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Nursing homes and Covid-19 – defensiveness persists 

Nursing homes – consternation, condemnation are words that rule the day. Rant on. It must be tough to be focal points for nursing home policy these days. Even as a task force is being set up to focus on nursing homes, on the one hand, that seems positive. On the other hand, Leading Age CEO was 'enraged' about shortages of PPE.  And seniors (AARP) who are most likely NOT in nursing homes, demand that workers have adequate PPE, that the public be notified which nursing homes have cases of Covid-19, workers are striking at nursing homes, and so on. Go back to 2019, for just a moment. What were the top issues early in the year?  "Challenges facing nursing homes serving primarily long-stay residents covered by Medicaid; workforce challenges, which are unlikely to dissipate; nursing home regulations; and the growing popularity of Medicare Advantage."

Times change – staffing turnover and low pay have been issues forever.  It used to be that CNA (certified nursing assistant) pay at an average of $12.52/hour was as low as that of Walmart workers. Scratch that. Walmart workers, say the company, average $14.26/hour in 2019.  Whatever. The CNA job is in a different league of difficulty from the Walmart job. The staffing requirements (minimum guidelines from the federal government, interpreted by states) and actual staffing in nursing homes, given the level of care required, have been issues long before the emergence of Covid-19.   

Can a commission open up its lens to view overall care? It could be a good thing that CMS has announced formation of a commission to address 'Safety and Quality in Nursing Homes.' Consider, for example, what nurses describe as the safety issues of their jobs. It would be great if they looked at the broader picture – not just Covid-19, but include the care ratios and oversight processes. Also, who will validate compliance with whatever the commission recommended? Will that be a new organization – and who will be in it? It would be great if the response of association lobbyists like LeadingAge and AHCA/NCAL would broaden their near-term advocacy to focus on the long-standing issues of staffing and worker turnover.  Perhaps even taking a close look at a recent disaster – what can it mean for families and residents when most of the staff calls in sick and residents need to be moved elsewhere?

What role can technology play in new initiatives? Measurement of progress should be key – and not just squirreled away in out-of-date, potentially irrelevant inspection reports.  A new tracking system should accompany implementation of commission recommendations – looking at a few resident safety metrics prior to implementing commission guidelines.  [Note the item already in the current reporting process: "Have a program that investigates, controls and keeps infection from spreading."] Then add in the guideline assessment elements – hopefully these staff-to-resident ratios. Note what the status was in each nursing home of those elements, the date, and comparison to prior period. Hopefully the big changes will be improvements in staffing/pay/retention to match the expectations of the commission. Ultimately, the real transformation could be the analytics (who would look at this data?) about performance over time, by state, county, nursing home, and placing the results onto maps for viewing by anyone interested.  Pipe dream?  Rant off.



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