For the second time in two weeks, American Health Care Association (AHCA) President and CEO Mark Parkinson has asked President Joe Biden to abandon the cornerstone of his 2022 nursing home reform agenda – establishing a minimum nurse staffing requirement for nursing facilities in order to ensure that “every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care” – and to substitute the trade association’s four policy proposals. Only one of the four topics – building the nursing home workforce – has merit, although AHCA’s specific proposals largely do not.
Publicly report customer satisfaction: AHCA asks the President to add a customer satisfaction measure to the federal website Care Compare. The CoreQ short-stay discharge measure, developed by AHCA, is a public relations measure already used by many facilities. CoreQ calls on facility staff to identify residents who have been discharged to home or assisted living (excluding residents who left for a different nursing facility or for hospice or who left against medical advice, and others who might have had a negative experience) and asks them to complete a four-question written form. The leading questions are meaningless and without context, as illustrated by the question “How would you rate the care you received?” How will a resident who returned home evaluate the quality of the discharge plan, another question, if the resident does not know what a discharge plan requires? CoreQ allows facilities to choose which discharged residents will receive the survey and its scoring methodology overstates positive responses. AHCA does not purport to explain how its customer satisfaction tool would improve nursing home quality.
Improve the Special Focus Facility (SFF) Program. The SFF Program identifies 66 of the worst performing facilities in the country that were cited with multiple serious deficiencies over a several year period and requires that they receive an additional standard survey each year. The Program does not address the additional 400+ nursing facilities that qualify for the SFF program, but are not included due to budget limitations. Not only has the Program not achieved its goal of improving quality of care in these facilities (here and here), but the President included the SFF Program in his reform agenda and has also already taken steps to strengthen it.
The Value-Based (VBP) Program: This program provides additional financial incentives – beyond Medicare and Medicaid payments for care – for facilities meeting certain goals. Not satisfied with current reimbursement, existing VBP bonuses, and hundreds of millions of dollars in COVID relief funds, AHCA proposes additional financial incentives – yet another bonus – for facilities meeting standards of care.
Building the Long Term Care Workforce: In addition to proposals already included in President Biden’s reform agenda (such as launching a national nursing home career pathways campaign), AHCA calls for financial assistance programs for its underpaid workforce – housing and childcare assistance. The federal government already subsidizes the nursing home industry with billions of dollars through needs-based assistance programs (Medicaid and food stamps, as well as housing and childcare assistance) because workers’ poverty-level wages are too low to support working families. AHCA’s workforce proposal also promotes immigration reform, which will not solve the country’s staffing crisis. Nowhere in workforce proposal does AHCA identify actions that facilities themselves must take to build the long-term care workforce: improving working conditions, paying living wages and benefits, and treating workers with respect. As LeadingAge reported in 2020 in Making care work pay, paying a living wage to workers would pay for itself and improve quality of care for residents.
Parkinson ends his letter to the President by describing the four proposals as “complementary” to Care For Our Seniors Act, which AHCA introduced in 2021 with LeadingAge. The trade associations’ far less combative legislative agenda includes many of the same proposals put forward in 2023 (for example, customer satisfaction), but also, among other recommendations, calls for 24-hour registered nurse coverage in all nursing facilities nationwide. The nursing home industry’s proposed 2021 legislative package shares recommendations in common with President Biden’s nursing home reform agenda (here).
AHCA needs to support the President’s reform agenda enthusiastically and to work collaboratively to ensure that nursing facilities are good places to live and work in.
July 27, 2023 – T. Edelman