Nursing Homes After COVID: A Vision for the Future

Conversations with Katie | March 16, 2021

President & CEO Katie Smith Sloan describes the nursing home reform agenda released this week by LeadingAge and the American Health Care Association.

This has been a tragic year of unprecedented challenges for every member of LeadingAge, no matter your size or location, or the number of years you have been delivering long-term services and supports (LTSS) as trusted providers in your local communities.

Many of you have shared with me harrowing stories illustrating the trauma you and your staff have experienced since March 2020. You’ve been in the fight of your lives. Nursing home members, in particular, found themselves at ground zero of the coronavirus pandemic, as this deadly virus tragically took aim at older adults.

You shared with me the conviction that COVID-19 exacerbated the challenges that, for too many years, you have faced on your own and without sufficient federal support. Those challenges include a broken financing system ... underfunded government reimbursements … a struggling workforce ... an uncollaborative oversight process … an aging infrastructure. You know about these challenges better than anyone.

The pandemic shined a new spotlight on these longstanding challenges, while also focusing the attention of policymakers on the need for reform. LeadingAge hopes this newfound interest in nursing homes will finally result in concrete and meaningful action. That hope spurred us to join this week with the American Health Care Association in releasing a reform agenda called the Care For Our Seniors Act.

You won’t find anything revolutionary in this reform agenda—in fact, I suspect that many of the recommendations will seem all-too-familiar to you. We’ve been raising these issues, over and over again, for many years.

This year, however, we’ve brought our long-standing policy positions together in one place in the hope that the document will give policymakers the information they need to take a wholistic approach to assessing the challenges nursing homes face, and devising solutions that will lead to sustainable change.

The Care for Our Seniors Act calls for changes in four areas:

Enhancing quality of care: We call on policymakers to develop clearer standards for infection prevention and control practices. We also recommend government action to require that each nursing home have an RN on staff 24 hours a day, and maintain a minimum 30-day supply of personal protective equipment.

Workforce: We emphasize strongly that reform must begin by strengthening and supporting the essential direct care professionals who provide the bulk of intimate, hands-on care in nursing homes around the country. We’re asking for a multi-phased, tiered approach that helps us attract, retain, and develop more LTSS professionals by leveraging the resources of federal and state governments, and academic institutions.

Oversight: We call for the development of an effective oversight system and processes to support improved care and protect residents. We believe the current nursing home survey process does not serve residents’ best interests and is too focused on punishment rather than improvement. We also recommend steps for addressing poor-performing nursing homes and for strengthening the government’s Five-Star Quality Rating System.

Structural: We recommend ways to modernize nursing homes, many of which are between 40 and 50 years old. We call for a national study to explore how we might promote resident privacy, autonomy, and dignity—and support infection control best practices—by increasing the number of private nursing home rooms.

It goes without saying that meaningful reform of aging services depends on fixing our chronic underfunding of Medicaid. We’ve long known that Medicaid reimbursement isn’t consistent with the cost of delivering quality care in most states. We’re asking policymakers to fill that gap.

Taken together, these recommendations represent our vision for creating a better system in which nursing homes can be bastions of quality care and quality of life. I know we all agree that older adults and their families deserve that.

The clarity provided by the tragedy of COVID-19 has created the most important moment in a generation to seek fundamental nursing home reform. Change won’t happen overnight and it will require an investment of time, creativity, and financial resources.

LeadingAge is working hard to ensure that policymakers deliver the resources needed to begin this transformation process. The proposals we released this week represent important first steps in reaching that goal.