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Opinion/Editorial: Nursing homes are scrutinized for reform

Opinion/Editorial: Nursing homes are scrutinized for reform

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When last we looked at the issue of long-term care (on March 28), it was in reference to a survey showing that, alarmingly, a substantial percentage of employees were reluctant to be vaccinated against COVID.

That puts residents and patients at risk.

Today, the topic is a reform movement aimed at improving the lot of residents and perhaps employees as well.

The national push comes from the American Health Care Association and LeadingAge, an organization of nonprofit providers of long-term care.

The General Assembly already has asked its Joint Commission on Health Care to study workforce needs in nursing facilities.

As reported by the Richmond Times-Dispatch, the reform movement is aimed at strengthening standards for nursing homes, particularly those receiving Medicare and Medicaid reimbursements, and tying funding to performance.

A component would be workforce improvement, which potentially could mean better conditions for employees.

“The next round, if we’re going to put money into the nursing home system, it needs to be with ... the teeth of accountability tied to staffing,” Del. Vivian Watts, D-Fairfax, told the newspaper. She has tried without success (so far) to get the state to set minimum standards for direct-care staffing in nursing homes.

Higher staffing levels would improve patient care, but also should make shifts easier for workers. The reform proposal includes a call for state and federal governments, along with the long-term care industry, to make a concerted effort to attract and train more staff. It also would require that a registered nurse be on duty at all times, and that nursing homes maintain a long-term supply of personal protective equipment.

Another component of the reform movement calls for nursing homes to be modernized, moving in the direction of single rooms for patients instead of shared rooms — in part to provide patients with more privacy and dignity.

Improving standards for nursing homes would have a spillover effect, proponents believe, resulting in better performance by other long-term care facilities as well, although they are regulated somewhat differently in Virginia than are nursing homes. Other types of facilities would especially benefit from a staffing push, since all such facilities are affected by a statewide staffing shortage.

Finally, there would need to be stronger forms of accountability, proponents say, to make sure nursing homes are meeting the new standards.

Many of the proposed reforms would directly benefit patients — and employees — in the event of another fast-moving infection such as COVID-19. Having adequate protective equipment for staff would be key, along with having medical assistance — in the form of a nurse — available 24/7. Even the shift to single rooms could curtail the spread of infection.

If all this sounds expensive — you’re right. Adding more patient rooms, adding more staff, adding more equipment could be difficult for nursing homes primarily reliant on low-cost Medicare and Medicaid funding.

Funding would almost certainly require boosts in reimbursement levels — which in turn would mean more money from state and federal governments. That could mean higher taxes for residents or reductions in other services; after all, the money has to come from somewhere — and the “somewhere” is ultimately the taxpayer.

The state study currently underway must look at such issues to arrive at a fair balance between the reform movement’s aspirations and its affordability.

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