Nursing home care, funding system needs overhaul, says report

Nursing home care, funding system needs overhaul, says report

NEW YORK ( Associated Press) — Nursing home residents are subjected to ineffective care and poor staffing, while facility finances are shrouded in secrecy and regulatory loopholes are not enforced, according to a Wednesday report, an industry wholesale Change has been called for whose failures have been spotlighted by the pandemic.

For anyone watching the scourge of COVID-19 on the nation’s most vulnerable, the findings from the National Academies of Science, Engineering and Medicine may seem grim but surprising, as the inadequacies of the long-term care system were made clear by more than 150,000 Was. resident deaths, Author of a 605-page report Insisted that this may be an incentive to address issues that have received little more than lip service for decades.

“The public is so concerned about the quality of care that most people are actually afraid to stay in their family’s nursing home,” said nurse Betty Farrell, who chaired the report committee. “We are very hopeful that our government officials will respond to someone who has actually been a traitor.”

The report covers a vast cross-section of long-term care, such as the way in which facilities are designed for fundamental issues that would require massive political capital and investment. Among them: The authors advocate for creating a new national long-term care system that would exist outside of Medicaid, the program at the heart of most long-term care funding.

The chances of such a proposal successfully finding its way through Congress are slim in the current political climate. The most recent federal effort to reform long-term care financing was a voluntary long-term care insurance program known as the CLASS Act. It was included in the Affordable Care Act, but was later repealed when the Obama administration found it impractical.

“As a country we have long wanted to dig in and improve how we finance, pay, regulate and deliver nursing home services,” said David Grabowski, a nursing home specialist and professor at Harvard Medical School. Report Committee.

Katie Smith Sloan, who leads LeadingEdge, which represents the nonprofit nursing home, called the report “a piercing wake-up call” about an industry “in dire need of an overhaul”. The success of rebuilding the system, Smith Sloan said, will depend on how the government addresses funding.

“As policymakers consider how to implement the report’s recommendations, they should support their actions with sufficient funding to make change a reality,” she said. “Without this, the work of the committee would be for naught.”

On the issue of nursing home staffing, what advocates have repeatedly said is too littleToo untrained and too underpaid, the report’s authors also called for facilities to have at least one registered nurse on duty at all times and an infection prevention and control specialist and social worker on staff.

Broadly speaking, across all staffing in homes, including nurse aides, who make up the bulk of front-line caregivers, the authors called for additional studies on optimal staffing.

Industry lobbyists have fought fiercely against more stringent staffing requirements. Federal law only requires nursing homes to have enough staff to meet the needs of residents, but almost all interpretation of what that means is left to the states. President Joe Biden, The U.S., too, has called for establishing a national staffing minimum.

Among the more regular themes in the report, but nonetheless affecting the everyday lives of residents, the authors call on households to prefer private rooms and bathrooms rather than communal ones that can promote infection and disrupt institutional settings. can underline. And in a blunt reminder of how bleak life can be in nursing homes, the report says most residents spend “less if any time” outside, calling for facilities to make outside access more accessible. We do.

The proposals, Grabowski said, have the potential to improve the lives of residents who are meeting their basic medical needs yet are often lacking in other areas of their lives.,

“I think the average nursing home resident has an okay quality of care but a poor quality of life,” Grabowski said.

Advocates for nursing home residents have long called for attention to the homes’ shortcomings, and the pandemic has brought them into the media spotlight. But decades of inaction by politicians and resistance by industry are hard to overcome, and what sparks the report might spark remains unclear.

The precursor to the study, the 1986 “Improving the Quality of Care in Nursing Homes,” was also a product of the National Academies. Some of the issues in that report were taken up in the Comprehensive Nursing Home Reform Act of 1987, which created the regulatory framework that is in place today. The others remain unaffected even after 36 years.


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