Skilled nursing and other long-term care providers may need to prepare for major nursing home reform efforts, including increased penalties, under President-elect Joe Biden’s administration, according to industry advocates and experts. 

“From a nursing home regulatory perspective, the Biden administration could choose to reverse the Trump administration’s relaxation of enforcement, penalties, and oversight,” said David Grabowski, Ph.D, Harvard Medical School professor and healthcare policy expert. 

Specifically, he noted that could mean the restoration of mandatory penalties for violations when residents are in Immediate Jeopardy but did not suffer any harm. He added that the new administration also could move to reinstate the regulator ban on binding arbitration agreements in cases of resident harm or death from nursing home negligence. 

“They could also reject pending regulations that would relax current requirements around an infection preventionist, psychotropic drug use, grievance process, and staffing data retention,” he told McKnight’s Long-Term Care News. 

He added that there could be a push to improve nursing home staffing and training. 

“[The Biden administration] could increase oversight by increasing the frequency and scope of facility inspections, strengthen protections against inappropriate resident discharge, and require increased oversight of nursing home cost reports and ownership data,” Grabowski said. 

LeadingAge also ranked nursing home reform, whether it’s via changes to regulation or payment models, as one of the major initiatives that could be likely under the incoming administration. 

However, the organization also noted that the most immediate focus for Biden will be the COVID-19 pandemic. It said it is awaiting word from the new administration on its next steps for provider relief since many providers are still “overstretched covering the unexpected increased costs” associated with the public health crisis. 

“We support the Biden team’s expressed goal of focusing on beating the pandemic for the first year and a half. What we’re seeing so far with vaccines, even after only a few short weeks, is very promising, with dramatic drops in positivity rates in some [long-term care communities even after one vaccine clinic,” Ruth Katz, LeadingAge’s senior vice president for policy, told McKnight’s. “We will work with the new administration on some of the initiatives discussed during the campaign.” 

A recent government report found that the Centers for Medicare & Medicaid Services has not fully addressed recommendations made by a federal nursing home commission following a probe of the federal response to the pandemic. Among Biden’s first courses of action could likely be to improve the management of COVID-19, especially in nursing homes, Grabowski suggested.

“Nursing homes are currently getting the COVID vaccination for residents and staff, but the Biden Administration could greatly strengthen support for residents, their families, and their caregivers by implementing our recommendations,” he said. “Additionally, the rollout of the vaccine in long-term care facilities has been slow in many states and the Biden Administration could revisit how this process could be improved.” 

Other areas of focus for Biden will be a shift toward home- and community-based services to expand long-term care services, both Katz and Grabowski noted. 

In the long-term, Grabowski said he hopes that Biden will consider larger scale changes to how long-term care is financed. 

“The current system is broken, and the pandemic showed us by just how much. There will be lots of areas in need of policy attention in the post-pandemic world, but I hope we do not forget about long-term care,” he said.