Nursing homes are under pressure to improve safety. Here's what people are saying about Biden's reform package

Welcome back to Path to Recovery, a newsletter that will bring you weekly conversations on how the health care profession will recover from one of the most significant crises of our time. Click "subscribe" above or follow along using #PathtoRecovery.

Here’s what we’re talking about this week.

Nursing homes and long-term care facilities often get left out of discussions about the health care industry. It’s a sector that’s chronically underfunded and draws most of its revenue from Medicaid, which has notoriously-low reimbursement rates, with the next largest piece coming from out-of-pocket payments from patients and their families.

But nursing homes came into the spotlight in a big way during the pandemic, as the COVID-19 virus tore through facilities. To date, a quarter of all U.S. covid deaths have been linked to nursing homes, including both residents and staff.

President Biden last week laid out a sweeping — and controversial — reform package in his State of the Union address, and called for an investigation of private equity-owned facilities in particular, which studies have linked to worse outcomes. The proposals include a number of measures aimed at improving safety, such as minimum staffing levels, limits on room sharing, crackdowns on the overprescribing of drugs like antipsychotics and higher penalties for underperforming facilities.

Private equity firms have been rapidly buying up nursing homes and long-term care centers over the past two decades. Yet the data paints a less-than-favorable picture, linking PE backed-facilities to higher rates of hospitalizations and emergency room visits — even as they cost taxpayers more money.

Advocates for the aging say reform is long overdue. (Click on the posts to read more.)

Yet long-term care providers quickly criticized the proposals, and on Tuesday requested a meeting with Biden as well as other health department leaders to emphasize two points: nursing home quality has been improving, not declining, they say, and they can’t meet minimum staffing levels without additional funding to address the workforce crisis.

“We want to hire more caregivers, but there are no workers to hire,” Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living, wrote in a letter to Xavier Becerra, Secretary of the Department of Health and Human Services.

“Nursing homes have lost 238,000 workers since the beginning of the pandemic,” he added. “Skilled nursing is 15 percent below pre-pandemic levels, and workforce levels within the entire long term care industry are at a 15-year low. Virtually every nursing home in the country is short staffed and increasingly having to rely on expensive temporary staffing agencies (if it can find an agency).”

Workers in the long-term care sector hold some of the lowest-paying and riskiest jobs in health care, though the staffing crunch has led to an increase in wages and benefits. Nursing home operators argue that, without more funding, they won’t be able to hire enough workers to meet staffing requirements, and will need to limit access to patients, especially in rural areas.?

Moreover, some argue that private equity investment has provided a necessary cash infusion to a struggling sector.

“PE knows math; therefore, they run the business as a business,” wrote Andrew Salmon, chief future officer at SALMON Health and Retirement, which operates senior living communities in Massachusetts, in a post on LinkedIn. “They run to the REIMBURSEMENT level the state and federal governments provide. PE firms expose the flaws in any system and understand how to make the numbers work.”

Now it’s your turn: What will it take to bring more workers into long-term care? How do you think increased regulation and enforcement would affect the sector? To what extent should for-profit operators undergo additional scrutiny?

Let me know in the comments below.