LETTERS TO THE EDITOR

Help facilities help themselves

Posted

EDITOR’S NOTE: The following are excerpts of a letter sent to U.S. Department of Health and Human Services Secretary Xavier Becerra.

On behalf of the American Health Care Association and the National Center for Assisted Living’s more than 14,000 long term-care member providers — including more than 10,000 nursing homes — I want to thank you for your continued leadership, especially during the COVID-19 pandemic. We appreciate your administration’s focus on improving the quality of care provided in America’s nursing homes or skilled nursing facilities. It has been our primary focus, and the support and collaboration of the administration can propel our work even further.

To facilitate the need for collaborative progress, AHCA/NCAL would like to officially request meetings with President Biden, Centers for Medicare & Medicaid Services administrator Chiquita Brooks-LaSure, and you. It is crucial that you hear directly from dedicated nursing home operators and professionals about the quality efforts that are already taking place, the successes that skilled nursing facilities have achieved, and our bold plans for the future.

It is also important that providers share the critical challenges they face in recruiting and retaining health care workers and other critical personnel. We have lost hundreds of thousands of workers since the beginning of the pandemic, and it is not clear that we can get them back — let alone add minimum staffing standards —— without significant support from federal policymakers.

The skilled nursing sector has made considerable progress in terms of quality improvement, and we have done so in partnership with CMS. The White House fact sheet and other comments made around the administration’s nursing home reform plan implied that quality in nursing homes has declined. That is simply factually incorrect. Ten years ago, our association worked with CMS administrator Donald Berwick and developed the “quality initiative.” We agreed to focus on specific quality measures that would have a meaningful impact on the lives of residents, and make a national, collective effort to improve. We set specific goals with concrete timelines to achieve them.

It worked. Pre-pandemic, skilled nursing facilities improved in 16 of the 20 CMS quality measures, including some of the most important ones.

It is rare to find people who want to — and are willing to — take care of our frail, elderly residents. And yet more than 1 million nursing home caregivers risked their lives, their families’ lives, and worked night and day during the pandemic to serve our nation’s most vulnerable.

They didn’t do it for the pathetic pay that Medicaid allows. They did it because of a love for and commitment to the residents. Blanket statements about declining care are not only factually incorrect, they are insensitive to the heroic sacrifices these men and women have made.

We are particularly shocked by statements regarding the COVID-19 pandemic, placing blame on nursing home caregivers and criticizing the care provided. There were a series of horrible public health policy decisions that left skilled nursing facility providers without testing, personal protective equipment, staffing support, and at times, COVID-19 treatments. Ultimately, long-term care was not prioritized by public health officials, even though COVID-19 uniquely targeted our residents, and the results were tragic.

Dedicated nursing home caregivers should not be blamed for the adverse effects of the pandemic, but celebrated for the additional one-on-one care and comfort they provided to residents during this unprecedented time.

Secondly, we hope to discuss the long-term care workforce crisis and the administration’s proposal for adding minimum staffing requirements.

We want to hire more caregivers, but there are no workers to hire. Nursing homes have lost 238,000 workers since the beginning of the pandemic.

Virtually every nursing home in the country is short-staffed and increasingly having to rely on expensive temporary staffing agencies — if it can find an agency.

Even if the caregivers were there, the resources needed to invest in them are not. More than 60 percent of our residents rely on Medicaid, but the program does not adequately fund the actual cost of care.

Increasing staffing minimums in the midst of this workforce crisis without corresponding resources does little to help residents, and would result in nearly every nursing home being out of compliance.

Facilities — especially in rural communities — would be forced to further limit access to care for residents in order to meet arbitrary staffing ratios, or close altogether.

We recognize the need to hire more caregivers and offer more private rooms, among other ongoing improvements, but we must also recognize that the government funding to bring forth these improvements is not currently there.

Policymakers and providers need to work together to prioritize where we can make the biggest difference in the lives of residents in a cost-effective manner.

We must work together to invest in our long-term care residents and staff members, incentivize ongoing improvements, and prepare for a growing elderly population.

Our frontline caregivers have been heroic. They have made great sacrifices. We look forward to working with you to improve nursing home care, but we need real support and meaningful solutions.

Mark Parkinson

The author is president and chief executive of the American Health Care Association and the National Center for Assisted Living

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Mark Parkinson,

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