Significant Improvements to Safety and Quality Care for Long-Term Care Residents

Last week, the Biden administration announced several nursing home reforms that will improve staffing and accountability at nursing homes throughout the country. Advocates are calling these the most significant reforms in decades.

As part of Biden’s plan, the Centers for Medicare and Medicaid Services (CMS) has updated a guidance on minimum health and safety standards that long-term care facilities must meet to participate in Medicare and Medicaid. The guidance specifically addresses nursing home staffing concerns.

“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “CMS is proud to be leading President Biden’s initiative to improve the safety and quality of care in the nation’s nursing homes, and this set of improvements is our next step toward that goal.”

Proposals Called the “Most Significant Reforms in Nursing Homes in Decades”

The Consumer Voice, an advocacy group for long-term care issues, says these are the “most significant reforms in nursing homes in decades.” The nonprofit John A. Hartford Foundation refers to the plan as “a major step forward for quality and safety in our nation’s nursing homes.”

Highlights of the Updated Guidance

Below are some of the highlights of Biden’s plan and the updated guidance.

Infection Control Is of Utmost Importance

Long-term care facilities were hit hard with COVID-19 infections. According to the Government Accountability Office (GAO), most nursing homes experienced multiple COVID-19 outbreaks and those outbreaks typically lasted several weeks to months. The updated guidance provides more information on the role of infection preventionists (IPs) in long-term care facilities. The agency is requiring each facility to have someone (an IP) on staff who can oversee infection prevention and control programs to help mitigate the start and spread of infectious diseases, such as COVID-19.

Overcrowding Needs to Stop to Prevent Infections from Spreading and to Ensure Privacy

The updated guidance aims to reduce nursing home overcrowding by encouraging facilities to find more ways to have single occupancy rooms for residents, or at least allow for a maximum of double occupancy per room. In the latest announcement, CMS “has highlighted the benefits of reducing the number of residents in each room for preventing infections and the importance of residents’ rights to privacy and homelike environment.”

CMS will explore ways to phase out multi-occupancy rooms and promote single-occupancy rooms.

More Staffing Is Needed

Studies have revealed that nursing home staffing levels are often inadequate and inaccurately reported

Currently there are no minimum staffing levels for nurse’s aides, who provide most of the day-to-day care. Instead, nursing homes are required “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident.”

CMS will study the level and type of staffing needed to ensure safe and quality care and propose minimum staffing levels within a year. CMS will also add data on staff turnover rates and weekend staffing levels to its Care Compare website, giving consumers another tool when choosing a nursing home.

Poorly Performing Nursing Homes Will Be Held Accountable

Poorly performing nursing homes will be held accountable for improper and unsafe care and immediately improve their services or they will be cut off from taxpayer dollars. CMS will explore making per-day penalties the default penalty.

Transparency Will Be Increased

In an effort to increase transparency of nursing home ownership, CMS will create a database to track nursing home owners and operators across states. In addition, the government will investigate the role private equity firms play in buying and selling nursing homes.

The public will have better information about nursing home conditions so that they can find the best available options.

“Much of Biden’s plan promises to dig deeper into the finances of homes and make that information publicly available. “It’s just been so complicated,” said David Grabowski, a professor of health care policy at Harvard Medical School. “They’re going to finally determine who owns this building, what the arrangements are there, how the dollars really flow. That’s essential. We should have done this years ago.”

The updates described are just one piece of CMS’s ongoing effort to implement President Biden’s vision to protect seniors by improving the safety and quality of our nation’s nursing homes, as outlined in a fact sheet released prior to his first State of the Union Address in March 2022.

Are You Looking for the Right Nursing Home for a Loved One?

Hopefully the changes described above will help improve nursing home staffing, care, and infection control. If you are currently looking for a nursing home for a loved one, as you navigate your search, be sure to check the Care Compare website, visit the facility, and assess the quality of care provided by each nursing home using my Nursing Home Evaluation Tool.

My 2012 best-selling book, the Nursing Home Survival Guide, is also an extremely helpful tool. Please note that it is currently in the process of being updated to a second edition, which will be published later this year.

By remaining observant, asking lots of questions, and keeping your loved one the focal point of the conversation, you can find a comfortable and caring space in which they can age safely.

Paying for Nursing Home

Nursing homes are catastrophically expensive, ranging from $10,000- $14,000 a month in the greater DC Metro Area. When it comes to paying for nursing home care, Medicaid Asset Protection Planning can be started while your loved one is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your loved one is already in a nursing home or receiving other long-term care.

To afford the astronomical costs of long-term care without depleting all of your loved one’s hard-earned assets, you should begin Long-Term Care Planning as soon as possible. You should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Contact the Farr Law Firm today to make an appointment for an initial consultation:

Elder Care Fairfax: 703-691-1888
Elder Care Fredericksburg: 540-479-1435
Elder Care Rockville: 301-519-8041
Elder Care DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.