The American Health Care Association and LeadingAge, the two national nursing home trade associations, have jointly proposed a legislative agenda for 2021, which they call “Care for Our Seniors Act: Improving America’s Nursing Homes By Learning From Tragedy & Implementing Bold Solutions For The Future.” Unfortunately, the agenda seems all too familiar – seeking more public funding and less public oversight.
The joint document begins with a discussion of “How Did This Happen?,” identifying four factors that led to the enormous toll of coronavirus cases and deaths in nursing facilities. All four factors shift blame away from nursing facilities:
- Demographic data document that “frail and elderly adults with underlying health conditions” were at particular risk.
- Early public health directives focused on a symptoms-based approach and did not recognize asymptomatic and pre-symptomatic spread of the virus. Changing guidance and conflicting guidance from different levels of government created challenges for facilities.
- “Independent research” showed “that COVID-19 outbreaks in nursing homes are principally driven by the amount of spread in the surrounding community. Even the best nursing homes with the most rigorous infection control practices could not stop this highly contagious, invisible enemy.”
- Long term care facilities were not made “a priority for necessary resources,” despite provider requests for help. “The LTC community was left behind, forgotten, or even blamed.”
The statement calls out “crucial mistakes . . . made by public health officials,” but the only acknowledgment of providers’ “role and responsibilities in this response” is self-serving, highlighting staff’s unwittingly bringing in COVID-19 from the community and facilities’ conserving personal protective equipment.
The trade associations identified four Nursing Home Reform Principles (Clinical, Workforce, Oversight, Structural), but did not support these principles with meaningful proposals, except for the excellent inclusion of 24-hour registered nurse staffing in the Clinical Principle.
The Workforce Principle, for example, calls for loan forgiveness, tax credits for licensed LTC professionals, “programs for affordable housing and childcare assistance,” and “increased subsidies to professionals’ schools whose graduates work in nursing homes for at least five years.” The Principle does not include the living wage recommendation in LeadingAge’s own September 2020 report, Making Care Work Pay: How Paying at Least a Living Wage to Direct Care Workers Could Benefit Care Recipients, Workers, and Communities.
The Oversight Principle calls for changing the “punitive” survey system, turning around or closing chronically poor performers, and adding “customer satisfaction” to the government’s five-star rating system.
Ultimately, the legislative agenda asks for additional Medicaid money.
At least 172,000 nursing home residents and staff members have died of coronavirus, accounting for 34% of all COVID-19 deaths in the United States. Many cases and deaths could have been prevented with better nurse staffing levels, better infection control practices, and better enforcement of federal standards of care, among other factors.
The nursing home industry’s “bold” agenda fails to address these disturbing facts and should be dismissed.
 Care for Our Seniors Act is available at https://www.ahcancal.org/Advocacy/Documents/Care%
 https://leadingage.org/sites/default/files/Making%20Care%20Work%20Pay%20Report.pdf. The report is discussed in “Paying Direct Care Workers a Living Wage” (CMA Alert, Oct. 15, 2020), https://medicareadvocacy.org/paying-direct-care-workers-a-living-wage/
 “More Than One-Third of U.S. Coronavirus Deaths Are Linked to Nursing Homes,” The New York Times (updated Feb. 26, 2021), https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html
 Cinnamon St. John, “Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic” (Feb. 2021), https://medicareadvocacy.org/wp-content/uploads/2021/02/CMA-NH-Report-Geography-is-Not-Destiny.pdf