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Biden vows to crack down on poorest-performing nursing homes

More than 200,000 residents and staff have died from covid since the start of the pandemic, data shows

A wastebasket with syringes and gloves after residents of a nursing home received vaccines. (Alvaro Barrientos/AP)
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The White House on Monday announced plans to boost nursing home staffing and oversight, blaming some of the 200,000-plus covid deaths of nursing home residents and staff during the pandemic on inadequate conditions.

Officials said the plan would set minimum staffing levels, reduce the use of shared rooms and crack down on the poorest-performing nursing homes to reduce the risk of residents contracting infectious diseases. The White House also said it planned to scrutinize the role of private equity firms, citing data that their ownership was linked with worse outcomes and higher costs.

The initiatives are among a broader package of domestic policies that President Biden plans to tout in his first State of the Union address Tuesday.

Nursing homes have been an epicenter of covid spread during the pandemic, as the virus initially tore through facilities before vaccines were available in 2020, and then continued to sicken and kill residents at an elevated rate last year. Advocates have demanded better policies to ensure the facilities are prepared for emergencies and follow practices to curb the spread of infections.

Under Biden’s plan, officials at the Centers for Medicare and Medicaid Services will propose minimum staffing levels within the next year, which the White House said would improve safety by ensuring residents receive sufficient care and attention. The administration also cited a study that found increased staffing levels were linked with fewer covid cases and deaths.

The nursing home industry has warned that the pandemic has exacerbated long-running staffing shortages, noting that roughly 420,000 employees in nursing homes and long-term care facilities, many of whom complained about low pay, have departed over the last two years.

Federal officials also will explore tactics to encourage nursing homes to shift to single-occupancy rooms and phase out rooms with three or more residents, which increase the likelihood an infectious-disease might spread, the White House said.

Meanwhile, Biden will call on Congress to provide almost $500 million — a 25 percent bump — for health and safety inspections in nursing homes. Thousands of the long-term care facilities went without such inspections in the first months of the pandemic, as inspectors ran short of personal protective equipment and some states prioritized remote visits.

The Biden administration also vows tougher scrutiny of nursing home facilities and investors with a track record of safety concerns, announcing an array of new oversight measures and financial sanctions. For instance, Biden will ask Congress to allow nursing homes to be penalized up to $1 million for certain areas of poor performance, up from $21,000 now.

“For too long, corporate owners and operators have not been held to account for poor nursing home performance,” the White House said in a fact sheet.

Federal officials also plan to create a database that would track and identify owners and operators across states to highlight their safety records.

“These are all great steps,” said David Grabowski, an expert in long-term care at Harvard Medical School who has called for improved oversight of the nursing home sector.

Grabowski said he had questions about whether increasing accountability of nursing homes would free up funding to hire additional workers to meet minimum staffing levels. “How do we make sure there are dollars available to fund all these new positions?” Grabowski asked.

Some industry officials raised their own concerns about Biden’s proposals, arguing their facilities need more funding and contending that Medicaid — the primary payer for nursing care — doesn’t cover all the necessary costs.

“Regulations and enforcement, even with the best intentions, just can’t change that math,” Katie Smith Sloan, president and CEO of LeadingAge, which represents nonprofit aging services providers, said in a statement.

“We would love to hire more nurses and nurse aides to support the increasing needs of our residents,” Mark Parkinson, the head of the American Health Care Association, a major nursing home trade group, said in a statement. “However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions — nor when we don’t have the resources to compete against other employers.”

Administration officials also said they planned to investigate the role of private equity firms and other investors in the nursing home sector, the White House said, citing studies that investment groups’ ownership of nursing homes is linked to lower quality of care and higher costs. Biden also will call on Congress to expand regulators’ authority to scrutinize chain owners.

During his 2020 presidential campaign, Biden pledged to improve nursing home safety and reverse policy decisions under former president Donald Trump, such as reducing penalties for nursing homes, that health experts said had put residents at risk.

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