Nursing Homes

Part of LeadingAge's 2020 Policy Priorities

LeadingAge Advocacy Goals

  • Improve the public image of nursing homes.
  • Preserve nursing homes as part of the continuum of care.
  • Ensure regulations promote quality and evidence-based best practices.
  • Promote alternative survey and certification processes that focus on outcomes and are collaborative rather than punitive.
  • Advance a quality measurement system that truly reflects quality care.
  • Ensure members have the resources needed to provide person-centered care.
  • Prevent inconsistent and flawed alerts on Nursing Home Compare.
  • Advocate for fair, sufficient, and prompt payment to nursing homes.
  • Ensure that state Medicaid rates paid to nursing homes are sufficient to cover the costs of care.
  • Eliminate barriers to staff training, recruitment, and retention.

The Issue

Nursing homes are an essential element of the long-term services and supports system. They provide treatment and care in a safe, home-like environment that supports older adults to maintain high quality of life when aging in the community is no longer an option. But nursing homes are at risk due to inadequate reimbursement, burdensome regulation that does not promote quality care, and a general misconception by the public and policy-makers about the realities of nursing homes.

Advocacy Action 2020

116th Congress

  • NASEM Study: We support a study by the National Academies of Sciences, Engineering, and Medicine to evaluate the current long term care survey process, the link to care outcomes, and alternative strategies to assure quality nursing home care.
  • IMAGINE Proposal: We propose the creation of an aging-forward immigration system that would engage foreign-born workers to address the workforce crisis faced by many nursing homes and aging services providers.
  • CNA Training Programs within SNFs: We support Nursing Home Workforce Quality Act (H.R. 4468) and Ensuring Seniors’ Access to Quality Care Act (S. 2993) that would allow reinstatement of a nurse aide training program once a nursing home has been determined by CMS to be in substantial compliance.
  • Observation Stays: We support the Improving Access to Medicare Coverage Act (H.R. 1682; S. 753) that would mandate that all time spent in a hospital, regardless of admission status, would count toward the 3-day qualifying stay required for SNF services under the Medicare benefit.
  • Value-Based Payment: We support the Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 (H.R. 3417) that would authorize the development of additional quality measures for the SNF Value-Based Purchasing (VBP) program.
  • Telehealth: We support the reintroduction of the RUSH Act to improve access to telehealth services in nursing homes.
  • Medical Expenses: We support the Medical Expense Savings Act (S. 110; H.R. 2073) that makes permanent the reduction in the adjusted gross income threshold that must be exceeded before a taxpayer can claim an itemized tax deduction for medical expenses.
  • Elder Justice Reauthorization: We support reauthorization of the Elder Justice Act that identifies and addresses elder abuse and neglect where it happens, not disproportionately targeting nursing homes.
  • Mandatory Staffing: We oppose H.R. 5216 and S. 2943 that would impose on nursing homes mandatory staffing requirements that have not been supported by empirical data and do not address the workforce shortage crisis.

Executive Branch

  • Requirements of Participation (RoPs): We provide feedback to CMS to ensure that regulations and interpretive guidance are clear and evidence-based.
  • Survey and Certification: We call on CMS to improve consistency and accuracy in the survey and certification process. We propose alternatives focused on a collaborative approach to quality improvement and utilization of enforcement remedies that reflect a just culture.
  • Quality Measures: We promote activities to establish quality measures that are evidence-based and accurately reflect quality care.
  • Nursing Home Compare: We advocate with CMS for the removal of the Consumer Alert Icon and the prevention of future alerts and icons that are not clear representations of nursing home quality information.
  • Patient-Driven Payment Model (PDPM): We provide feedback to CMS on members’ experiences to promote the successful implementation of PDPM.
  • Alternative Payment Models: We engage in activities geared toward the development of alternative payment models, such as the Unified Post-Acute Care Prospective Payment System Technical Expert Panel.

Actions You Can Take Now

  • Visit the Advocacy Action Center to let your representative and senators hear your voice on the issues facing nursing homes.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact nursing homes and the people who live and work in them.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support nursing homes and the care they provide for residents.

Additional Resources