A stressed nurse
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Steep challenges faced by nursing homes during the COVID-19 pandemic continue to hinder their ability to provide quality care and adequate staffing, according to new report findings from the US Department of Health and Human Services Office of Inspector General released Thursday.

The federal watchdog outlined five steps regulators should take to help providers going forward, leaving providers hopeful but wary. 

The contents of the report will not surprise long-term care providers, who have broadly struggled with a shrinking workforce and rising costs across the country. 

Report authors recommend the Centers for Medicare & Medicaid Services expand its policies to better support the long-term care workforce, reassess care worker certification requirements and update infection control policies. They also want federal authorities to provide assistance to nursing homes with implementing such new policies and facilitate collaboration with operators to improve care.

Provider leaders on Thursday supported the “common sense” recommendations the OIG made to CMS — especially those related to strengthening the workforce. 

“A strong, qualified workforce is a critical component of ensuring quality care for older adults living in nursing homes,” said Katie Smith Sloan, president and CEO of LeadingAge. “As the report acknowledges, nursing homes’ staffing challenges are massive, complex and chronic.”

Push for collaboration

The OIG suggested CMS implement new workforce development programs through the Center for Medicare and Medicaid Innovation. It also highlighted the potential for utilizing temporary nurse aid waivers to get care workers onboarded quickly and, in the process, receive on-the-job training. 

Sloan praised the OIG’s call for more collaboration and emphasized that an “all-of-government approach” is necessary to adequately address staffing challenges. She also called attention to the elephant in the room — the looming proposed federal staffing mandate from CMS.

“Staffing mandates are not the answer,” Sloan said. “Implementing them as CMS proposes is not feasible due to the lack of potential hires and the massive cost — anywhere from $4 billion to $7 billion in the first year alone.”

While it did not make direct cost projections, OIG report authors did point out that nursing homes have been forced to increasingly rely on expensive agency staffing as the workforce shrinks in the wake of the pandemic They also acknowledged that such an approach has had “significant downsides” for care providers.

While nursing homes are a critical part of providing healthcare to the nation’s seniors, the challenges the sector faces have often been ignored or addressed too slowly by policymakers, said Mark Parkinson, president and CEO of the American Health Care Association.

“At the heart of this discussion is the crucial fact that nursing homes do not operate in a vacuum,” Parkinson told McKnight’s Thursday. “When any part of the health system is not properly supported, the impact will be felt throughout. We saw this during the pandemic. We saw it when we made calls for help, but it took months for public health officials to respond. Now, we’re seeing it again with the historic workforce crisis that long-term care providers are working diligently but struggling to solve.”

Like Sloan, Parkinson praised the OIG’s call for more collaboration with government regulators and argued that lawmakers backing will be necessary to transform nursing home care to meet current and future staffing and infection control challenges.

Infection control tied to staffing

CMS offered qualified agreement to the report’s recommendations but also suggested that some of them have already been met. For example, CMS said that its planned staffing mandate and $75 million set aside for financial incentives for new care workers would adequately address OIGs concerns, according to the report. 

OIG disagreed, maintaining that it is “looking for CMS to implement a process that allows for sustained attention to the crucial issue of the nursing home workforce and for CMS to explore additional tools it can bring to alleviate nursing home staffing shortages and related challenges.” 

The OIG report’s focus on both workforce issues and infection control illustrates just how interlinked those “related challenges” are today, according to Devin Jopp, CEO of APIC — the Association for Professionals in Infection Control and Epidemiology.

The report addressed a real need to implement updated infection control measures following the pandemic, but even OIG stopped short of mentioning some measures that are necessary for comprehensive infection control, Jopp told McKnight’s Thursday, 

“It’s great that OIG is pointing out these components and I think they’re spot-on in terms of needing better training, better policies, better guidance,” he said. “But with that also comes the need for some other elements around standards of reporting, infection preventionists and support measures to help build nursing homes and make them successful.”

Jopp highlighted three main areas for improvement in nursing home infection control: maintaining full-time infection preventionists in facilities, requiring additional infection reporting through the National Health Surveillance Network and increasing training for CMS surveyors so that they can adequately assess infection control readiness at nursing homes.

Money still matters

Despite highlighting these additional infection control measures, Jopp agreed with OIG that nursing homes face such funding and staffing challenges that those must also be addressed in order to free up resources for the up-to-date infection control. 

“This report paints a very challenging environment for just how thin staffing is in these organizations,” he told McKnight’s, noting that many facilities do not have enough free staffing hours to have time to train their care workers in sufficient infection control methods. 

Still, Jopp remained cautiously optimistic that a combination of additional oversight and adequate incentives and reimbursements returning to facilities will ultimately lead to the results providers and regulators both desire.

“The reality is, if we start setting requirements around this and then start providing support around it, it’s doable,” he said. “But it’s going to take a coordinated effort to make it happen.”