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Nursing home advocates and researchers hope today’s House subcommittee hearing will spur legislative action to help the sector recover from the ravages it’s still feeling from COVID-19.

Experts are expected to highlight the suffering of nursing home residents and staff during the pandemic and offer suggestions for better conditions in the future. The event will be livestreamed on YouTube and the website of the Select Subcommittee on the Coronavirus.

A federal booster shot mandate has previously been endorsed by one of the hearing’s planned witnesses, David Grabowski, PhD, professor in the department of health care policy at Harvard Medical School. That could come into play again, along with hopes for vaccine clinics for nursing homes with low vaccine rates.

“I plan to outline how COVID has decimated US nursing homes,” told McKnight’s Long-Term Care News. “In many respects, this is a ‘crisis on top of a crisis’ in that COVID was layered on top of a nursing home model that often doesn’t work for residents, families, or their caregivers. In order to fortify nursing homes, we need major reforms.

“In the short-term, I would advise policymakers to focus on vaccinations and supporting staff. In the longer-term, I would advise major reforms very much in line with the recent National Academies recommendations to address financing, regulation and delivery.”

Grabowski served on the National Academies of Science Engineering and Medicine Committee on the Quality of Care in Nursing Homes which on April 6, 2022, released the report The National Imperative to Improve Nursing Home Quality.

He has been among those noting in the past that most nursing home staff are not fully vaccinated. A mandate ideally would raise vaccination rates, thereby protecting workers and residents alike, as various pro-vaccination experts have pointed out.

“Most nursing home staff received their initial vaccines but only half are fully boosted. This is unacceptable and puts residents at risk,” Grabowski also told McKnight’s. “I would support expanding the federal vaccine mandate to include booster doses. Some states have already gone down this path. I would recommend the federal government follow suit.”

Grabowski and numerous other researchers and clinical leaders have noted that mass staff departures that were predicted if staff COVID-19 vaccination mandates were put in place proved unfounded. They were enacted and ultimately upheld by the Supreme Court.

The Federal Pharmacy Partnership for Long-Term Care Program provided access to clinics at every US nursing home in 2021, which could be a model for pumping up booster vaccination rates. Various experts have expressed hopes for more clinics at nursing homes, especially those with low conversion rates.

Tying pay to quality outcomes

Today’s hearing also is expected to produce a call to have the Centers for Medicare & Medicaid to expand its successful efforts at provider accountability. Illinois, California and Connecticut are among the states that have tied funding to quality outcome levels.

Student loan forgiveness, tax credits, affordable housing and child-care assistance have been among topics raised in the past as ways to improve staff retention and morale and could come into play again today. In addition, “strike” teams of outside caregivers also have been praised in the past.

Other subject matter experts testifying today are: Alice Bonner PhD, RN, FAAN, senior advisor for aging at the Institute for Healthcare Improvement and the chair of the Moving Forward Nursing Home Quality Coalition; Adelina Ramos, a certified nursing assistant and 1199NE member, from Greenville, RI; and Jasmine Travers, AGPCNP-BC CCRN PhD RN, assistant professor of nursing, NYU Rory Meyers College of Nursing, will also testify before the subcommittee today. Travers joined Grabowski on the NASEM Committee on the Quality of Care in Nursing Homes.

Providers launch preemptive defense

Although the hearing is all about nursing homes and their experiences, no provider or operator representative was scheduled to testify at today’s hearing. That was at least partly the reason behind a preemptive statement issued by the nation’s largest nursing home association Tuesday.

“Long-term care staff, residents and families are still grappling with the effects of the historic pandemic,” Mark Parkinson, CEO of the American Health Care Association and National Center for Assisted Living said in the statement.

“The pandemic has amplified long standing challenges — many of which have been raised by the long-term care profession for years — that must be solved. Our profession is facing historic staffing and financial challenges — due in part to inadequate Medicaid funding — which have left many facilities struggling to keep their doors open. Hundreds of nursing homes have closed as a result, and more will follow without additional support.

The association has proposed comprehensive reforms to address the challenges and “help create a brighter future for current and prospective residents,” he added. “We look forward to working with lawmakers on meaningful solutions to ensure our nation’s seniors continue to have access to the highest level of care.”

Parkinson said that at first, the sector’s needs were ignored, resulting in sparse allocation of PPE, testing and other assistance, despite its residents’ vulnerability. 

“Our dedicated caregivers worked day in and day out to combat the deadly virus,” he said. “We implemented unprecedented infection control policies to keep our most vulnerable safe. We repeatedly called on lawmakers to prioritize seniors for resources and funding. When the vaccines became available, we launched a nationwide campaign to encourage vaccinations, leading to a dramatic decline in hospitalizations and deaths.”

Despite the progress, Parkinson said there is still much to be done. The pandemic magnified sector challenges which existed before the health emergency that still must be solved. Staffing and financial challenges which Parkinson said are due in part to inadequate Medicaid funding, are pushing many facilities to the brink of closure. “Hundreds of nursing homes have closed, and more will follow without additional support,” he said. “We have proposed comprehensive reforms to address these challenges and help create a brighter future for current and prospective residents. We look forward to working with lawmakers on meaningful solutions.”