The COVID-19 pandemic has exposed the country’s long-term care system, particularly in skilled nursing facilities, as “deeply flawed, chronically underfunded and in need of reform,” according to the co-founder and former CEO of the National Investment Center for Seniors Housing & Care, Robert Kramer, now CEO of Nexus Insights.

Yet amid the current scrutiny of Congress and state policymakers, the skilled nursing industry has entered a “historic moment” ripe for pushing needed reform to improve outcomes and quality of life for nursing home residents and the frontline workers who care for them.

Kramer shared his insights on the multifaceted solutions the skilled nursing industry must pursue in a commentary published Tuesday in Health Affairs. In particular, Kramer pointed to the need to incentivize nursing homes to deliver person-centered, whole-person care and to keep residents out of the hospital. 

“We must also stop subsidizing shortfalls on the care of Medicaid residents with the profit margins on short-stay Medicare residents,” he wrote. “Reimbursement currently drives what type of care is delivered, and in what setting. We have a siloed and uncoordinated maze as a result.”

To meet the challenges the industry faces today, Kramer suggested that policymakers tie increased funding to improved wages, benefits and training for frontline staff and address gaps in infection prevention and registered nurse coverage. He noted, however, that this investment must be paired with meaningful transparency and accountability across providers’ ownership structures and finances.

Kramer also suggested coupling this transparency with some sort of legal immunity for operators to avoid “frivolous lawsuits seeking settlements mandated by insurers regardless of the merits of claims.” Applying creative incentives such as buyback programs, to help the industry close functionally obsolete buildings and convert multiple occupancy rooms to single occupancy also is critical, he said, as is the use of regulation and funding to promote household or neighborhood models that use consistent staffing and even universal staffing.

Most importantly, however, industry stakeholders must work together to enact true reform, Kramer concluded.

“Skilled nursing facilities and long-term care are, for a moment, center stage,” he said. “Those of us who care about this sector, and the millions of Americans it serves, must seize this moment. We’ve got to be bold, and perhaps the boldest step is to work together, even with those we consider to be adversaries, whether that’s industry providers, organized labor, consumer advocates, investors, or regulators.”