Senior Living Full Court Press Addresses Implications of NASEM Report on Nursing Home Quality

The May 4 Senior Residential Living Full Court Press meeting focused on the recommendations contained in a highly anticipated report from the National Academies of Sciences, Engineering, and Medicine (NASEM), The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. The 600+ page report, developed with support from a coalition of sponsors, including the Jewish Healthcare Foundation (JHF), examines how the United States delivers, finances, regulates, and measures the quality of nursing home care. Many themes that appear throughout the report were captured in JHF's award-winning 2020 documentary What COVID-19 Exposed in Long-Term Care.

A featured quote in the report from the daughter of two parents who required nursing home care during COVID-19 echoes the sad fact that the problems with long-term care are not new: "The pandemic has lifted the veil on what has been an invisible social ill for decades."

Terry Fulmer, PhD, RN, FAAN, president and CEO of The John A. Hartford Foundation, lead funder of the NASEM report, delivered opening comments. The overarching conclusion is that "the way the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable." She noted that the report provides a comprehensive road map to improving the long-term care system in the United States, focusing on the interconnectedness of systems to ensure that all older adults have access to quality care. Dr. Fulmer highlighted the JHF Revisiting the Teaching Nursing Home project, funded by The John A. Hartford Foundation, which is addressing one of the key action items of the report, namely, to ensure a well-prepared workforce.

An expert panel of study authors and funders discussed how to engage in advancing the proposed strategies. Panelists were Stuart Butler, PhD, senior fellow at The Brookings Institute; David Grabowski, PhD, professor of Health Care Policy at Harvard Medical School; and Tricia Neuman, ScD, senior vice president at the Henry J. Kaiser Family Foundation.

Dr. Grabowski provided a high-level overview of the NASEM report and reviewed the seven areas for improvement. Dr. Butler reflected on what the long-term care system might look like 20–30 years from now and which recommendations will get us there. Dr. Neuman took an optimistic tone, sparked by President Biden's State of the Union Address, which referenced federal action on staffing levels, value-based care, and transparency regarding facility ownership. All agreed that addressing workforce issues and the financing of nursing home care are crucial areas for immediate focus.

Following the expert panel, attendees shared questions and perspectives on the starting points to address the recommendations outlined in the report. Comments focused on the need to be cautious with implementing new regulations in an already highly regulated and financially stressed industry, as well as the lack of alignment of incentives between hospitals and nursing homes and the need for creative solutions to both workforce challenges and models of senior living. 

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