April 19, 2022

Nursing Home Reform: The Work Can’t Stop Now

BY Katie Smith Sloan

Once I built a railroad, I made it run, made it race against time.

Once I built a railroad; now it’s done. Brother, can you spare a dime?

There wasn’t a dry eye on the Zoom screen when Danny Williams, president & CEO of Eliza Bryant Village in Cleveland, OH, sang these Depression-era song lyrics to Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS), during a March 31 meeting with LeadingAge providers.

“Older folks shouldn’t have to beg for dimes,” Danny told Brooks-LaSure. “Agencies like ours shouldn’t have to beg for dimes to provide the quality of care that we all want to see happen.”

Danny’s spur-of-the-moment rendition of “Brother Can You Spare a Dime?” came at the end of an emotional presentation during which he shared painful news: Eliza Bryant had just made the decision to close its 126-year-old nursing home, the oldest continually operating African American-founded long-term care setting in the United States.

Eliza Bryant will continue operating its home care, adult day, affordable housing, and other services. But the nursing home’s closure on June 8 will be a devastating loss for Cleveland’s east side and for the field of aging services.

“Our death is not from natural causes,” Danny told the CMS Administrator. “Our demise is (due to) chronic underfunding.”

Take a moment to let that sink in. An at-risk community in Cleveland is losing its vital connection to long-term residential care because a mission-driven, committed, high-quality nursing home simply does not have the funds it needs to keep the doors open. It’s another stark example that decades of underfunding have left America’s nursing home system in desperate need of an overhaul.

Other providers on the CMS call—including Deke Cateau of A.G. Rhodes in Atlanta, Jeffrey Farber of The New Jewish Home in New York, and Sondra Norder of St. Paul Elder Services in Kaukauna, WI—echoed Danny’s concern about the future of nursing homes. Over the past month, we have voiced the same concerns in meetings with Health and Human Services (HHS) Secretary Xavier Becerra and his staff, and with White House staffers, including Domestic Policy Council Director Susan E. Rice and National Economic Council Director Brian Deese.

LeadingAge requested these meetings in a March letter urging President Biden to take a bold, all-of-government approach to ensuring that older Americans and families have access to consistently high-quality nursing home care. In all three meetings, we proposed these immediate steps:

  • Address the dire staffing crisis by drawing on the expertise and resources of a broad range of agencies—including HHS, CMS, the Federal Trade Commission, and the departments of State, Homeland Security, Education, and Labor.
  • Take an evidence-based approach to quality improvement by reserving the most frequent survey schedules for poor performers, rather than punishing good homes by forcing them to devote limited resources to unnecessary compliance steps.
  • Fund quality care by increasing current reimbursement rates and reviewing those rates regularly to ensure they’re aligned with changing costs.

A comprehensive, all-government approach could provide nursing homes with the help they need to continue providing life-sustaining services and supports to the most vulnerable older Americans. Such an approach might have saved Eliza Bryant Village’s nursing home.

That’s why LeadingAge remains fully committed to our continuing advocacy work on behalf of nursing homes. When will that work produce results? That’s a question none of us can answer right now. But I remain optimistic that we’re on the right path.

My optimism was reinforced on April 6 when the National Academies of Sciences, Engineering, and Medicine (NASEM) released a long-awaited, 600-page report entitled, The National Imperative to Improve Nursing Home Quality: Honoring the Commitment to Residents, Families, and Staff.

We appreciate the in-depth research and thoughtful deliberation that went into the NASEM report and its recommendations, which could profoundly change the delivery, financing, and quality of care in nursing homes. But we also know that we have much work ahead of us before needed reform strategies can be developed, widely accepted, and broadly implemented.

Last week, David Grabowski of Harvard Medical School, who was a member of the committee that wrote the NASEM report, gave us good reason to think these efforts will eventually bear fruit. He noted that the coronavirus pandemic set the stage for needed reforms by dramatically—and tragically—exposing the challenges that nursing homes have faced for decades.

“There’s a momentum that we haven’t had previously,” Grabowski said, adding an important proviso:

“The work can’t stop now. We need to keep moving forward with it.”

LeadingAge couldn’t agree more.