Healthcare leaders and policymakers must “reverse the narrative” around incompetent or neglectful nursing home staff and work collaboratively to ensure care teams meet regulatory requirements, according to the medical leader of a large skilled nursing chain.

Deep mistrust between frontline healthcare workers in nursing homes and industry overseers has led to an accusatory survey process that pits the sides against each other, said Arif Nazir, M.D., chief medical officer of Signature HealthCARE, during a presentation at AMDA’s virtual annual conference Friday.

“There’s no room for punitive and punishment approaches … in a complicated system like healthcare,” Nazir said.

He called on surveyors to stop looking at mostly well-intentioned workers as if they are all out to do wrong. He compared the current survey approach to beating children who make an error because they don’t know better.

“Nursing homes represent the same issue with all the regulatory issues and patients being sicker,” he said. “You need me to improve, and you’re going to take a million dollars away from me? That doesn’t work anymore.”

He also called on regulatory agencies to reduce the amount of required reporting and to streamline data collection processes.

Nazir is past president of AMDA and served on a survey task force that last year called for engaging geriatric experts in the survey process and recognizing high-performing and innovative facilities rather than assigning blame and focusing on punishments for providers. That group also included geriatrician Michael Wasserman, M.D., then-AMDA president-elect Karl Steinberg, M.D., Alan Horowitz, Esq., RN, and James Lett II, M.D. 

In last week’s wide-ranging talk on leadership, Nazir emphasized the importance of clinical expertise both during the pandemic and as the needs of the average nursing home patient increase.

He said engaging physicians on site more frequently and more cooperatively can help change the culture of nursing homes and improve patient outcomes. At Kentucky-based Signature, nurse practitioners lead a care hub model that assigns each patient a care path to assure coordination and transparency. 

The model established a new on-call process focused on quality improvement and defined the role of the medical director as a mentor and coach. It also features weekly grand-rounds sessions for continued team training.

“We have to create an environment of learning,” Nazir said. “Gone are the days when the physician is the only clinical education leader on the team.”

The chain recently introduced an in-house app that “nudges” physicians to keep them more engaged with facility leadership. The mobile app provides routine educational refreshers, with three to five actionable recommendations related to topics such as pneumonia management.

Nazir also cautioned that not all innovation has to be “sexy” or high cost.

“We have so much we can change tomorrow by changing clinical workflows,” he said. “These are the heart of innovation that is required. It does not require policy change. It does not require millions of dollars.” 

Opportunity for change

The pandemic has provided nursing homes a “unique opportunity” to change the perception that negatively impacted the industry over the past year, geriatrician Sharon Brangman, M.D., urged during AMDA’s opening keynote presentation on Thursday. 

“It was okay if you died of COVID in a hospital but if you died of COVID in a nursing home that was sometimes perceived as being really bad and that means that facility was bad,” she explained. “That unequal perception based on all the negative connotations about nursing homes came into play.” 

She added that “the time is now” to look at ways of improving long-term care and making it viable for seniors and providers, which includes reimagining long-term care from different perspectives (the people who live and work in facilities) and ensuring that providers have a seat at the table during decision-making time.  

“This is what I think our call is now: To look at the system and decide how we improve it and build it,” she said. “We have a number of opportunities here.” 

Danielle Brown also contributed to this report.