The Build Back Better Act, currently pending in the U.S. Senate, includes provisions that could significantly increase the quality of care and safety of nursing home residents. But we are at a crossroads. The devastation inflicted by the coronavirus pandemic in our nation’s nursing homes is dangerously close to being forgotten or, at the very least, diminished in our collective memory.
COVID-19’s impact on nursing homes was severe and pervasive. Nationwide, more than 140,000 nursing home residents and staff lost their lives, another 1.4 million were infected, and serious, long-standing problems in nursing homes were exposed and exacerbated. In Connecticut, COVID-related deaths in long-term care facilities account for 53% of the state’s total COVID death toll. While the statistics themselves are staggering, behind each number is a human being – a parent, grandparent, spouse, sibling, or friend – with a life history and loved ones. These individuals are frail in many ways and powerless against decisions made based on spreadsheets and financial bottom lines. The best chance to protect nursing home residents is through Congressional action. The opportunity to do just that is in front of us now.
The Build Back Better Act is a chance for Congress to prioritize the health and well-being of vulnerable people living in nursing homes and the people who provide their care. Five interrelated provisions that address nursing home issues holistically are included in the bill. These provisions would make significant positive changes in the care that residents receive and would require:
1. Staffing studies to determine a recommended minimum level of staffing hours for nursing homes and the commitment to implement those recommendations;
2. Services by a professional registered nurse 24 hours per day, seven days a week in every nursing home;
3. Auditing of Medicare cost reports submitted by nursing homes to increase accuracy;
4. Improving the reliability of nursing facility data collection; and
5. Improving survey and enforcement practices.
As we’ve learned during COVID-19, the issues affecting nursing homes were varied and interconnected. The solutions must look the same. Though different in nature, these five provisions relate to and affect one another. We need all five, passed in their entirety and fully funded.
There is significant pushback from elements of the nursing home industry – especially about the provisions around staffing and requiring registered nurse coverage 24 hours a day. This pushback persists despite studies, like this one for Connecticut, showing a clear line between increased registered nurse staffing and a reduction in COVID-19 cases and deaths.
The opposition often sounds like this: We can’t get enough staff hired now, how can you expect us to get more? The answer is also in the Build Back Better Act, which includes funding that would go directly to long-term care facilities to help with staff recruitment and training. This bill is a good first step toward better care, providing a strong foundation for change, while also offering funding to help resolve many of the nursing home industry’s concerns.
While it may seem like the wrath of COVID-19 is nearly in the rearview mirror, the reality is it still lurks. Nursing home residents are still the most vulnerable. For example, Kaiser Family Foundation analysis shows that nursing homes felt the impact of the Delta variant surge more severely than the rest of the country in terms of COVID-19 cases and deaths. The urgency persists.
It’s time to do what is right to help protect older Americans and people with disabilities who live in our nation’s nursing homes. That means passing all five nursing home provisions in the Build Back Better Act.
Judith A. Stein is Executive Director of the Center for Medicare Advocacy. Mairead Painter is the Connecticut State Long Term Ombudsman in the Department of Aging and Disability Services.