Literature Review

Fix needed now—America’s long-term care financing system is brokenBy Katie Smith SloanThe HillDecember 11, 2023Nonprofit providers of aging services have been warning for decades that America’s system for financing long-term care is dangerously broken. The dedicated professionals serving older adults in nursing homes, home health agencies, hospice programs, and senior living communities have toiled side-by-side with families across the country to cobble together care and services for parents, friends, and neighbors—connecting the tattered pieces of our patchwork long-term care system in an effort to ensure dignity, comfort and independence as the needs of our loved ones change. The New York Times KFF Health News’ series “Dying Broke” aptly illustrates the impact of the United States’ insufficient approach to financing of long-term services and supports. It’s an important and unflinching look at how our country is failing us. ... We can do better. A comprehensive and equitable long-term care financing system would make all the difference. The longer lives that many Americans will enjoy offers enormous potential for our nation. We must seize this opportunity and ensure that potential isn’t squelched by an oppressive and unfair long-term care financing system. The solutions are complicated—but smart approaches abound. The variable is political will. ... I urge our leaders to listen to the voices of their constituents, and join us in creating solutions. All of our futures depend on it.

Maine nursing homes lead in meeting proposed staffing standardsMaine MonitorDecember 10, 2023Maine nursing homes are closer to meeting the Biden administration’s proposed minimum staffing standards than their counterparts in most other states, but recent payroll data show that still fewer than one in 10 are meeting these proposed standards every day. And while some long-term care advocates said the national standards should go further, nursing home industry leaders said it would be difficult for a rural state like Maine to find the workers to meet the required minimums, which could lead to more closures. ... During the second quarter of 2023—from April to June—Maine nursing homes met the proposed minimum care hours from both registered nurses and nurse aides an average of 59 out of 91 days in the quarter, according to analysis from The Maine Monitor, USA TODAY and Big Local News at Stanford University, the latest federal staffing data. ... However, only 8% of Maine nursing homes met both standards on all 91 days of the quarter.

State—Nursing home dumped alleged rape victim at homeless shelterIowa Capital DispatchDecember 8, 2023An Iowa nursing home resident was evicted and dumped at a homeless shelter after complaining that an employee of the home raped her, according to state records. ... John Hale, a consultant and advocate for Iowa seniors, said “the story of what allegedly happened to this resident is absolutely sickening. It’s simply incredible that a nursing home and its parent corporation would allegedly have such an awful response to a rape allegation, allow an alleged rapist to continue to be employed, deal so inhumanely with a resident, and would suspend a facility employee who tried to do the right thing.” Hale also questioned the state’s response to the situation. “How the governor or any state legislator can sleep at night knowing that this kind of alleged cruelty exists in an Iowa nursing home is beyond me,” he said. “If this doesn’t serve as a wake-up call to take action, nothing will.”

MedPAC Advises Cutting Skilled Nursing Medicare Payment Rate by 3%Skilled Nursing NewsDecember 8, 2023The Medicare Payment Advisory Commission is recommending that for fiscal year 2025, Congress should reduce the 2024 Medicare-based payment rates for skilled nursing facilities by 3%, citing strong margin projections, occupancy growth and access to capital for the sector.

Summit County nursing homes testing robots to address staff shortagesAkron (OH) Beacon JournalDecember 6, 2023Two Akron-area nursing homes—Copley Health Center and The Village of St. Edward—are turning to robots to help alleviate staffing shortages in their facilities. The robots are part of a pilot program facilitated by the Direction Home Akron Canton Area Agency on Aging & Disabilities. Each facility has adopted different procedures for their robot to help with. Examples of tasks the robots perform include meal and package delivery, hydration carts and cleaning food trays and dining areas.  ... So far during the pilot program, the two robots have traveled more than 163 miles and have made over 2,220 deliveries to residents. Though the robots are used daily and have been well received by staff and residents, they are not intended to replace human contact, according to the news release.

CMS’ New Transparency Rule Can Help ‘Weed Out a Few Bad Actors’ but Won’t Impact Deals Much, Other Factors at PlaySkilled Nursing NewsDecember 6, 2023Nursing home ownership changes have largely been embraced by the industry and will have little impact on deal activity, with the new transparency rule from the Centers for Medicare & Medicaid Services having very little impact on the sector. Instead, the new rule will force nursing homes to report ownership details during critical junctures like Medicare or Medicaid applications and recertification, according to executive managing director of VIUM Capital, Steven W. Kennedy. And if anything, the new transparency rule will eliminate any bad actors on the real estate and operating side because these might cause them “discomfort,” and that’s certainly better for the industry, he said. “Every industry no matter where you are has some bad actors,” he said. “I think in general, skilled nursing has very few bad apples, but if they’re out there, this can help weed them out.” 

OIG’s Audit of Nursing Home Workers in Louisiana Finds Flaws in Background Check ProcessSkilled Nursing NewsDecember 6, 2023A federally commissioned report released Wednesday found that nursing homes in Louisiana failed to complete background checks on a portion of their non-licensed employees. In conducting the audit to examine whether Louisiana nursing homes complied with federal requirements for backgrounds checks, the Office of Inspector General chose a sample of 9 Louisiana nursing homes out of a total of 276 licensed facilities in the state, basing its sample size on a variety of risk factors and on the need to select nursing homes in urban and rural settings, the agency said. ... The OIG report states. “Although Federal requirements do not specify the methods or types of information that should be considered for a background check to be regarded as having been satisfactorily completed, we identified potential limitations in the nursing homes’ background check searches and adjudication methods for 49 of the 209 non-licensed employees we reviewed.” In response to OIG’s findings and recommendations, Louisiana has agreed to update its standard survey process to ensure routine monitoring of nursing homes’ compliance with background check requirements by reviewing a sample of 5% of current non-licensed staff and by directing nursing homes to conduct self-audits of current personnel files. ... Among the findings, some disturbing practices emerged. Of the 9 nursing homes closely investigated, six nursing homes, and some of the staffing companies with which they contracted, had employee background check searches conducted that did not include a statewide search of State police records.

More people with dementia opting to age in place over senior livingMcKnight’s Senior LivingDecember 7, 2023People living with dementia are more likely to choose aging in place over an assisted living or a continuing care retirement community, according to a new study. A research letter in the Journal of the American Geriatrics Society reported that over the last two decades, a variety of factors have shifted where people with dementia live, including family caregiver availability, declining marriage and birth rates, alternative residential care arrangements, Medicaid expansion of home- and community-based services and the long-term care workforce crisis. Researchers said their study showed that the COVID-19 pandemic noticeably altered living arrangements for individuals living with dementia, increasing the number of those opting to age in place. ... What concerned researchers was increasing functional impairment and levels of unmet needs among those living alone or in a residential care setting, including assisted living and CCRCs, “given the limited regulatory oversight and lack of uniformity in services available in these settings.”

The Center to Advance Palliative Care Celebrates 20th Anniversary of its Palliative Care Leadership CentersNews ReleaseDecember 5, 2023New York, NY—Since 2000, the percentage of hospitals (with 50 or more beds) with a palliative care program has more than tripled, from 25% to more than 83%. Additionally, palliative care has expanded beyond the hospital into community settings such as long-term care facilities, nursing homes, office practices, and patient homes. This expansion and growth has been fueled by the Center to Advance Palliative Care’s Palliative Care Leadership Centers first launched in 2003 with funding from the Robert Wood Johnson Foundation. ... Over the past 20 years, more than 1,300 palliative care teams have trained with a PCLC. And, 80% of them went on to institute palliative care services within two years. Today, there are eight Palliative Care Leadership Centers, including:

Models can predict when older adults with dementia may need nursing home careMcKnight’s Long Term Care NewsDecember 5, 2023It often can be difficult to determine when a person with dementia may need to go to a nursing home or receive that level of care. A new study created models to help people determine when older adults living with dementia will require nursing home-level care. The results can give people and their loved ones evidence-backed data if it comes time to make that decision. The study was published on Dec. 4 in JAMA Internal Medicine.

NY latest to adopt LGBTQ+ Bill of Rights for long-term care residentsMcKnight’s Senior LivingDecember 4, 2023New York has become the latest state to adopt legislation establishing a bill of rights for LGBTQ+ residents in other long-term care facilities. S 1783A / A 372 prohibits assisted living communities and other long-term care facilities and their staffs from discriminating against residents on the basis of actual or perceived sexual orientation, gender identity or expression, or HIV status.

Nursing Homes’ Letter to CMS Calls Out Lack of Teeth—and Clarity—in Final Rule’s Medicare Advantage ReformSkilled Nursing NewsDecember 1, 2023In order to keep Medicare Advantage plans in check for denial of services, provider organizations are pressuring federal authorities to do more, and asking them to closely monitor and aggressively enforce reforms for these plans as envisioned in a final rule that takes effect on Jan. 1. Companies managing MA plans have said they don’t believe they need to do anything different, based on what was laid out in the final rule, a worrying concern that needs to be addressed, providers said, who are also seeking to gain clarity on how the Center for Medicare & Medicaid will monitor MA plans’ compliance. To that end, nursing home and hospital associations are seeking to influence the implementation of CMS’s rule regarding MA plans.