The American Health Care Association and LeadingAge Monday released a $15 billion reform agenda, the Care for Our Seniors Act, to address long-standing challenges affecting the quality of care provided in America’s nursing homes. 

The joint proposal offers a “bold approach” to improving care in facilities, with the hope being that the effects of a future pandemic on the long-term care industry would be greatly minimized, said Mark Parkinson, AHCA’s president and CEO.

“Over the last year, the COVID-19 pandemic has been by far the greatest tragedy in the history of the skilled nursing profession,” he said. Although reiterating that no one is to blame for the devastating effects of the virus, he noted that chronic state Medicaid underfunding resulted in a very fragile financial structure for providers even pre-pandemic, and COVID only has exacerbated that fragility.

The proposal prioritized four principles designed to support better pandemic management, help prevent such devastation from happening again and strengthen nursing home care: 

  • Workforce principles, including loan forgiveness for new graduates who work in long-term care, tax credits for licensed long-term care professionals, programs for affordable housing and childcare assistance;
  • Structural principles, including the provision of data on private room conversion costs and a recommended approach to make this shift;
  • Oversight principles, including resident survey improvements and new processes to help turn poor-performing facilities around; and
  • Clinical principles, including updated guidelines for staffing infection preventionists and a new federal requirement that each nursing home have a registered nurse on-staff 24 hours a day.

The proposal will cost approximately $15 billion annually to implement, including $11 billion for the clinical improvements and another $4 billion to address the long-term state Medicaid underfunding, Parkinson estimated. The funding mechanism for the proposal, he added, would be through Enhanced Federal Medical Assistance Percentages (EFMAP), in which increased federal Medicaid funds are provided to states to pay for the mandatory nursing facility benefit, with requirements that additional federal funds be used for nursing facility rates.

“Unlike what has happened in some states in the past, they couldn’t siphon off the funds they receive to other projects,” Parkinson said. “Instead, states would be required to pay most providers their allowable cost to a break-even point. In addition, providers would then be required to spend those funds on the clinical suggestions we’ve made in the proposal.”

The steps the proposal suggests to help close the Medicaid funding gap, LeadingAge President and CEO Katie Smith Sloan said, are the only way for the industry to achieve its goal of ensuring that those who need nursing home care have access to the highest quality of care.

“The clarity provided by the tragedy of COVID has created the most important moment in a generation to seek fundamental nursing home reform,” she said. “Change won’t happen overnight but we must ensure that policymakers deliver the resources needed as transformation of our nursing homes begins.”