Patient advocates and nursing home operators intent on shifting the traditional approach to skilled nursing care should seize on a call for demonstration projects included in the Affordable Care Act, two experts said during a national webinar Tuesday.

“If Congress would like to [invest in innovation], and we hope they will, we need your help to get them to do it,” long-term care policy analyst Anne Montgomery said during a webinar on the future of nursing homes. “It could be attached to the legislative authority … in … the Affordable Care Act. … It hasn’t yet been used for its intended purpose of transforming the nursing home system.”

Montgomery, a member of the Moving Forward Coalition and a former senior advisor to the Senate Special Committee on Aging, has embraced the Green House model and sees investment in a nationwide pilot as both cost- and care-effective. 

She helped write sections of the Affordable Care Act and said it is primed to be put to work as lawmakers and the Biden administration consider how to further reform long-term care and move it away from its core of providing “task-oriented institutional care.”

The ACA provided an initial budget for new payment and care delivery models tested through demonstration projects and gave the Department of Health and Human Services the authority to expand such pilots if they reduce spending or improve quality. 

“The Department of Veterans Affairs has been given the resources for innovation not long ago in 2022 to invest in overhauling the nursing home system that they run,” Montgomery noted. “So why can’t we do it elsewhere?”

Montgomery last year co-authored a proposal on reallocating federal funding to improve quality of life in nursing homes that was submitted last year by Gray Panthers NYC to Sen. Ron Wyden (D-OR), chairman of the Finance Committee.

She calls it the Einstein option, and includes in her standards for innovation commitments to person-directed care, especially training; small home models; alternative payment policies; and development of a stronger direct care workforce. Even a $600 million investment to kick off such catalytic change, she said, would cost just one-tenth of 1% of SNF spending over the next three years.

Joining Montgomery Tuesday was Roger Myers, president and CEO at Presbyterian Villages of Michigan, which has tackled innovation on its own embracing many of the same concepts Montgomery touted.

PVM about 20 years ago started working with Bill Thomas, founder of The Eden Alternative and The Green House Project, on adopting principles of person-centered care.The organization today has about 7,500 residents across 34 communities, including the unique Thome Rivertown Neighborhood in Detroit.

The community opened in 2014, using a mix of federal loans, philanthropy and regulatory waivers to launch a range of affordable care for seniors accessible and successful from both the patient care and financial sides.

The campus includes HUD-subsidized apartments for independent seniors; 80 affordable assisted living apartments subsidized through the state or city; a robust PACE program; and two Green House households with 10 residents each, although they’re currently licensed under a state “Home for the Aged” label rather than as SNFs.

Myers put the total development cost at 55 million dollars, with about $12 million going through grants or other charitable support.

“I’ve been in this field for a long time, and I’ve seen the desperate need for change,” Myers said during the event, part of an ongoing series hosted by Gray Panthers NYC. “This was, again, certainly a risky proposition when we were doing this. We undertook it during the middle of the Great Recession. But it’s been proven to be very effective. It’s effective economically, financially [and by] the quality of life for the participants.”

Today, PVM is replicating the same affordable model in Flint, Port Huron, Pontiac and Westland, MI.

Montgomery said such “transformational models” deserve a chance to be tested for a national audience. 

“The Einstein option is about evaluating innovations, so as people have new or different models, whether they be Green House or others, that gives a national platform for the potential for transformational change,” added Gray Panthers NYC President Emeritus Jack Kupferman.