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A new report on the state of long-term care in New Jersey has suggested sweeping changes to policy points of emphasis, regulations and financial incentives in the sector — drawing a mixture of reactions from providers and consumer groups.

The report from the New Jersey Task Force on Long-Term Care Quality and Safety identified three main themes — an overreliance on nursing homes and lack of investment in home and community-based care; a lack of smaller facilities with private resident rooms; and a shrinking workforce. 

The task force was formed in 2020 to develop potential solutions to improve outcomes in the sector. It gave a nod to dedicated providers and frontline staff while also making a long list of policy suggestions for the state government in its 74-page report, which was published Friday. 

“The Task Force recognizes that New Jersey is home to many good nursing home providers that score well on federal quality metrics, with staff who performed heroically and with very little

public acknowledgement during the worst of the COVID-19 pandemic,” the group wrote. “However, the current framework for delivering nursing home care is outdated and generally does not support person-centered care.”

Some suggestions included increasing state investment in home care, incentivizing a transition toward fewer-occupant rooms and “Green House”-style facilities, standardizing the Medicaid reimbursement system with data-based adjustments over time, increasing audits and financial transparency requirements for nursing homes, and building workforce pipelines into the sector through scholarships and more flexible training programs.

Operators see roadblocks

Provider leaders told McKnight’s Long-Term Care News Monday that they saw both good news and some causes for concern in the report. 

“Our association broadly supports the recommendations surrounding acuity rate adjustments, updating Medicaid reimbursement rates based on recent cost reports (something that hasn’t been done in New Jersey for more than a decade), investing in the direct care workforce and expanding access to home and community-based services,” said Meagan Glaser, vice president of LeadingAge New Jersey & Delaware. 

But Glaser warned that the suggested changes would require funding and could be hampered by other provisions that could be overly punitive to struggling providers.

“Without substantial investment in long-term care, the recommendations are otherwise unattainable,” she explained. “LeadingAge NJ & DE does not believe extensively increasing punitive measures will help poor performing facilities improve as the report suggests, but will rather further marginalize those providers and potentially create access to care issues for older adults.”

One such punitive measure suggested by the task force would be to “curtail admissions in appropriate circumstances when nursing homes consistently do not meet minimum staffing ratios.”

A statement from the Health Care Association of New Jersey provided to McKnight’s echoed Glaser’s sentiments and urged state leaders to put more into the sector if they want to meet the task force’s vision.

“​​We are limited by real shortages in workforce and funding, and we need to focus on how to best care for vulnerable seniors in the context of those real world constraints,” the statement said. “The report’s failure to focus on the current underfunding of our existing system undermines all of its recommendations. The state cannot delay making a significant investment to serve its most vulnerable population, it’s not a choice it’s an obligation.”

A bittersweet pill

If policymakers take the task force’s suggestions seriously, providers likely would see a mixed bag of boons and burdens.

For example, increased investment into oversight could mean clearing the state’s survey backlogs, but also would come with increased scrutiny into related-party transactions and private ownership structure.  

Nursing home providers would be granted more reliable and predictable Medicaid adjustments, but would be required to adapt to shifting funding priorities that incentivize a move away from large, hospital-style facilities to smaller operations with more privacy and space for residents. In fact, the task force asks the state to “aim to eliminate higher occupancy (three and four persons) bedrooms.”

Providers would also see more programs and state funding to bring new workers in to fill nurse aide jobs, but as a tradeoff would see greater punitive measures if they fail to meet staffing requirements. 

Consumer advocates were broadly united in favor of the suggestions. New Jersey’s Long-Term Care Ombudsman — Laurie Facciarossa Brewer — characterized the report as a chance to “fundamentally rethink” long-term care in the state.

“We applaud the New Jersey Task Force on Long-Term Care Quality and Safety for providing a clear framework for transforming our long-term care system,” agreed Chris Widelo, state director of the AARP New Jersey in a statement Friday. “This report prioritizes home and community-based care so more New Jerseyans can age in place and avoid nursing homes.”