The LeadingAge Nursing Home Network met on November 29 to review recent nursing home policy updates and share feedback among members. Dr. Tom Tsai, MD, MPH, Senior Advisor to the White House COVID-19 Response Team joined the call to discuss the importance of vaccination and therapeutics in preventing serious outcomes among older adults. Register for the Nursing Home Network here. Check out the Nursing Homes page on the LeadingAge website here.

COVID-19 Vaccination and Therapeutics

Dr. Tom Tsai, MD, MPH, Senior Policy Advisor to the White House COVID-19 Response Team, joined the Nursing Home Network call to share updated information about the impact of COVID-19 on older adults and to request support from LeadingAge members in raising awareness about the importance of COVID-19 testing and antiviral treatments. Dr. Tsai’s slide presentation, available in the Nursing Homes group on the LeadingAge Member Community, shows that while we are seeing the lowest number of deaths from COVID-19 at any point in the pandemic, a striking 89% of the deaths between January-November 2022 occurred among those aged 65 and older. Another notable pattern change is that a growing proportion of COVID-19 deaths are occurring in long-term care facilities or an individual’s home, and not in the hospital. 

In response to this data, the White House and the U.S. Department of Health and Human Services (HHS) are engaging with a wide range of healthcare stakeholders in a campaign to emphasize that Paxlovid is highly effective at reducing symptoms, hospitalizations and deaths, and that access to this lifesaving treatment is only possible through testing, which leads to diagnosis. 

Dr. Tsai noted that clinician education is key, and his presentation highlighted key messages the Administration is sharing with medical groups. The bottom line is that COVID-19 deaths can be prevented through vaccination and treatments. Testing and treatments are widely available and can protect older Americans from the impact of COVID-19 that continues to affect them disproportionately. He also promoted a new tool from the Centers for Disease Control & Prevention (CDC) called the COVID-19 Personal Action Plan, which encourages individuals to identify proactively the precautions they can take to avoid COVID and the steps they will take if they have symptoms or test positive.

Policy Updates

LeadingAge Efforts to Improve COVID Outcomes LeadingAge, in collaboration with American Health Care Association, has partnered with the Department of Health & Human Services (HHS) in an All Hands on Deck Campaign to increase bivalent booster uptake among nursing home residents. LeadingAge will be promoting booster and flu vaccine uptake among members, communicating about vaccination rates in member communities, and identifying member needs and access barriers to HHS. In return, LeadingAge has requested assistance removing barriers to vaccine access and efforts to increase uptake including vaccination prior to hospital discharge. Read more about the All Hands on Deck campaign here. LeadingAge is additionally engaged in efforts to improve COVID and other outcomes as we face the threat of a winter tripledemic. Read about these efforts here.

Timely Access to Therapeutics and Vaccines CMS released memo QSO-23-03-ALL on November 22 stressing the importance of timely access to COVID-19 therapeutics and maintaining up to date status with COVID-19 vaccination. The memo comes as part of the Biden Administration’s 6-week campaign to improve vaccination rates nationwide in which the White House promised “new enforcement guidance to ensure nursing homes are offering updated COVID-19 vaccines and timely treatment to residents and staff.” We note that the memo does not change policy or enforcement, and instead reminds providers of requirements to educate on the risks and benefits of COVID-19 vaccination and offer or assist with accessing vaccines and boosters.

Beyond this reminder, the CMS memo largely focuses on the importance of timely access to COVID-19 therapeutics. CMS states that all individuals testing positive for COVID-19 should be evaluated to determine appropriateness for therapeutics and providers may consider working with pharmacies to pre-order therapeutics for more timely access. Read more here.

National Labor Relations Board Proposed Rule The National Labor Relations Board (NLRB) proposed a standard on September 7 that would significantly expand the standard for determining whether separate entities may be considered “joint employers” of particular employees under the National Labor Relations Act. This standard is important because if an organization is considered to share or codetermine certain terms and conditions of employment for another organization’s employees, both organizations may be required to bargain with a union representing jointly employed workers, and each organization may be liable for unfair labor practices committed by the other. LeadingAge submitted comments on December 7 emphasizing that the expansive breadth of the proposed standard would unreasonably impose risks on organizations of expanded collective bargaining obligations and of liability for unfair labor practices committed by those organizations’ business partners with respect to their own employees. Read the proposed standard here. LeadingAge comments on the standard can be accessed here.

Rural Emergency Hospitals CMS recently finalized a rule that includes a new hospital designation. The new designation will allow critical-access hospitals and small rural hospitals to convert to a Rural Emergency Hospital. The intent is to preserve access to healthcare in under-served areas by preventing total closure of these hospitals. Rural Emergency Hospitals (REHs) will provide no inpatient services except for Skilled Nursing Facility (SNF) care. This new designation could potentially impact nursing homes in 2 ways. First, with critical access hospitals and small rural hospitals converting to REHs and no longer providing inpatient services, nursing homes lose a critical referral source, particularly when the Qualifying Hospital Stay (3-day stay) waiver ends. Secondly, nursing homes may find themselves in competition with the REH for what limited referrals remain should the REH choose to offer SNF services. This rule, with its finalized enrollment and payment policies, will go into effect January 1, 2023.

Psychotropic Use in Nursing Homes The Office of the Inspector General (OIG) released a report on November 14 on trends in psychotropic use in nursing homes from 2011 – 2019. The report details findings from an examination of data from the Minimum Data Set (MDS), Medicare claims, and Payroll-Based Journal (PBJ). OIG identified in the data trends including an increase in the use of anticonvulsants as rates of antipsychotic usage decreased; higher utilization of psychotropics among nursing homes with lower Registered Nurse (RN) ratios; and an increase in unsupported schizophrenia diagnoses over time concentrated in a small number of nursing homes. OIG made 3 recommendations to CMS: evaluate the use of psychotropic drugs to determine if additional action is needed; use data to identify nursing homes / nursing home characteristics associated with higher use of psychotropics and focus oversight where trends signal potentially inappropriate use; and expand the elements required on Medicare Part D prescription drug claims. CMS concurred with the first 2 recommendations. Read the report and recommendations here.

Physician Data on Care Compare CMS has added new data elements to the information publicly reported on Care Compare. As of November 14, physician’s provider pages now display facilities with which the physician is affiliated. This includes the hospitals, nursing homes, hospices, and home health agencies in which the physician serves Medicare beneficiaries. Consumers may find this information helpful when planning care transitions, such as choosing to discharge from a hospital to a nursing home or home health agency with which a particular physician is already affiliated.

Webinars on the LeadingAge Learning Hub The LeadingAge Learning Hub is an excellent resource for accessing aging services-focused education on current topics. New on the Hub this month, nursing homes can purchase The New MDS v1.18.11: Are You Prepared? to help prepare for the October 2023 implementation of the latest update to the Minimum Data Set. Coming soon, providers can access Creating and Maintaining a Secure Environment. This webinar, presented live on December 14, is a follow up to Active Shooter Preparedness that was presented in June 2022 and is currently available for purchase. All webinars are offered at a discount to LeadingAge members.

The LeadingAge Nursing Home Network call takes place on the last Tuesday of every month. If you are a LeadingAge nursing home member and would like to join this group, you can register here. Your LeadingAge login is required to register. If you do not have a LeadingAge login, you can create one here using your work email address. Our next monthly call will take place Tuesday, December 27 at 2pm ET.