Report: nursing home quality of care declining, action and research needed

A new report from the National Academies of Sciences, Engineering, and Medicine paints a dire picture for nursing home residents if issues brought to light during the pandemic are not immediately addressed. Specifically, it found that inadequate staffing numbers, shortcomings in oversight and regulation, and poor infection control are jeopardizing the lives of 1.3 million Americans living in the 15,000 certified nursing homes nationwide.

Nursing home residents died from Covid-19 and suffered hospitalization at higher rates than other demographics. Those in nursing homes make up less than 1% of the population in the United States, but as of October 2021, they accounted for 19% of the total Covid-19 deaths nationwide, the report added. At last count in February of 2022, 2,200 nursing staff members and over 149,000 nursing home residents to date had died from Covid-19. This, the report highlighted the “pervasive ageism evident in undervaluing the lives of older adults.” Many older adults have complex, underlying health conditions and that is common among nursing home residents.  

The problems at nursing homes extends across states, and has grabbed attention at the federal level. Just this April, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would allow public feedback on both nursing home staffing numbers as well as patient outcomes. CMS plans to utilize the feedback to determine minimum staffing levels allowed at nursing homes.

“Everyone deserves to receive safe, dignified, and high-quality care, no matter where they live,” said Health and Human Services Secretary Xavier Becerra in a news release. “Today we are starting the necessary work to ensure our loved ones living in nursing homes receive the best care at the staffing levels they need. We are working hard to deliver on President Biden’s commitment to protecting seniors and improving the quality of our nation’s nursing homes.”

How the U.S. delivers and regulates nursing home care is not only inefficient and ineffective, but also unsustainable, according to the report. The staff is often underprepared to carry out necessary duties, resulting in subpar care. Despite regulations in place to prevent against such shortcomings, they are often not enforced. Throw the pandemic into the mix and it’s no wonder the quality of care plummeted even further.

The report recommends a combination of state and federal government in conjunction with researchers, regulators, and payers, should jointly collaborate to improve the quality of care at nursing homes. When implementing changes the report cautions against adjustments that may worsen disparities — be they in resource allocation, quality of care, or resident outcomes. Ethnic and racial disparities are common in this demographic, according to the report, so the changes should be done in a manner as not to exacerbate these inequities.

For sustainable and actionable steps towards improving nursing home care, the report has several suggestions. For one, it recommends research be conducted that does not rely on retrospective cohort designs, as retrospective cohorts are constrained by data that is available. Additionally, the report advocates for salary improvements for nursing home staff as well as increased staffing and training to make such jobs more desirable.

The ultimate goal is for nursing home residents to receive culturally sensitive and personalized care that covers the gambit: oral, hearing, vision, dementia, rehabilitation, psychosocial, behavioral, and physical care. Further, when the time comes, they should also receive personalized and high-quality palliative and end-of-life care. Additionally, the report advocates for patients and their families having a say in determining the plan of care, rather than a one-size-fits-none approach.

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