Long-term care group pushes back on 'factually incorrect' quality claims in Biden's nursing home pitch

A top advocacy organization for skilled nursing facilities and other assisted living entities has taken issue with statements from the Biden administration characterizing a decline in nursing home quality and is now requesting a sit-down with the president and other federal health leaders to address rhetoric and policy proposals recently outlined by the administration.

Feb. 28, the White House released a breakdown of new nursing home quality and safety reforms spearheaded by the Department of Health and Human Services (HHS).

Among the improvement initiatives listed by the administration were the introduction of minimum nursing home staffing requirements, stronger quality performance incentives, more funding for facility inspections, improved transparency into facilities’ safety and finances, nurse training support and pandemic preparedness, among other efforts.

Of note, the White House introduced its reform plan by highlighting the over 200,000 long-term care residents and staff that have died from COVID-19 over the past two years.

“Despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm,” the administration wrote in its Feb. 28 fact sheet. “In fact, failure to comply with Federal guidelines at nursing homes is widespread. The Government Accountability Office found (PDF) that, from 2013 to 2017, 82% of all inspected nursing homes had an infection prevention and control deficiency, including a lack of regular hand-washing, that was identified through Medicare and Medicaid surveys.”

In a Tuesday letter to HHS Secretary Xavier Becerra, American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) President and CEO Mark Parkinson wrote that although the group’s long-term care provider membership appreciates the focus on improving care, the implication that nursing home quality has declined “is simply factually incorrect.”

He described a quality initiative launched over 10 years ago by AHCA/NCAL and the Obama-era Centers for Medicare & Medicaid Services (CMS) that, prior to the pandemic, yielded improvements in 16 of 20 quality measures, such as reducing the off-label use of antipsychotic medicines.

Parkinson said the organization was “particularly shocked by statements regarding the COVID-19 pandemic, placing blame on nursing home caregivers and criticizing the care provided.”

Rather, he wrote, the “tragic” infections and deaths among nursing homes were the outcome of “a series of horrible public health policy decisions” that did not prioritize long-term care and left facilities without testing, personal protective equipment, staffing support and treatments.

Federal direction to isolate residents in their rooms led to “predictable” declines in their conditions, he said, at the same time that rampant community spread—not poor infection control—ultimately introduced COVID-19 to residents and staff.

“What is concerning about the rhetoric surrounding last week’s announcement is that it demoralized an already beaten down sector,” Parkinson wrote. “More than one million nursing home caregivers risked their lives, their families’ lives, and worked night and day during the pandemic to serve our nation’s most vulnerable. They didn’t do it for the pathetic pay that Medicaid allows. They did it because of a love for and commitment to the residents.”

“Blanket statements about declining care are not only factually incorrect, they are insensitive to the heroic sacrifices these men and women have made,” he wrote.

As for the reform plan itself, Parkinson asked that the administration take a closer look at the workforce shortages spurred by over 200,000 workers lost since the beginning of the pandemic.

To implement several of the goals outlined by HHS, the industry would need substantially greater government funding.

“Increasing staffing minimums in the midst of this workforce crisis without corresponding resources does little to help residents and would result in nearly every nursing home being out of compliance,” Parkinson wrote. “Facilities, especially in rural communities, would be forced to further limit access to care for residents in order to meet arbitrary staffing ratios or close altogether.”

Parkinson requested a meeting with Becerra, CMS Administrator Chiquita Brooks-LaSure and Biden himself to discuss the announced reforms and to advocate for other policy changes outlined in the group’s Care For Our Seniors Act.

AHCA/NCAL represents over 14,000 nonprofit and proprietary long-term care providers across the nation, more than 10,000 of which are nursing homes, according to the letter.

Of note, Parkinson’s letter did not address the impact of private equity ownership on nursing home operations, which made up a substantial portion of last week’s policy pitch.

In the White House’s fact sheet, the administration pointed to ballooning private equity investment in these facilities from 2000 to 2018 as well as studies suggesting those in private equity nursing homes are more likely to experience preventable healthcare encounters, mortality and COVID-19 infection or death compared to other nursing homes.