Missouri advocate for quality long-term care weighs in on President Biden’s efforts to help nursing homes

COLUMBIA, Mo. (KMIZ)

President Joe Biden announced his plan to overhaul nursing home quality, including minimum staffing levels and steps to increase inspections while continuing to keep COVID-19 under control.

Marjorie Moore, the executive director of VOYCE, a St. Louis nonprofit that advocates for quality living across long-term care, says the pandemic was not easy for people in nursing homes and the organization is glad the president is working to make changes.

"For the last two years, nursing home residents have had a really hard time. For two full years, they were essentially locked in their rooms with maybe a roommate, sometimes not," Moore said.

More than 200,000 residents and staff of long-term care facilities have died from COVID-19, according to the nonpartisan Kaiser Family Foundation. While nursing home residents and staff account for a tiny share of the U.S. population, they have accounted for more than 1 in 5 deaths.

Plus, Moore says the pandemic wasn't just hard on residents.

"The staffing shortages started long before COVID started, but were made so much worse because of COVID. A lot of people left the industry," Moore said.

The cornerstone of Biden’s nursing home plan is a new requirement for minimum staffing levels. He’s ordering the Centers for Medicare and Medicaid Services to conduct a study on staffing and publish proposed regulations within a year.

Moore said Missouri consistently ranks at the very lowest number of hours per resident per day across the U.S.

"So that means that you know, somebody who's in skilled nursing, maybe getting only about three hours of care, hands-on in a nursing home. So, you know, by raising those numbers, hopefully by providing facilities with additional funds to pay their workers we're hoping to get a lot better care for nursing home residents," Moore said.

Lawmakers in Congress have been debating legislation to require minimum staffing standards for facilities that accept payment from Medicare and Medicaid, as virtually all do.

The original plan was to include staffing requirements in Biden’s domestic agenda bill, but with that legislation stalled the administration seems to be shifting to using its regulatory powers to bring about changes.

Moore said moving forward both in Missouri and in the United States, she hopes officials will be able to figure out a way to provide higher Medicaid reimbursement rates for nursing home stays and to make sure that a lot of those funds go to direct care workers.

"One of the things that the President's framework talked about was that there's a lot of private equity money in ownership in nursing homes right now. I think we can all agree that you would want a lot of mom and pop shops to do well, but I think you know, putting more money in millionaires' pockets isn't what our Medicaid system is for," Moore said.

Biden's plan calls for the government to keep a focus on vaccinating and boosting nursing home residents and staff, along with regular testing.

"Missouri is now sitting at about 70% of our nursing home staff or workforce being vaccinated and we need to get that to 100% to comply with the guidelines from CMS," Moore said.

On Wednesday, the Missouri State Senate will be hearing a bill that would allow each resident to appoint two essential caregivers, family, friends, pastors, or other health care workers, that would have access to that person no matter what was going on on the outside.

"We would have a chance for residents not to be locked away without friends and family again, and that's a really important bill that's going through right now and that we're hoping to see passed," Moore said.

Biden's plan also calls for moving nursing homes toward private rooms for their residents, directing federal regulators to explore how to phase out living arrangements that house three or more residents in the same room.

His plan calls for increasing the nursing home inspection budget by $500 million, a boost of nearly 25%. Nursing home inspections are generally carried out by the states, following guidelines from Medicare. Biden is planning to revamp a special inspection program that focuses on low-performing facilities, to raise fines on nursing homes that fail to improve and, if necessary, cut off Medicare and Medicaid payments.