that sponsor, the Centers for Medicare & Medicaid Services didn’t see it that way. Instead, after two weeks of meditating on the independent commission’s findings, CMS leaders declared the report vindication for many initiatives they had already undertaken.

This was news to at least a handful of the commissioners. But, they figured, there was no way the group paying for the study wasn’t going to frame results any way but positive.

Yet as any child who writes an arm’s-length Christmas list can tell you, it’s not necessarily what you ask for that matters: It’s all about what’s eventually delivered. So most eyes are going to be on what actually comes of the 186-page report’s recommendations.

Many (but not all) agree to call the report a “good start.” To what end, nobody’s sure yet. The devil will be in the details of any execution. But the high-minded ideas within are certainly fodder for any special interest group to adopt as its own. Declare victories or losses accordingly, based on which side you sit on.

Easing the heartbreak

Then Thursday came a showy discussion of the previous day’s issues and new federal guidance on the opening up nursing home visitation policies. It’s hard for anyone to solely claim the high road on this one. If there’s anything that’s been universal throughout the pandemic, it’s that the isolation of senior care residents has been devastating. Which is more important to save: The body or the soul? As if the two aren’t interconnected. Or that the “body” part doesn’t have frightening implications for many other vulnerable individuals around it if ignored or treated carelessly.

The other big questions have always been: Why hasn’t more been done to keep senior living residents safer, and why hasn’t it been done sooner? The important subtext for providers, of course, is just who’s responsible for making it happen?

Thursday’s guidance, signed by David Wright, Director of CMS’s Survey and Certification Group, focuses squarely on the psychosocial risks of strict visitation restrictions.

The feds have pledged ideas, edicts and even some cash for materials to help facilitate better visiting experiences. But like any overseer — be it corporate exec, Army general or federal regulatory body — CMS is leaving much of the execution up to the frontliners.

To its credit, the administration came out with plenty of hopeful words for the voters, er, residents and their loved ones, who have suffered restricted access to one another over the last six months.

But out of its 3,132 words, only one was both underlined and bolded for emphasis. Just one. Providers would be wise to take note. 

The word? Must. As in “a nursing home must facilitate in-person visitation consistent with the regulations.”

If you don’t, dear cautious operator, you’re risking citations and further punishment. 

“Nursing homes that fail to facilitate visitation under the regulations could be subject to enforcement actions,” is how CMS Administrator Seema Verma put it Thursday evening in a column she wrote for the South Florida Sun-Sentinel.

After listing some of the adjustments that have been made, she added, “… there’s no reason nursing homes can’t facilitate more visitation.”

So there you have it, providers. The stage has been set, and you’re on it. It’s time to deliver. Or else.

Follow Executive Editor James M. Berklan @JimBerklan.