I ended my last post (A Once In A Generation Opportunity – Reimagining Nursing Homes) with what turned out to be a prescient sentence, “If all that results from the COVID19 tragedy in nursing homes is more punitive enforcement, ownership transparency and mandatory nursing staffing levels then the opportunity for true holistic transformational change in nursing homes would be lost.”
It appears that the only new monies under the Biden Plan will go to the hiring of more compliance surveyors ($500,000,000). No direct dollars will go to the existential staffing shortage. The to-be-determined mandatory staffing levels will at best have a marginal impact. The paucity of workers is a societal problem, not merely a staffing level one.
I would have liked the Biden proposal to have offered a positive message so desperately needed to a demoralized profession. For example, a message that serving the frail elders and people with disabilities is an honorable and venerated profession. We are facing as a country an unprecedented staffing shortage therefore we will incentivize high schools, community colleges, four year colleges and universities to increase their studies in the geriatric and healthcare fields. Educational offerings for certified nursing assistants, LPN’s, RN’s, geriatricians, gerontologists, social workers, etc.
Biden’s emphasis on more enforcement with increased civil monetary penalties and mandatory staffing levels is hardly transformative. This approach has been tried many times over the decades and has not been effective. It’s as if they want to prove Einstein’s definition of insanity: doing more of the same will bring about different results.
Holding property owners, for example REITs, responsible for leasing to reputable operators and to assure that the lease payments are reasonable so that operators have sufficient resources to offer person centered care has merit. Perhaps this is what the Biden Plan is offering, which is a positive.
There are promising new models such as the Green Houses, small houses, and household environments that have demonstrated success. The Biden Plan is disappointedly silent on them. The Biden Plan had the opportunity to open up financial markets through federal backed financing (HUD) and/or offering a higher federal Medical Assistance Percentage for states that increase the property component of its Medicaid reimbursement system. The same approach would potentially incentivize older nursing homes to convert to private rooms and baths.
Instead this is a piecemeal approach that will not, in this writer’s opinion, barely move the status quo. A missed opportunity indeed.
For further information on the Biden Plan consider reading this summary from McDermott, Will & Emery.
