Biden, nursing homes clash over quality of care

By Tammara Fogle | March 31, 2022

President Joe Biden recently proposed reforms that he says would improve the safety and quality of nursing home care and hold nursing homes accountable for the care they provide.

 “Despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm,” Biden said in a Feb. 28 statement issued by the White House.

Biden did not make the reforms effective immediately, however, and the nursing home industry is criticizing the proposals, saying nursing home care has improved and Biden’s measures would likely put many out of business.

“Providers and caregivers should be recognized for these improvements made over the past decade, even as we raise the bar even higher,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (and former Kansas governor).“But that will only be possible if health policy officials and lawmakers help us secure the resources we need moving forward.”

News reports said Biden’s reforms would be the most significant tightening of nursing home regulations in decades. Biden said new federal regulations would ensure that:

• Every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care;

• Poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars; and

• The public has better information about nursing home conditions so that they can find the best available options.

Biden said the pandemic highlighted the impact of substandard conditions in nursing homes. Currently, more than 1.4 million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation. More than 200,000 residents and staff in nursing homes have died from COVID-19 — nearly a quarter of all COVID-19 deaths in the United States.

The federal Government Accountability Office found that, from 2013 to 2017, 82% of all inspected nursing homes had an infection prevention and control deficiency that was identified through Medicare and Medicaid surveys.

Biden warned that conditions may get worse because private equity firms have been buying up struggling nursing homes, and research shows that private equity-owned nursing homes tend to have significantly worse outcomes for residents. 

“Too often, the private equity model has put profits before people.”

Other reforms proposed by Biden would reduce resident room overcrowding, reinforce safeguards against unnecessary medications and treatments, adequately fund inspection activities and beef up scrutiny on the poorest performers and expand penalties. 

The AHAC/NCAL, which represents 14,000 nursing homes across the country, issued a report of its own March 14, saying it showed the quality of care in skilled nursing facilities has been on an upward trend in the 10 years prior to the COVID-19 pandemic. The report claimed:

• Nursing homes welcomed approximately 3.5 million admissions from hospitals each year for the past decade, and nearly two-thirds of those patients were able to return home after receiving rehabilitation therapy from SNFs.

• Since 2011, 8.7 percent fewer residents were sent to the hospital during their nursing home stays.

• On average, nurses were putting in an additional 198 total hours of care per nursing home each quarter.

• One out of three nursing homes received four or five stars from the Centers for Medicare and Medicaid Services (CMS) for staffing, with five stars being the highest rating.

• Fewer than one in seven nursing home residents are receiving antipsychotic medication – a 40 percent decline since 2011.

• Nursing homes improved on 19 out of the 22 quality outcomes measured by CMS.

AHCA/NCAL also recently released a separate report emphasizing the economic crisis that nursing homes are facing “as a result of lack of prioritization from Congress in the face of the pandemic.”

An AARP representative praised Biden’s proposal, which the president also mentioned in his March 1 State of the Union address.

Not every issue gets mentioned in the State of the Union,” AARP lobbyist Rhonda Richards said. “It is significant that the president is talking about this.”