Nursing homes would be required to meet minimum staffing standards but also receive additional Medicaid funds to support workforce and care improvements under federal legislation introduced Tuesday.
It aims to improve staffing, quality and oversight of facilities in response to the COVID-19 pandemic and its ongoing toll on the industry.
“This legislation represents a big step towards nursing home care that is safer, higher quality, more accountable and more supportive of the workers who care for our most vulnerable,” Senate Finance Committee Chairman Ron Wyden (D-OR) said in a statement Tuesday.
More staffing requirements, more funding
The legislation, billed the Nursing Home Improvement and Accountability Act, was introduced by Democratic lawmakers on the Senate Finance and Aging committees. The bill would require skilled nursing and other nursing facilities to have a registered nurse on duty 24 hours a day, as well as a full-time infection preventionist.
States would also be provided with a temporary, enhanced federal Medicaid match to fund the staffing and care improvements under one proposal in the legislation. It would kick in during the first full calendar quarter after the legislation’s enactment, if it’s approved by lawmakers.
The funding would only be allowed to expand efforts to improve nursing facility staffing, such as improved wages and benefits, and resident care, including expanded person-centered models of care.
The American Health Care Association/National Center for Assisted Living said it appreciates that lawmakers recognize the need to enhance Medicaid funding for additional staffing, but that a permanent funding source would be a more helpful solution. The association, along with LeadingAge, has pushed for more funding to help providers address staffing challenges exacerbated by the pandemic.
“While the profession appreciates the initial steps offered in this bill, more is needed to adequately serve the vulnerable residents in our nation’s long-term care centers,” AHCA President and CEO Mark Parkinson said in a statement Tuesday.
“The proposal to institute permanent minimum staffing requirements without a permanent funding source would be incredibly challenging for long-term care providers. Providers will not be able to meet staffing requirements if we can’t find people to fill the open positions. There must be a comprehensive approach to staffing beyond just numbers,” he added.
Parkinson added that “with proper funding, providers can offer meaningful jobs with competitive wages and enhance the overall quality of care for residents.”
The legislation also would establish a $1.3 billion skilled nursing facility building modification and staff investment demonstration program. The pilot would provide select SNFs and nursing facilities additional funding to build and pursue resident-centered care approaches. While research has shown small, neighborhood-style nursing homes with private rooms were less vulnerable to deadly COVID outbreaks, many in the industry have argued that there is no viable funding mechanism to pay for construction of such facilities.
Applications would be accepted beginning in 2023, with participants pledging to meet standards to serve between five and 14 residents, provide private rooms, maintain accessible outdoor spaces for residents, and have standing resident and family councils, the proposal explained.
“Should this bill become law, the entire Green House Project team stands ready and eager to help any person or organization interested in participating in the program,” The Green House Project Senior Director Susan Ryan said Tuesday. “We won’t rest until every elder in America – regardless of income, race, ethnicity, or hometown – has a host of human-centered options for care in the setting of their choice, including a small-home campus.”
Additionally, the proposal calls for federal officials to review and improve existing surveys, enforcement and provider compliance, audit a sample of SNF Medicare cost reports, and prohibit pre-dispute arbitration agreements, which has typically been opposed by the long-term care industry.
“Arbitration is quicker and less costly than litigation in court and provides similar outcomes for residents and families,” Parkinson said. “An excessive litigation environment, coupled with the existing financial crisis, means thousands of long term care facilities would be forced to close their doors, in turn, displacing tens of thousands of vulnerable residents and limiting access to critical services for our nation’s seniors.”