Dan Keller's Nursing, Health Policy & Healthcare Technology Blog

May 11, 2022 -- Having worked in a few SNFs (skilled nursing facilities, i.e. nursing homes), I implore my children not to let me end up in one. Even the ones that don't reek of urine are depressing places. Even the ones that cost $8000/month. Let alone the ones that are largely federally-funded.

But change is coming. In an article today in JAMA, National Academies: US Nursing Home System Needs Fundamental Overhaul, the problems are identified and solutions proposed.

Problems

• Understaffing -- a critical problem.
• Funding and reimbursements -- "Medicaid, the dominant payer of long-term care services, doesn't fully cover nursing homes' costs -- especially the cost of providing quality care."
• "Predatory owners and operators who seek to maximize their profits at the expense of vulnerable residents' health and safety."

Solutions

• Improve low-paid nursing home workers' wages and benefits.
• Shore up minimum staffing standards and education requirements.
• Provide smaller and more home-like environments with single- rather than multiple-occupancy bedrooms and bathrooms.
• Incorporate residents' families experiences into enhanced quality measures in the Centers for Medicare & Medicaid Services (CMS) Care Compare website, where consumers can research facilities, for the first time.
• All health care professionals to receive geriatrics training, ideally with nursing home experience.
• Give state agencies that conduct nursing home surveys the resources they need to monitor facilities, investigate complaints, and enforce rules.
• Create incentives to increase adoption of electronic health records in nursing home facilities. (Yes! Go informatics!)
• Collect, audit, and make publically available data on nursing homes' often opaque finances, operations, and ownership.
• Develop a federal long-term care benefit. (I have long-term care (LTC) insurance; I don't count on the gummint to take care of me in my dotage.)

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