A stressed nurse
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Editors’ Note: This story has been updated to include comment from the National Association of Directors of Nursing Administration in Long Term Care.

Long-term care advocates say they are grateful President Joe Biden is placing what they call a much-needed priority on nursing homes, but the administration’s plan to crack down on providers through more oversight is also a disappointment, many in the struggling sector say. 

Biden laid out his nursing home reform measures Monday and referred to the initiative during his State of the Union address Tuesday evening. It includes more than 20 actions to improve quality of care. They include implementing a minimum staffing requirement, ratcheting up penalties for poor performing facilities, reducing overcrowded rooms and more transparency regarding nursing home ownership.

“We are in favor of increasing quality in nursing homes but this isn’t the path to improvement,” Amy Stewart, vice president of education and certification strategy for the American Association of Post-Acute Care Nursing, told McKnight’s Long-Term Care News Tuesday. 

“Nursing homes across the country struggle to find adequate staff and mandating requirements for minimum staffing won’t magically make more staff appear at their doorstep,” Stewart added. “Biden’s announcement will only result in a reduction in the number of nursing homes available to provide skilled nursing care.” 

Stewart and provider association LeadingAge both noted that the White House’s fact sheet does discuss launching a National Nursing Care Pathways Campaign, which will be a robust nationwide push to recruit, train, retain and transition workers into long-term care careers.

Stewart added that the campaign is a “generational approach that we support; however, it does not fix an immediate problem.” 

“Providers today need urgent assistance. We need nurses now, not in 10 years,” she said. 

The long-term care industry needs to stick together now more than ever and show lawmakers the successes within the sector, Sherrie Dornberger, RN, executive director of the National Association of Directors of Nursing Administration in Long Term Care, told McKnight’s Tuesday.

“Ask our residents and families to tell the stories of how our staff were there and stayed with the residents and loved them like family, even though they themselves were scared to death [and] invite legislative representatives into our buildings to see the quality of care we administer,” Dornberger said.

“No one knows all that we go through in one day and now these same people are  making unrealistic expectations of us. We would love to have more staff. If you know where we can find them, send them,” she added. “We have the most severe staffing shortage ever. Reimburse us at reasonable levels [and] don’t kick us while we are down.”

National spotlight a good thing

Sen. Bob Casey (D-PA) applauded Biden’s plan, which he said builds on key elements of his bipartisan Nursing Home Reform Modernization Act. That proposal aims to get more accountability out of nursing homes placed on the Special Focus Facility list. Biden’s plan directs CMS to heighten penalties for facilities that fail to improve.

“The issues President Biden’s plan seeks to address existed long before the pandemic. However, COVID-19 brought the need to protect the health and safety of nursing home residents and workers into sharper focus,” Casey told McKnight’s Tuesday. “The president’s plan takes a big step in that direction and I will continue to fight for improvements in quality and safety for nursing home residents and workers across the country.”

Geriatrician Michael Wasserman, M.D., said that everyone from advocacy groups to healthcare professionals in long-term care “should all be thrilled that the president is prioritizing the care of nursing home residents.” 

“We all need to work collaboratively to bring about effective, implementable and sustainable change,” Wasserman told McKnight’s. “I am particularly glad to see the strong focus on transparency. The industry needs to own the impact that financial pressures have on facility leadership and their decision making. We need to openly address quality concerns in the context of the financial health of nursing homes.”

Wasserman said he hopes the need to improve the effectiveness of the survey process can also be addressed. 

“While there are disagreements regarding how to do this, I believe that  all parties agree that the existing system is not working,” he said. 

Finding bright spots 

There are some positive aspects of the proposals, according to Christopher Laxton, executive director of AMDA, the Society for Post-Acute and Long-Term Care Medicine. 

“First, we are grateful that the administration is appropriately placing a priority on nursing homes, which is much-needed in the face of this devastating and ongoing pandemic,” Laxton told McKnight’s. “We also enthusiastically support the proposal to limit occupancy in rooms. Single-occupancy has been shown to reduce the spread of infection in congregate settings, and should be implemented.” 

He added that the administration’s plan to seek greater transparency of nursing home ownership is also encouraging. However, the minimum staffing proposal, which thus far has come without any indication of how facilities could afford to abide by it, is disappointing.

“This may well leave nursing homes with few options other than to close units or entire buildings, with a potentially devastating effect on vulnerable patients and residents needing care, and their families,” Laxton said. 

The American Society of Consultant Pharmacists accredited nursing homes and pharmacies for their admiral response to the unprecedented pandemic and staffing exodus. Despite providers stepping up to the monumental challenge, the federal government’s allocation of resources, such as monoclonal antibody treatments, has been poor. 

“We continue to face challenges accessing the treatments to this day that could save lives in nursing homes,” Chad Worz, PharmD, ASCP’s chief executive, said Tuesday. “This is a failure of the administration and the agencies, not the nursing homes or their providers.”