Time For a New Path Forward for Long Term Care by Katie Smith Sloan

Time For a New Path Forward for Long Term Care by Katie Smith Sloan

Neglect and abuse of older adults, the subject of last week’s Senate Finance Committee hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” is never acceptable. As we said in our statement for the record, and have stressed for years, our nonprofit members strive to provide high-quality care. 

We have long been a partner to the Centers for Medicare & Medicaid Services and policymakers in establishing best practices.

We make no excuses for improper care. Those who make mistakes must be held accountable. Those who commit illegal acts must be punished. Remedies do exist to address unacceptable situations such as those described in last week’s hearing.

We are very concerned that issues of abuse and neglect, along with poor quality care, continue, even as our members and others have made significant strides to improve care. We ask: How might we work together to reduce incidents of abuse and neglect?

Positive change is possible. In the 32 years since OBRA ’87 was enacted, LeadingAge and its members have joined with CMS and other stakeholders on initiatives like the elimination of restraints and the reduction of the inappropriate use of antipsychotic drugs. Both have had measurable success in improving the quality of care in nursing homes. 

Some may say that more regulation is needed. However, nursing homes currently must comply with an extensive set of regulations. Will more yield better care? Or should we ask ourselves whether the approach established as part of OBRA over 30 years ago is relevant and sufficient to meet the needs of older adults and providers today?

We believe it is time to forge a new path forward: One of close collaboration between providers, policymakers, regulators and consumers that will better help providers to deliver the type of care older adults need as they age.

To be sure, this is a complex, multifaceted problem and any solution is going to take an equally complex set of responses.  

Potential areas of focus include:

Financing long-term services and supports. Without a change, staffing and quality are going to continue to be challenges. Our current system revolves around reimbursements. Policymakers and budgeters have to be willing to pay for the quality care that residents have a right to receive. Studies have shown that Medicaid rates paid to providers of long-term care are less than the cost of care, which means that providers must make up the difference. 

Because states set Medicaid reimbursement rates, the rates received by providers vary across the country. Medicaid pays for many services an average of about 60% of what Medicare or private insurance pays. Yet providers across the country are grappling with the possibility of less, not more. One example comes from New York State, where lawmakers have proposed a $246 million cut to Medicaid reimbursements. The impact of cuts is real: $9 a day per resident less means less money to cover costs necessary to provide quality care.

Concerted efforts to professionalize or at least paraprofessionalize direct care work. The fact that people are paid the same or more to work in fast food or retail compared to long-term care undervalues the many skills that LTC direct care work requires.

Actions to increase the labor pool. There aren’t enough people born in the US willing to provide this care today, and the projected increase in older adults who will need care in the coming years raises the immediacy of the need for solutions. Immigration reform and/or consideration of a guest worker program would be in order to encourage foreign nationals to come here to fill some of these open positions.

Reconsideration of our regulatory approach. Our current Requirements of Participation, survey process, 5-Star system, and CMPs/fines are not yielding the results — sustained compliance of regulations and a national standard of high quality care — they were created to achieve. It is time to revisit the IOM study of the early 1980s and scientifically determine what works to improve quality and create a quality assurance system for the 21st century.

So, what might collaboration look like?

Consider a proposed collaboration between LeadingAge Washington, Washington Health Care Association and SEIU 775, all of whom would work together to study staffing models and fund Medicaid rates to enable hiring and staff retention. 

We stand ready to lead this kind of collaboration among stakeholders with a variety of interests as a possible template for successful policy change at the national level. 

This is not an us versus them situation. Fundamental change and continued progress toward high-quality services and supports will require all of us to work together to find common ground to advocate on behalf of people who need long-term services and supports. 

Katie Smith Sloan is president and CEO of LeadingAge, the largest association dedicated solely to nonprofit providers of aging services.