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- White House officials say a recent USA TODAY nursing home survey shows reforms are needed
- Regulators could impose minimum staffing requirements and tougher penalties for violations
- Industry groups fear mandates will not come with sufficient funding
President Joe Biden’s health policy advisers cited a USA TODAY survey of nursing home care during the pandemic as evidence of a struggling industry in urgent need of reform to clamp down on bad students and profiteers.
The report, released last week, showed residents of a single Midwest chain with 115 campuses died of COVID-19 last winter at twice the national average for nursing homes, based on the numbers institutions must file weekly with the federal government. Presented at USA TODAY findings, the company said it overstated hundreds of deaths during the wave.
Trilogy is a for-profit company backed by a real estate investment trust, a healthcare investment strategy that has until now operated largely under the radar of federal nursing home regulators. The White House hopes to shed light on the various ways Wall Street benefits from taxpayer-funded health care for the elderly and people with disabilities.
Investigation:This chain of nursing homes stood out with high death rates nationwide as the pandemic peaked
Greater financial transparency is part of a broad package of proposals Biden unveiled as part of the State of the Union address on March 1. He also called for increased reporting of for-profit retirement home ownership, including REITs and private equity; minimum staffing standards; a database to track operators across state lines; and stiffer violation penalties.
Trilogy’s investment firm is based in Southern California, but its retirement homes span four Midwestern states: Indiana, Kentucky, Ohio and Michigan. The federal Centers for Medicare and Medicaid Services have acknowledged that they are focusing on the performance of individual nursing homes, not chains, during the pandemic.
“We’re actively looking to improve,” CMS Senior Deputy Administrator Jonathan Blum said in a January interview.
Senior Biden administration officials, speaking on condition of anonymity during negotiations with departments, expressed concern that some operators could siphon money from federally funded retirement homes to the detriment patient care.
They told USA TODAY they were working on the reforms through the Department of Health and Human Services and its Centers for Medicare and Medicaid Services. Some changes can be enacted by administrative action after a rule-making process, but others will require legislation passed by Congress.
Officials said the industry should expect changes in “weeks and months”, not years.
The White House wants to enforce a provision of the Affordable Care Act that requires ownership information for any nursing home entity with a 5% or greater share to be reported to the federal government. Officials want to make this information easier to find on a government website, where consumers can view quality ratings of a facility for a loved one.
As part of its survey released last week, USA TODAY scored more than 15,000 retirement homes based on their performance during last winter’s COVID-19 surge and presented the results in a new reporting tool. research.
Database:Find out how they fared during the winter wave of COVID-19, 2020-21
Biden is asking for a $500 million increase in CMS funding to increase nursing home inspections and wants to raise the penalty cap for poorly performing facilities from $21,000 to $1,000,000 — both requiring action from the Congress.
Nursing advocates and AARP’s Rhonda Richards, Senior Legislative Representative in Government Affairs, applauded the proposal “to better protect older adults.”
For-profit and non-profit nursing home lobby groups oppose the measures, saying Medicaid funding is not enough to reimburse nursing care. “Regulation and enforcement, even with the best of intentions, simply cannot change that calculus,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement.
Another industry group called for a meeting with Biden and HHS Secretary Xavier Becerra, in a letter released last week.
American Health Care Association President Mark Parkinson took issue with the president’s rhetoric about announcing and cracking down on bad actors, which he said “demoralizes an already battered industry” and ignores “sacrifices heroics” of the nursing staff.
“We are particularly shocked by statements regarding the COVID-19 pandemic, blaming nursing home carers and criticizing the care provided,” Parkinson wrote.
In an op-ed to USA TODAY, AHCA’s David Gifford, a geriatrician, and the group’s chief medical officer wrote, “It’s time we stop blaming nursing homes for a global pandemic that’s only happening once per century.
Opinion:Don’t blame care homes for pandemic resident deaths
The association criticized Biden’s proposed minimum staffing requirements — a move that doesn’t require congressional action and could hit industry bottom lines.
Congress debated a bill that would mandate the minimums, which stalled. White House officials have said Biden will attempt to do so through a new administrative policy that will require a rulemaking process.
Officials said while industry is understandably afraid of what it sees as a reduction in payments, the government is more concerned about maintaining minimum standards of care.
“It’s important to have adequate staffing to avoid nurse burnout,” an administration official said this week. “(The USA TODAY) had some emotional and heartbreaking stuff with the staff at their wits end because there were so few of them. That will help, not hurt, on the burnout side.
Nick Penzenstadler is a reporter with USA TODAY’s investigative team. Reach him at [email protected] or @npenzenstadler, or on Signal at (720) 507-5273.
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