Nursing homes are facing unprecedented challenges, due to the realities of the modern economy and the surge in airborne diseases. While politicians on both sides of the aisle scramble to find solutions that keep patients healthy and safe, Seema Verma, the former administrator of the Centers for Medicare and Medicaid, feels pessimistic about many of the latest proposed regulations.
Currently, nearly 1.2 million senior citizens reside in long-term care facilities across the nation. As some of the most vulnerable members of the American family, these residents are at increased risk of contracting diseases and are often unable to effectively advocate for their own care, Verma noted.
New proposed federal regulations are seeking to aid seniors in nursing homes by mandating staffing requirements and discouraging private equity firms from owning and operating long-term care facilities. Both options, though well meaning, are policy mistakes that will lead to decreased quality of care for seniors, while raising operating costs for facilities, according to Verma.
On Sept. 1, the Biden administration put forth a proposal that would require long-term care facilities that receive money from Medicare and Medicaid to adhere to strict staffing requirements.
The proposed regulations mark a sea of change in the federal government’s relationship to nursing homes. They would create the first period in the nation’s history in which long-term care facilities had to adhere to minimum staffing standards. Specifically, the regulations would require all long-term care facilities to have one registered nurse on site at all times and employ enough registered nurses and nurse aides to ensure that each resident receives three hours of personal care per day, no matter their circumstances.
The Centers for Medicare and Medicaid Services estimates the proposed requirements would result in three-quarters of long-term care facilities needing to hire more workers. The need for more staffing would come at a moment in which nursing salaries have jumped dramatically, in response to inflation and a shortage of care providers, according to Seema Verma.
Writing in a recent Op-Ed piece published in the journal Modern Healthcare, she took issue with the nationwide mandates.
“A one-size-fits-all staffing ratio concocted by federal bureaucrats won’t consider differences in a patient’s acuity or local factors, but it will thwart innovation in operational and technological advances that can improve care with existing workforce numbers,” she wrote.
A Better Way
Instead of mandating a nationwide staffing requirement, Verma advocates for a state-by-state solution that would allow governments closer to individual facilities to set staffing rules.
New staffing rules would be both expensive and unhelpful, she added. While the Bureau of Labor Statistics estimates the long-term care industry has lost 238,000 workers since early 2020, mandated extra staffing will not improve care.
The new requirements could lead to a higher decrease in care. The accountancy firm CliftonLarsonAllen (CLA) found that staff nurses at long-term care facilities saw an hourly wages growth of 14.7 percent in 2022 while those under short-term contracts saw a 10.2 percent bump in pay for the same year.
“Current regulations, though well-intentioned, do not consider new technological advancements via telehealth, nor do they meet the clinical needs of patients,” she wrote. “Simultaneously, they create an administrative and operational burden on the many under-funded and under-resourced facilities, which often cannot be met. Moreover, the regulations do not reflect the reality of our accelerating gap in the clinician workforce.”
In an Oct. 19 Op-Ed column published with Dr. David Chess of Tapestry Health in McKnight’s Long-Term Care News, Verma argued that nursing homes should be free to use modern technology to supplement on-site career, instead of insisting on in-person staff members as mandated under the proposed federal staffing rules.
Telehealth services, which connect facilities to remote care providers, allow nursing homes to provide high levels of care without compromising their budgets by doling out extra money for unnecessary staffers.
“Telemedicine–defined as bidirectional video, a digital stethoscope allowing the clinician to listen to the patient’s heart and lungs, an otoscope and a wound care camera–can provide care on-demand and reduce hospital admissions,” Verma wrote. “Telemedicine equipment is inexpensive to implement and nearly universally available, with high-speed internet accessible even in most rural locations.”
A Place for Privatization
In addition to staffing requirements, the proposed regulations echo many of President Joe Biden’s negative remarks towards nursing homes owned by private equity investors. Some of the new rules specifically target nursing homes owned by private entities, which the White House has claimed slash staff levels and offer worse care in order to turn a greater profit.
Verma takes exception to many of these claims. Citing a study published in the Journal of the American Medical Association that found facilities owned by private equity firms had similar staffing levels and patient outcomes during the Covid-19 pandemic, she argued that different ownership structures allow for greater innovation in care and treatment.
“The president is using the nursing home crisis to unleash federal investigators on facilities owned by private equity investors who help fund groundbreaking innovation across the healthcare industry,” she wrote in her Modern Healthcare Op-Ed. “Their investments may one day lead to improving the quality of care in nursing homes.”
A Focus on Outcomes
Calling upon her expertise and experience in the healthcare industry, Verma provided her own solutions for improving long-term care facilities.
Nursing home residents and their families would be better served by regulations that focus on patient health outcomes, instead of implementing complicated processes and expensive rules, according to Verma.
“There is broad agreement that many of America’s nursing homes must make significant improvements to deliver the care that patients deserve,” she wrote in Modern Healthcare. “A modern, results-oriented approach that focuses on outcomes has a better chance of improving quality than the president’s outdated policy prescriptions.”
-McKnight’s Long-Term Care News Op-Ed (Oct. 22)
-Modern Healthcare Op-Ed (March 2022)
-Skilled Nursing News article (March 2022)