NASEM Report Slams ‘Ineffective’ Nursing Home System, Highlights Post-Acute Care Utilization Shifts Leave a comment

The National Academies of Sciences, Engineering and Medicine (NASEM) on Wednesday released its long-anticipated report on how to improve nursing home care in the U.S.

In doing so, NASEM reinforced what so many long-term and post-acute care stakeholders have learned over the past two years: that, for multiple reasons – both within and beyond their control – nursing homes are plagued by inadequate staffing levels, poor infection-control practices and general deficiencies, all of which result in “actual patient harm.”

“The pandemic’s enormous toll on nursing home residents and staff drew renewed attention to the long-standing weaknesses that continue to impede the provision of high-quality nursing home care,” the over 600-page report states.

While the NASEM report doesn’t focus on home health or home care directly, it highlights how current nursing home shortcomings and COVID-19 pandemic have drastically changed post-acute care utilization and discharge patterns. Furthermore, it advances the notion that the country’s long-term and post-acute care infrastructure needs whole-sale transformation.

“Everyone wants excellence in long-term care for our families, friends and ourselves,” Terry Fulmer, president of the John A. Hartford Foundation, one of the report’s main funders, said in a statement. “This report shows the way.”

Roughly 1.3 million Americans live in the nation’s 15,000 nursing homes, receiving 24/7 care from millions of staff members. As of April 6, nearly 170,000 nursing home residents are estimated to have died from COVID-19, with many more experiencing long periods of social isolation during a strict lockdown lasting upwards of 20 months.

That tragic death total, along with gut-wrenching stories shared by nursing home residents, as well as their friends and family members, has led to sweeping reforms from the Biden administration and a stronger spotlight on senior care. Wednesday’s report, in particular, is the culmination of over 18 months of digging by a 17-member committee assembled by NASEM.

“This report is a piercing wake-up call for policymakers,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “Decades of underfunding have left America’s nursing home system in desperate need of an overhaul.”

Among its key findings, the report concludes that “the way the United States finances, delivers and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable.” To help reverse that, the committee made several overarching recommendations.

On the workforce front, for example, low staff salaries and benefits combined with inadequate training has made nursing homes a “highly undesirable” place of employment, the report notes. That, in turn, has impacted staffing levels.

To bolster the workforce, competitive compensation and training programs are essential. But to do that, a “more rational and robust financing system” is likewise needed.

“The days of underpaid and undervalued caregivers working in understaffed nursing homes must end,” committee members David Grabowski, Marilyn Rantz and Jasmine Travers wrote in a related article.

Another recommendation is implementing methods of ensuring a more transparent operating environment. Currently, complex ownership structures make it extremely difficult to hold bad actors accountable.

“To increase financial transparency and accountability by nursing homes, policymakers must collect, audit and make available detailed facility-level data on the finances, operations and ownership of all nursing homes in real time in a readily usable database,” the three committee members continued.

Other recommendations included investment and research in innovative care models, along with improved oversight and survey measures. The NASEM offered recommendations across seven key themes, overall.

“As our nation grows rapidly older, millions of older Americans will need safe, high-quality care,” Sloan continued.

Although it focuses on nursing homes and skilled nursing facilities (SNFs), the report notes that, as a result of financial pressures and other factors, post-acute care utilization is rapidly changing. That’s true both in terms of the number of people receiving post-acute care services as well as in terms of the intensity of services.

“Patients are being discharged to the home setting more frequently (potentially with arrangements for home health care) instead of being discharged to a SNF,” it explains. “Discharge to the home may be a suitable option for only the healthiest patients and SNF use remains a common and costly option.”


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