Nursing-home referral service, A Place for Mom, is funded by nursing homes and has no information about their violations

Image from home page of A Place for Mom website

Kentucky Health News

The nation's largest nursing-home referral service, A Place for Mom, does not inform users about citations of facilities for neglect or other substandard care, The Washington Post reports.

A Place for Mom charges no fees to people seeking senior housing, but "is paid large fees by assisted-living facilities and does not independently assess their records," the Post reports. "More than a third of its most highly recommended facilities in 28 states were cited for neglect or substandard care in the past two years, many of them repeatedly."

Those 28 states put nursing-home inspection reports online, enabling the Post to easily research them. Kentucky is among the 22 states that do not put inspection reports online. Medicare's Nursing Home Compare website, which ranks facilities on a five-star systen, is based on those reports.

"A Place for Mom does not include these reports in its profiles of facilities, even in cases where poor care has led to death," the Post reports. 

Some places cite for substandard care have received a “Best of Senior Living” award from A Place for Mom for providing “exemplary care and support to aging loved ones.” The company says the awards are based on user reviews, "which are often anonymous," the Post reports.

"Current and former staff of some large chains told The Post that these reviews are often manipulated by the care providers; some claimed they were encouraged to obtain fake reviews from their own friends and relatives. . . . None of the sources suggested that A Place for Mom itself is involved in generating fake or manipulated reviews. But they say the site’s prominence creates incentives for facilities to push for favorable ratings."

Ky. nursing-home industry says Biden administration's rule mandating staffing levels for homes is 'impossible' to meet

Centers for Disease Control and Prevention photo

By Melissa Patrick
Kentucky Health News

A new law that sets minimum staffing requirements for federally funded long-term care facilities will require many of them to hire more nurses and nurse aides. It has been met with pushback from the nursing-home industry. 

Morgan Jemtrud, director of communications for the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living, told Kentucky Health News in an email that the staffing mandate is not attainable for several reasons, including the health-care workforce shortage. 

"The staffing mandate is impossible. CMS estimates it will cost around $300,000 per building (AHCA estimates more), but there is no funding to support the implementation of the rule," said Jemtrud. "Also, the required staff are simply not available. RNs are in demand across all health -care sectors, and no pipeline is being built to produce the number of RNs this rule requires." 

Jemtrud was referring to an analysis from the American Health Care Association, a nursing-home lobby, that says meeting the mandate would require nursing homes to hire more than 100,000 more nurses and nurse aides at an annual cost of $6.8 billion. The analysis also says 94% of nursing homes were not meeting at least one of the proposed staffing requirements.

New staffing requirements

The "Nursing Home Minimum Staffing Rule" requires all nursing homes that receive Medicare or Medicaid payments to provide 3.48 hours of direct nursing care per resident per day, including a defined number for registered nurses (0.55 per resident per day) and nurse aides (2.45 hours per resident per day). 

"This means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards," says a White House fact sheet about the rule.

It will also require facilities to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

The new staffing requirements will be phased in over three years, except at rural facilities, which will get up to five years. The law allows for some "limited, temporary exemptions" for facilities in areas with workforce shortages that demonstrate a good faith effort to hire the required staff. 

Within two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, according to a Kaiser Family Foundation analysis. But the analysis says only 19% meet the defined number of hours required for RNs (.55)  and nurse aides (2.45) that is required under the full implementation of the law.  

“When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom, and meals – and it is less safe when residents have a medical emergency,” said the fact sheet,  noting that it will also “ensure that workers aren’t stretched too thin by having inadequate staff on site.”

Brice Mitchell, spokesperson for the state Cabinet for Health and Family Services, told Kentucky Health News in an email that the administration is reviewing the federal rule and its impact. 

"Medicaid funds 70% of all long-term care in the state and there is ongoing work to expand a nurse career ladder to help increase recruitment," Mitchell said. "At this time, we are unable to determine the number of Kentucky nursing homes that don’t meet the new federal rules." 

Pushback on the new mandate

Denise Wells, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, said her group was "very pleased" with the 24-hour RN requirement, but didn't think the minimum hours per resident per day went far enough.

She said  the 24/7 RN requirement is important because the acuity level of patients has increased over the years, meaning patients need more assistance with their activities of daily living than ever before. And, she said, "Medical emergencies don't just happen for eight hours of the day; they can happen 24 hours a day." 

Wells said they were disappointed in the hours per resident per day only being 3.48 because research shows that the minimum care that an average resident needs is 4.1 hours per day.

"And that is simply to avoid negative health outcomes," she said. "It's not to live their best lives, it's not to have the greatest quality of life, it's just to have that minimum care provided." 

Wells called the new staffing rules a "good first step." 

"We are trying to make sure that the message is that this is not the ceiling; that it's a floor," said Wells. "It's the absolute minimum, but facilities should be staffing higher than this. . . . Nursing homes are required to staff to sufficient levels to meet resident needs, and so if they have residents that their care plan indicates that they need more than the 3.48 hours per day, then the facility needs to staff to meet that need." 

Jemtrud with KAHCF and KCAL was asked about the financial impact of the rule. She said Kentucky nursing homes are already financially strained and there are no funds to help meet the new requirements. 

"Before this rule, 79.9% of Kentucky facilities are in distress or at risk of financial distress using the Altman Z-score," Jentrud said, citing a formula used to determine a company's risk of bankruptcy.

"CMS estimates the total cost of the final rule at about $4.3 billion per year, but AHCA continues to estimate the cost above $6 billion per year," she said. "There are no funds from Medicare, Medicaid, or other payers to increase payment rates to providers for any of the rule requirements." 

Wells, asked how facilities can address the health-care workforce shortage, said her group prefers to call it a "job quality crisis" caused by low pay, poor conditions and little support.  She pointed to reports from the National Consumer Voice for Quality Long-Term Care that have showed how nursing homes hide profits, and saif there is not enough transparency in how Medicaid and Medicare dollars are used these facilities. 

KFF Health News also points to researchers who are "skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors."

In a lengthy statement from the American Hospital Association, Stacey Hughes, AHA executive vice president, said, in part, "CMS’ one-size-fits-all minimum staffing rule for nursing homes creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements."

The American Health Care Association issued a statement in opposition of the mandate and said the industry will keep pressing Congress to overturn the regulation. 

“While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care,” Mark Parkinson, CEO of the AHCA, said in a statement. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”

The mandate also implements stronger transparency measures to ensure nursing home residents and their families know when a nursing home is using an exemption, according to the fact sheet.  

Guthrie expresses concern

Jemtrud said industry associations will "continue to reach out to Congress where there’s been bipartisan support for helpful legislation." 

"Providers have been hosting legislators for visits within their facilities to share firsthand the challenges they’re facing," she wrote. "Also, the AHCA/NCAL Congressional Briefing scheduled June 3-4 will allow members to discuss their concerns directly with members of Congress on Capitol Hill." 

On Tuesday, U.S. House Republicans at a House Energy and Commerce health subcommittee voiced their concerns about the new staffing mandate. 

The subcmmittee chair, Republican Rep. Brett Guthrie of Kentucky's Second District, said he was "extremely concerned" about the mandate along with the 80/20 rule which requires agencies that provide home- and community-based services to spend 80% of their Medicaid payments on compensation for workers who directly provide care. 

Guthrie said both rules "threaten access to long term care services for Medicaid beneficiaries by setting arbitrary staffing and pay standards. . . . This approach simply won't work." He added later, "These rules come at a time where we have seen more than 500 nursing home facilities close since the start of the pandemic and where we have 150,000 fewer long-term care workers than we did before 2020."

Nursing homes say they can't afford more staff, but critics say they manipulate their financial arrangements to make that case

Photo via iStock and KFF Health News

By Jordan Rau

KFF Health News

Nursing homes say they can’t afford higher staffing, as the Biden administration proposes to require. But their finances are often opaque.

Perhaps the biggest mystery, as the Monday deadline for comments on the proposal nears, is how much extra money do the nation’s 15,000 homes actually have to hire and retain more nurses and aides.

The proposal has provoked a fierce lobbying battle between nursing homes and patient advocates, with more than 22,000 comments filed already to the Centers for Medicare and Medicaid Services.

Official nursing home financial records — those submitted to the government — report that more than 4 in 10 homes lost money in 2021. The industry says that it can’t afford higher payrolls. But instead of pumping more dollars into Medicare and Medicaid to ostensibly help homes hire more staff, CMS has proposed a relief valve: exempting homes from higher staffing requirements if they’re more than 20 miles from any other long-term care facility and in an area with a documented shortage of health-care workers. That would include many Kentucky nursing homes.

To the further consternation of patient advocates and many rank-and-file nurses and aides, the agency announced in its draft rule, released in September, that it may also exempt homes that are financially struggling.

Beyond understaffing concerns, excusing broke homes could encourage more financial chicanery in an industry where many operators have mastered the art of appearing poor while their owners siphon money into their own pockets.

The most common trick, honed over decades, involves owners setting up a bunch of separate companies to offload big chunks of the nursing home business — sometimes management, the staff, the equipment or the building itself.

Those companies charge the nursing home whatever their common owner decides, while only the licensed home is required to reveal its finances to the government. The industry insists there is no evidence these related companies charge any more than independent contractors would.

The CMS proposal would require that states do more to track how much money each home spends on direct care billed to Medicaid, the biggest source of revenue for most homes. In theory, that could help discover which homes are shortchanging employees — and patients. The requirement, however, may be no match for the ingenuity of industry accountants, and notably lacks transparency about where money from Medicare, private insurance and out-of-pocket revenue ends up.

Existing federal rules only require homes to have at least one registered nurse working for eight consecutive hours each day, and at least one licensed nurse to be on duty around-the-clock. (Those workers are usually licensed practical nurses, or LPNs, who don’t go through as much professional education as registered nurses do.) CMS has mandated that homes have “sufficient” staffing but has never defined the term.

The new proposal would require each of the nation’s 15,000 nursing homes to have at least ne registered nurse on duty for every 44 residents, and a nurse aide for every 10 residents.

The agency has indicated it might add yet another requirement when it finalizes its rule: An umbrella staff ratio of one nurse or nurse aide of any kind for about every seven residents.

(If you’re reading the rule or planning to comment, be aware that CMS talks about staffing in a less accessible way than we do here, using a measurement of hours per resident day — HPRDs, in nursing-home lingo — instead of a staff-to-resident ratio.)

Patient advocates say the industry has plenty of money to raise staffing levels. They are demanding much more staffing than required in the CMS proposal, enough to provide the highest quality care — not just a minimum level of acceptable coverage.

Advocates want at least one nursing home worker for about every six residents, which a 2001 CMS study concluded would result in the best care. But in a move that enraged proponents of greater staffing, CMS didn’t even bother modeling that scenario when it drafted its proposal.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Kaiser Family Foundation — an independent source of health policy research, polling and journalism.

 

Scorecard for long-term care services and supports puts Ky. 42nd

AARP's Long-term Services and Supports Scorecard places Kentucky in the next-to-lowest tier. 

By Melissa Patrick

Kentucky Health News

The American Association of Retired Persons' latest Long-term Services and Supports Scorecard, three years after the Covid-19 pandemic, ranks Kentucky 42nd in the nation. That put the state in the next-to-lowest tier, but that was a move up from the the last report, when it was in the bottom tier.  

A state's score is determined by 50 indicators grouped in five dimensions, including affordability and access, choice of setting and providers, safety and quality, support for family caregivers and community integration. Among the 26 indicators with a trend, Kentucky saw "significant improvement" among eight of them, little or no change in 17 of them and a "significant decline" in one of them. 

That was in the "home care cost" indicator in this category, which measures the median annual home-care private-pay cost as a percentage of median household income for people 65 and older. Kentucky's percentage increased to 93%, from 77% last year.

The scorecard ranked Kentucky 42nd for affordability and access, which looks at indicators of whether consumers can easily find and afford services, with a "meaningfully available safety net" for those who can't afford services. 

In the "choice of setting and providers" category, Kentucky ranked 37th, placing it in the bottom tier for this measure. The indicators in this category look at whether the state has a person- and family-centered approach that allows for consumer choice and control of services. This measure also looks at whether the workforce is well-trained and adequately paid, whether home and community-based services are widely provided and whether provider choice fosters equity. 

In this category, Kentucky had the fourth highest average hourly wage shortfall for direct-care workers, with a shortfall of $1.75 less per hour than those of other occupations with comparable or lesser entry requirements across all states.

The state ranked 45th in the "safety and quality" category, which looks at whether consumers are treated with respect and whether they honor their wishes. It also looks at whether residential facilities and other care settings are adequately staffed and are prepared for emergencies and whether its policies and systems prevent disparities in quality and outcomes. 

The report ranked Kentucky 38th for "support for family caregivers," looking at measures that determine whether caregivers are getting the supports they need to continue their essential roles. 

The state ranked 40th for "community integration," which looks at whether consumers have access to services that facilitate long-term services and supports , including affordable housing, age-friendly, livable and drive-equitable communities. In this category, Kentucky was among one of the sixth lowest states when it came to transportation convenience, safety and options. 

The report's executive summary says AARP's "intention is to identify strengths and weaknesses in state systems to spark and inform the development of actionable solutions at the local, state, and national levels— solutions that respond in meaningful ways to individual preferences and family choices and care needs as well as to new pressures and challenges." 

90% of for-profit nursing homes would need more staff to meet proposed rules; 60% of others would, KFF Health News estimates

KFF Health News graph; individual estimates for staffing by RNs and aides are in the story.

Kentucky Health News

For-profit nursing homes would have to hire more staff to meet proposed federal rules than other nursing homes would, according to an analysis by KFF Health News, a service of the Kaiser Family Foundation.

"90% of for-profit facilities would need to hire additional nursing staff, compared with 60% of non-profit and government facilities," says the analysis by Alice Burns, Priya Chidambaram, Tricia Neuman and Robin Rudowitz.

In Kentucky, about two-thirds of nursing homes are for profit, and only 21% of all homes meet the proposed standard, which is about the same as the national figure of 19%, KFF Health News estimates.

The Centers for Medicare and Medicaid Services has proposed that nursing homes employ registared nurses for at least 0.55 hours per resident per day, and nurses' aides for at least 2.45 hours per resident per day. The rule would also require facilities to have an RN working at all times.

"CMS is seeking comment on several alternatives to the proposed rule, one of which would require facilities to comply with requirements that were adjusted to reflect the health and frailty of nursing facility residents," KFF Health News notes. "Assuming this alternative was implemented using CMS’ existing approach for adjusting staff hours for resident health and frailty, virtually all facilities would need to hire new staff to meet the requirements."

Nursing homes say some of them might have to go out of business because they already have big problems finding enough nurses and nurses' aides. To address that concern, the rules would be phased in, with some differences for rural and urban nursing facilities.

The first phase, starting 60 days after publication of the final rule, would require facilities to "assess the needs of each resident, include input from nursing facility staff and residents’ families or legal representatives, and develop a plan to meet required staffing levels given residents’ needs," KFF notes.

Two years after publication, urban nursing homes would need round-the-clock RNs. For rural nursing homes, that would occur three years after publication. After that, the rules for number of nursing hours per resident day would kick in.

The proposed rule would allow nursing hoems to have less staffing if they are "at least 20 miles from the nearest nursing facility, or in an area with workforce unavailability (defined as having a provider to population ratio that is at least 20% lower than the national average)," KFF notes. "Nursing facilities would also have to demonstrate good faith efforts to hire and retain staff and a financial commitment to staffing by reporting the total amount of money spent on direct care staff." They could not get such exemptions "if they had any staffing-related violations" or had been designated as a Special Focus Facility "with a history of serious quality issues."

KFF explains, "Nearly half of facilities meet the RN requirement (52%) but only 28% meet the nurse aide requirement. . . . When looking at ownership of facilities that meet the RN requirement, a larger share of non-profit facilities would meet the 0.55 standard than for-profit and government facilities (75%, 44%, and 61%, respectively). When looking at nurse aides, about half of non-profit and government facilities meet the minimum staffing levels, compared with only 20% of for-profit facilities."

However, "If the proposed staffing levels were enforced after accounting for resident health and frailty, virtually no nursing facilities would meet the requirements in the proposed rule," KFF estimates.

And what about the workforce shortage? "As of June 2023, employment levels were still more than 11% below pre-pandemic levels for workers in skilled nursing care facilities and 3% below pre-pandemic levels for workers in elderly care facilities," KFF reports. "Although fewer facilities would need to hire new RNs, those that do may find it difficult to compete with hospitals, many of which are also trying to increase the number of RNs they employ. To the extent that many nursing facilities receive hardship exemptions on account of workforce shortages, the effects of the proposed rule on minimum staffing levels will be muted."

CMS estimates that the proposed rules would cost nursing homes $40 billion in the first 10 years after the final rule takes effect. "Such costs are likely to be passed on to public and private payers for nursing facility services, including residents and their family members who paid $45 billion in out-of-pocket costs for care in nursing homes" and other long-term care in 2020. "Medicaid spent nearly $53 billion in that year, about twice the amount ($26 billion) that traditional Medicare spent on skilled nursing facilities in 2020, and although Medicaid financing is shared by the state and federal governments, all states except for Vermont must meet balanced budget requirements."

Feds call for first nursing-home staffing minimums, weaker than industry feared, but homes say it would force some to close

Federal officials' proposed minimum standards for nursing-home staffing are weaker than expected, Bridget Early reports for Inside Health Policy.

The nursing-home industry had anticipated a proposal for about 4.1 hours of employee work time per resident day, meaning that a home with 25 residents would require 18 staffers (times 4.1 hours per resident day = 175 hours per week, divided by 40 hours per week = 17.9 employees).

Instead, the Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards of 0.55 hours per resident for registered nurses and 2.45 HPRD for nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock.

"The combined three hours falls short of what a government analysis two decades ago said was the optimal level for quality care: 4.1 hours per day. It also falls short of the 3.76 total hours that a government study said nursing homes currently provide on average," reports Christopher Rowland of The Washington Post.

The proposal is "a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the Baby Boom," Rowland writes. "Much of the rule would kick in within three years for urban facilities and five years for rural facilities."

The regulation would have major implications for Kentucky, which is farther behind on its nursing-home inspections than any other state but Maryland.

"To address concerns in rural areas where workers are scarce, the Biden administration has provided a series of exemptions in the rule for facilities that can prove they can’t find staff even if they made good faith efforts to recruit and retain workers," Rowland reports. "It plans to pump $75 million into programs intended to bolster the nursing home workforce, such as scholarships and tuition reimbursement."

CMS estimates that the rules would make about three-fourths of nursing homes increase staffing, USA Today reports: "Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found. But a USA Today investigation last year documented how rarely the federal government enforces decades-old staffing guidelines and rules for nursing homes that participate in Medicare and Medicaid."

The regulation "cleared the White House Office of Management and Budget on Tuesday, Aug. 29, the same day a CMS study underpinning the rule was leaked and created a firestorm among stakeholders," Early reports. "The White House budget office also canceled its two remaining stakeholder meetings on the issue in the wake of the leak. The proposed rule had been pending at OMB since May 30. The two meetings were scheduled for the first and second weeks of September. The meetings were requested by the Organization of Nurse Leaders and the Association of Jewish Aging Services."

Early notes, "The nursing-home industry has lobbied hard against staffing minimums and has called for a White House event to explore alternatives, but patient advocates have backed staffing minimums."

LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the propsoed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

Free-market economist says certificates of need shouldn't be required for health facilities; hospitals, nursing homes disagree

John Garen (Lantern screenshot of KET legislative video)

By Sarah Ladd
Kentucky Lantern

Kentucky would be “well served by the improved access to health care” if it were to repeal its certificate-of-need laws, a retired economics professor told a legislative task force charged with examining the state’s CON structure.

University of Kentucky Professor Emeritus John Garen, who said he was speaking as an independent researcher, told legislators Aug. 21 that “the arguments made to justify certificate of need do not stand up to careful examination.”

“We should not have certificate of need on health-care services in general,” said Garen, who made his reputation as a free-market economist.

The certificate-of-need requirement mandates regulatory mechanisms for approving major capital expenditures and projects for certain health-care facilities, according to the National Conference of State Legislatures.

Sometimes called the “competitor’s veto,” 35 states and Washington, D.C., had such laws as of December 2021.

CON laws were passed with the notion that demonstrating a need for a health-care facility or service would prevent overbuilding and hold down costs, but Garen said the laws do not reduce health-care costs in general or improve quality care to underserved populations.

The Kentucky Association of Health Care Facilities, the Kentucky Home Care Association and the Kentucky Hospital Association previously testified before the task force that removing the CON review process would neither lower the cost of care nor improve its quality.

Proponents of keeping Kentucky’s CON rules in place argue that should they be repealed, competitors popping up would take away revenue-producing patients from hospitals, forcing closures or discontinuation of some services.

Sen. Stephen Meredith, R-Leitchfield, a former hospital adimistrator, said Kentucky can’t easily be compared to other places and must also be examined outside of the “average.”

“If we relied on ‘average,’ no one would ever drown in the Rio Grande,” Meredith said. “In the summertime, the average depth is three foot. Kentucky is not average. We get a lot of outlying situations, particularly for the poverty that we have in rural Kentucky, and even some of our urban areas have suffered the same problems.”

Representatives from Northern Kentucky’s St. Elizabeth Healthcare also testified, saying they support modernization of CON laws but not an outright repeal.

Mark Guilfoyle, an attorney with the Louisville firm DBL Law, who spoke alongside St. Elizabeth executive Sarah Giolando, said “certificate of need provides significant benefits,” such as access to care in rural areas.

Guilfoyle said the certificate-of-need law also reduces the need for more tax revenue for emergency medical services and incentivizes providers to serve disadvantaged patients and areas.

The next task force meeting is Sept. 18.

Kentucky is next to last in currency of nursing-home inspections, and it may not have hit bottom yet, health officials tell legislators

Kentucky is farther behind on nursing-home inspections than only one other state, and the huge backlog might last a long time, Beshear administration officials state officials warned a legislative committee Tuesday. That could leave health and safety problems undiscovered, reports John Cheves of the Lexington Herald-Leader.

“We’re waaay behind,” Health and Family Services Secretary Eric Friedlander told the Health and Human Services Delivery Task Force. “It’s gonna take us, if we’re lucky, a year to dig out of this.”

There are many reasons, he said, including the pandemic, but the main one is a lack of registered nurses, who "form the backbone of the health cabinet’s inspection teams," Cheves reports. Adam Mather, the cabinet's inspector general, said only 30 of the 83 nurse inspector positions are filled.

Adam Mather (KET image
via Lexington Herald-Leader)

“As a nurse myself, I’ve never seen a more challenging environment for the profession,” Mather said. “We’re just unfortunately, nationally, we’re not educating enough nurses to provide the care that’s needed in the country.”

The task force co-chair, Sen. Stephen Meredith, R-Leitchfield, said “We’ve got a very serious issue that kind of caught us by surprise.”

Cheves notes, "The Herald-Leader reported in July that 73 percent of Kentucky’s 277 nursing homes were listed as going more than two years without a so-called 'annual' inspection. According to federal data, only Maryland had a larger backlog, at 75 percent. The national backlog average is 11 percent." The figures come from the federal Centers for Medicare and Medicaid Services, which requires states to inspect nursing homes each year.

"Gov. Andy Beshear’s administration is trying a variety of possible solutions, including pay raises that have bumped the nurse positions from about $50,000 a year in 2020 to a salary range of $72,328 to $95,834," Cheves reports. "It’s also using private contractors to recruit nurses to the health cabinet and even to perform some facility inspections. And it’s creating a new career ladder at the health cabinet to allow licensed practical nurses, with less formal education than registered nurses, to be hired and advance while on the job, the officials said. In the meantime, as it works to reduce the inspection backlog, the cabinet will prioritize nursing homes that have a history of more serious citations or complaints, Mather said."

But Friedlander still isn't sure what they're doing will work. “I’m hoping we are at the nadir,” he said. “I’m hoping we’re at the bottom. But I cannot swear it to you all. It has been a tremendous challenge retaining and hiring nurses, and that’s exactly where we are.”

Libertarians want to repeal 'certificate of need' permit process for health-care facilities; they say it needs reform, not repeal

Kentucky Health News

Should Kentucky have a permitting process for health-care facilities or allow free-market competition? Or something in between? The General Assembly has begun debating the question, amid lobbying from a national libertarian group and health-care facilities that say unfettered competition would further complicate heath care and put some of them out of business.

When stand-alone birthing centers wanted an exemption from the state's "certificate of need" law this year, the legislature said no, but created a task force to examine the law and how it works. The task force heard July 17 from lobbies for hospitals, nursing homes home-health services and hospices, who think the law should be improved but not repealed, Sarah Ladd reports for the Kentucky Lantern. (This article is based mainly on her story.)

Nancy Galvagni

Without certificate of need, some facilities could close or stop offering services that don't make money, Kentucky Hospital Association President Nancy Galvagni told the task force. She said most services “are provided at a loss and must be subsidized by the few services from which hospitals derive revenue, such as elective surgery and . . . outpatient imaging. This is how hospitals pay for services such as behavioral health, obstetrics, emergency care, trauma care, and oncology, just to name a few.”

Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”

Tim Veno, president of Leading Age Kentucky, a lobby for nonprofits that provide aging services, told lawmakers that “over-duplication of health services can have multiple negative effects” on nursing homes. Too many nursing-home beds in an area could cause a home to close, or make staffing challenges worse, he said.

Home-health services also have staffing issues the inability to compete with hourly wages offered by places like Amazon and Target, said Evan Reinhardt, executive director of the Kentucky Home Care Association.

Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.

The week before the task force met, Americans For Prosperity promoted repeal of the certificate-of-need law at an event in Northern Kentucky. AFP is one of the groups funded by energy mangnate Charles Koch of Wichita, known for his spending on libertarian, conservative and Republican causes.

"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY (republished in the Kentucky Lantern).

AFP says it recently got the process repealed in South Carolina after 10 years of lobbying. "Kentucky is one of 35 states and the District of Columbia that operate certificate-of-need programs, which vary widely among the states, according to the National Conference of State Legislatures," Payne reports.

State Rep. Marianne Proctor

One speaker at the Northern Kentucky event was state Rep. Marianne Proctor, R-Union, who has field a bill to repeal certificate of need for Boone, Kenton and Campbell counties.

“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”

The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:

• Reform the application and appeals process to save time, allowing providers to apply at any time, and have shorter hearings.
• In formal-review cases, require written statements saying why an application shouod be rejected.
• In expedited-review cases, limit challenges to the issue of need and whether the applicant qualifies for expedited review.
• Allow hospitals to provide services at an additional location in the same county without an additional certificate.
• Allow hospitals to get expedited review for converting beds to adult psychiatric care if the county has no such hospital.

The next meeting of the task force is scheduled for 10:30 a.m. Aug. 21. It is seeking public input by Sept. 1; to submit a written statement, email DeeAnn Wenk at deeann.wenk@lrc.ky.gov.

State, far behind on nursing-home inspections, focuses on responding to complaints, but that often takes too long

Lexington Herald-Leader graph by John Cheves; click to enlarge

"As of June, 73 percent of Kentucky’s 277 nursing homes were listed as going more than two years without a so-called 'annual' inspection. It’s putting patients at risk," the Lexington Herald-Leader reports. The national average is 11%.

The federal government, which "essentially funds the American nursing home industry," requires annual, multi-day inspections "to catch problems early, before they get serious enough for residents to be hurt, sickened or killed," John Cheves reports. "But because of a dangerous shortage of inspectors — the worst in the United States, according to one report — Kentucky hasn’t reliably performed standard surveys since the Covid-19 pandemic shut down the state in spring 2020."

All this means "scant oversight at long-term care facilities, typically owned by for-profit corporate chains and where many thousands of vulnerable Kentuckians live every day," Cheves writes. "The delays also erode the accuracy of Nursing Home Compare, the quality rating website" of the federal Centers for Medicare and Medicaid Services. "It’s based largely on state inspections. Families consult this website before picking a nursing home for their loved ones. They are referred to it by the state health cabinet and respected experts at AARP and the National Institute on Aging. Even before the current inspection backlog, Kentucky nursing homes had among the worst collective ratings in the country. In 2018, 43 percent were rated 'below average' or 'much below average' by CMS."

Officials of the state Cabinet for Health and Family Services declined to be interviewed, and "also declined to answer most written questions the newspaper submitted over the next two months about Kentucky’s nursing home inspection backlog and the reasons for it," the Herald-Leader reports. "In a brief statement, health cabinet spokeswoman Susan Dunlap said the cabinet acknowledges an inspection backlog has been created in Kentucky since the pandemic.

Dunlap said the state is working to address the backlog "by raising salaries for inspectors in an effort to boost hiring and retention," Cheves writes, and is concentrating on “complaint surveys,” which are more focused visits "to look at a specific grievance about care that can be filed by residents, their families or others. . . . However, it can take two to three years for complaint surveys to work their way through their own separate backlog, said nurse Barbara Lear, a Kentucky nursing-home inspector who quit last summer. By the time inspectors finally arrive at a facility to investigate an old complaint, Lear said, residents involved in the case likely have died, and the employees no longer work there and might not want to speak to state officials about the allegations."

Cheves reports, "State records show that last year, Kentucky inspectors received more than 1,700 of the most serious kinds of complaints, classified as 'immediate jeopardy,' up from about 1,000 in 2018. The percentage of complaint surveys started in the 'federally required time frame' — within a matter of days — fell from 85 percent to less than 4 percent during this period."

Ky. nursing-home company closes 2 Louisville homes, agrees to pay $1 million penalty; inspectors found rodent infestation and filth

Exceptional Living Centers of Lexington, which operates several Kentucky nursing homes. "has agreed to close two of its Louisville facilities, displacing roughly 200 people, after state inspectors uncovered serious problems over the past six months, including a rodent infestation, filthy living conditions and a general lack of care for the elderly and ailing residents," John Cheves reports for the Lexington Herald-Leader.

The company and the federal government entered a settlement last week in U.S. District Court "to voluntarily terminate its Medicare provider agreements at Hillcreek Rehabilitation and Care and St. Matthews Care and Rehabilitation Center. Such a loss is typically a financial death blow for a nursing home," Cheves reports. "The company is working closely with state and federal officials to transfer residents of Hillcreek and St. Matthews to other nursing homes around Jefferson County by July 6, according to its closure plan, obtained by the Herald-Leader. The company also agreed to pay civil monetary penalties of $1,026,408 to the U.S. Centers for Medicare and Medicaid Services."

Inspection reports of the state Cabinet for Health and Family Services, "which inspects nursing homes on behalf of the federal government . . . cited a persistent rodent infestation; unheated bedrooms in freezing winter months; filthy living conditions, including dirty bathrooms, the lingering stench of urine and feces, and trash cans overflowing with adult diapers; a lack of clean linens; blood-testing equipment that was not sanitized between use on different patients; and direct-care employees hired despite having disqualifying criminal records," Cheves reports.

Hillcreek Rehabilitation and Care (H-L photo by Marcus Dorsey)

At Hillcreek, 3116 Breckenridge Lane, "Residents complained that staff did not check on them overnight, between 7 p.m. and 7 a.m., leaving them 'humiliated' and 'feeling dirty' in soiled pajamas and sheets because nobody responded to their calls for assistance, inspectors wrote. A resident who fell in his unheated room the day after Christmas lay uncovered on the floor for more than three hours until he finally was discovered, inspectors wrote. Emergency medical workers described his skin as 'freezing cold.' He died 10 days later at the hospital of hypothermia, they wrote."

The reports say residents and staff told inspectors they were scared by mice and rats scurrying through parts of Hillcreek, "including bedrooms and on a resident’s bed, and by hearing them skitter and shuffle on the floors," and one resident required medical care after a rat bit his thumb, Cheves reports. Inspectors found rodent feces near a nurse's station, and one rat was so familiar that housekeeping staff gave him a nickname, “Ben,” inspectors reported. One nurse “stated the rats were ‘huge’ and as big as cats,” inspectors wrote.

"Hillcreek, which already had a history of critical state inspections, has been hit with about a dozen negligence or wrongful death lawsuits filed by residents’ families since 2021. It is rated with one star, or 'much below average,' on Medicare’s Nursing Home Compare website," Cheves reports.

"At St. Matthews, inspectors cited abuse of residents, including 'a severely cognitively impaired' female resident whom police determined to have been sexually assaulted at the facility, and a resident who said she or he was hit by an employee but whose assault allegation was not reported up the chain of command, as required. As at Hillcreek, inspectors said St. Matthews used blood-testing equipment on different patients without sanitizing it, risking the spread of infectious diseases and blood-borne pathogens, and it hired direct-care employees despite 'disqualifying events' in their past, such as a social services assistant with a conviction for physical harassment."

Exceptional Living Centers President Tom Watts declined to comment to the Herald-Leader, as did the company’s lawyers. The firm continues to operate these facilities listed on its website: Bluegrass Senior Living in Somerset, Clifton Oaks Care Center in Louisville, Green Hill Rehabilitation and Care in Greensburg, Lyndon Woods Rehabilitation and Care in Lyndon, Stanford Care and Rehabilitation, Frankfort Care and Rehabilitation, and Vanceburg Rehabilitation and Care. 

Beshear increases Medicaid reimbursement rates for home and community-based services and long-term care facilities

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear has raised Medicaid reimbursement rates for home and community-based services and long-term-care facilities to help them deal with inflation, workforce shortages and the effects of Covid-19.

"We have a duty to make sure those who need in-home care, community-based care and long-term care get the services they need and the services they deserve," Beshear said at his weekly news conference Thursday. "This increase will provide some interim financial relief for organizations that take care of our parents and our grandparents. And right now they need our help, and we need to be there for them."

Most of the money for the increase will come from the federal government, which funds about 70 percent of traditional Medicaid spending. The state share "is able to fit within our current appropriated budget without the need for additional state funds," said Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services. "The current Medicaid spending trends allow the cabinet access to funds to increase the Medicaid rate."

Dunlap noted that the cabinet "is required to adjust price-based nursing facility rates for inflation every July 1. During the budget process, the cabinet accounts for an inflationary increase in our projections for the inflationary adjustment."

The nursing-home adjustments are retroactive, to make up for underestimated inflationary increases that were provided in the last three years, Beshear said. This will result in $99.6 million more for nursing homes in the next fiscal year, which ends June 30, 2024. The state's share will be $18.9 million. 

The adjustment for home and community-based services will be for services that were delivered from Jan. 1, 2022, to May 1, 2023, at an additional cost of $13 million, according to a news release.  

The main lobbying group for nursing homes and assisted-living facilities told Kentucky Health News that it is expecting an overall adjustment of about 8 percent, and that it will vary from facility to facility. 

Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, praised the governor's action, calling it "welcome relief" for struggling long-term care facilities that have been sounding the alarm about the skyrocketing costs required to keep their residents and patients safe and healthy. 

Betsy Johnson

“We are grateful for Gov. Beshear and his administration," Johnson said. "The pandemic had devastating effects and worsened the staffing crisis we were already facing. This funding will be paramount to providing quality care to residents and patients as well as building the foundation for a brighter future.”  

John Muller, chief operating officer for Carespring Healthcare Management in Northern Kentucky, thanked Beshear and his team at the news conference. Muller is also a KAHCF board member. 

“Nursing facilities were on the front lines of the Covid pandemic. The last number of years have been very, very difficult," Muller said. "And as we are coming out of the pandemic, the aftershock is the workforce challenges that we're facing. Nursing facilities are lagging far behind on catching up in the workforce. These much-needed funds will go a long way for the residents we serve . . . as well as the team members we need to retain and the new ones we need to recruit.”

David McKenzie, administrator and owner of The Jordan Center in Louisa, conveyed an urgent need for these increased funds in a letter to Health and Family Services Secretary Eric Friedlander on March 28. He painted a picture of his facility's dire financial situation and asked for a "funding bridge" to allow nursing homes to survive until July 1, 2024, when their rates are scheduled to be recalculated. 

"Our facility will not make it if we don't receive a funding bridge July 1, 2023," McKenzie wrote. "We have never seen price increases like this in our 49 years of business! In February 2022, we had to close half of our facility because we only had enough staff to operate 60 beds and maintain our 5-star staffing rating." 

Beshear has also committed to rebasing the Medicaid rate effective July 1, 2024, but that would require appropriations from the General Assembly next year, and Beshear's term will end late this year unless the voters given him a second four-year term in the Nov. 7 election.

"We're dealing with an election. We're dealing with a budget session. So there are lots of things for us to address," Johnson said. "But as you just stated, right now, where it stands, we understand that the current administration and the Kentucky legislature are very sympathetic to our challenges and we believe that we can all work together so that this money will be appropriated." 

Johnson said nursing homes have received inflation-based increases every July 1, but in many years the raise was only 0.1%, and since 2008 the state has not "rebased" their rates by looking at their cost reports to determine the true cost of running a nursing home. Those costs, she said, have gone up significantly. 

The $29 pandemic boost, which the legislature adopted, was an add-on to the basic rate. It "continues to be a lifesaver for our skilled nursing facilities and the residents that they serve," Johnson said. But she also says it's not enough, and it's time to rebase their rates.

"This funding is a good first step toward getting us back on our feet," she said, adding later, "If you ask any one of our member providers, when we say, 'Oh, post-pandemic world or post-Covid,' they will look you in the eye and say, 'Betsy, we're still in it' because the struggles are real. It has forever changed the way they operate and the staff that they need. It's very, very important that we should all, as Kentuckians, be invested in this taking care of our elderly, and our most vulnerable citizens."

59% of residents, just 16% of staff in Ky. nursing homes have had Covid-19 booster shots; both rates slightly above national rates

Centers for Disease Control and Prevention photo

By Melissa Patrick
Kentucky Health News

While Kentucky nursing homes' Covid-19 booster rates are higher than the national rates, many staff and residents remain vulnerable to the disease because over 80% of staff and nearly 40% of residents have not received booster shots.

In the week ending April 9, there were 116 new confirmed cases of Covid-19 among Kentucky nursing-home residents, or 5.9 cases per 1,000 resident-weeks; there were 54 cases among staff, or 2.8 cases per 1,000, according to the Nursing Home Vacciation Data Dashboard of the Centers for Disease Control and Prevention.

Through the week ending April 2, reports from about half of Kentucky's nursing homes showed that 59% of their residents were up to date with their Covid-19 vaccines, which means they had received the latest bivalent booster dose or have completed the primary series of vaccines in the last two months.  This was higher than the nationwide rate of 54%. 

Staff rates were much lower. In the week ending April 2, 16% of Kentucky's nursing-home staff were up to date with their Covid-19 boosters, which was still higher than the national rate of 12%. 

That said, 89% of Kentucky nursing-home residents and 42.5% of staff have completed their primary Covid-19 series and received an additional primary or booster shot – just not the recommended bivalent one.

The CDC recommends that people stay up to date with Covid-19 vaccines by completing a primary series and receiving the most recent booster dose for their age group.

At this point in the pandemic, much of the effort to get nursing home residents and staff boosted falls to the facilities.

Susan Dunlap, spokesperson for the Kentucky Department for Public Health, told Kentucky Health News that the department still offers several services to help nursing homes and other long-term care facilities promote Covid-19 vaccinations among residents and staff. 

"KDPH staff are available to provide in-service education and training to residents and staff regarding the safety and benefits of being vaccinated," Dunlap said in an email. "Regional infection preventionists can assist facilities with obtaining vaccines and conducting vaccine clinics by connecting facilities with community provider partners such as pharmacies and other healthcare facilities. Staffing support for vaccine clinics is also available to long-term care facilities by request through a KDPH Nurse STRIKE Team comprised of five nurses who can assist with clinic logistics and vaccine administration." 

While residents and staff in Kentucky's nursing homes are still getting Covid-19, there are fewer deaths from it. 

In the week ending April 9, the Covid-19 death rate among residents in Kentucky nursing homes was 0.1 per 1,000 residents.  But even though this rate is low, it's important to remember that seniors in nursing homes are among the most vulnerable to the disease. 

Virus found by swabbing floors: A recent study found that one way to detect the coronavirus in congregate settings is to do regular floor swabs.  

The study, published in The New England Journal of Medicine in February, found that regularly sampling floor surfaces for the virus in long-term care homes could improve detection of it. 

The researchers sampled floor surfaces in multiple locations weekly in 10 long-term-care homes between September 2021 and November 2022 and analyzed the samples for the presence of the virus. 

They found that "the percentage of positive swabs increased in the days and weeks before an outbreak was declared [and] the percentage of positive swabs also decreased in the days and weeks after an outbreak was declared."

The authors conclude that the detection of virus from these floor swabs "was strongly associated with Covid-19 outbreaks" and that the prevalence of positive floor swabs declined after the cessation of the outbreak. 

"Swabbing the built environment, similar to wastewater surveillance, may provide another tool for infection prevention and control for combating Covid-19 in congregate settings," they write. "Future studies evaluating the implementation and generalizability of this approach are needed."

Covid-19 booster rates in nursing homes lag, especially among staff, and especially in Ky., where rate is among nation's lowest

National Council on Aging photo

By Melissa Patrick
Kentucky Health News

Covid-19 booster rates lag in both nursing-home residents and staff, but especially among the staff.

A Kaiser Family Foundation analysis found that while over 85% of nursing home residents and staff were "fully vaccinated" last month, only 74% of residents and 51% of staff had received at least one booster shot or an additional dose. 

Kentucky's numbers were similar, except that staff booster rates were much lower than the national rate. 

Using Centers for Medicare & Medicaid Services Covid-19 Nursing Home Data from August 2021 to Sept. 18, Kaiser found that only 37% of Kentucky nursing-home staff had received at least one booster shot or an additional dose, placing Kentucky among the 10 worst states for staff boosters.

The analysis showed Kentucky's nursing-home residents were much more protected, with 74% of them having received at least one booster or an additional dose. 

Asked what Kentucky is doing to improve these numbers, Susan Dunlap, spokesperson for the Cabinet for Health and Family Services, first noted in an email that more recent data show that 43% of nursing-home staff in the state have been boosted.

Dunlap cautioned that punitive measures to increase Covid-19 vaccination and booster rates among staff could hurt the facilities: "Imposing fines or other responses for the flattened compliance rates for [vaccinations] doesn’t seem productive, given staffing challenges that facilities are grappling with."

The nursing-home lobby, the Kentucky Association of Health Care Facilities, agreed with the cabinet. KAHCF said its members have been working to improve booster rates by providing frequent clinics in their facilities and regularly communicating with their staff about the need to maintain safety for themselves, their co-workers and the residents for whom they care. 

"Historically, we have seen our long-term care vaccination rates mirror the community rates," Emily Weber, director of communications, marketing and public affairs for the association, said in an e-mail. 

Karen Venis, CEO of Sayre Christian Village in Lexington, which offers a range of housing and care options for seniors, said her facilities continue to stress the importance of Covid-19 vaccines and boosters as a way to protect this most vulnerable population from a virus that is a great health and safety risk to them.

"We continue to provide ongoing education to our staff and residents and do everything we can to encourage them to get the vaccine and/or the booster, including going the extra step of hosting on-site vaccine clinics on a regular basis so that we meet people where they are and make it more convenient for them," Venis said. 

At The Jordan Center in Louisa, vaccination rates were high early on. In an interview, owner David McKenzie said several strategies contributed to that: establishing a culture of trust to thwart misinformation, allowing time for private discussions to assess concerns, working with community partners such as health departments, and identifying "unofficial influencers" inside the facility. 

On its website, this nursing home thanked its staff for getting vaccinated.

"It takes good, old-fashioned, one-on-one communication, just sitting down with people," McKenzie said. "That's what it really really takes. . . . If they're fearful, then what are they afraid of?" 

He added that people can't be forced to take the vaccines and are more likely to listen to someone they know and trust than the government or a corporation. (Most Kentucky nursing homes are owned by non-family corporations.)

McKenzie said 93% of his residents are "up to date" with their Covid-19 vaccinations, meaning they have received a booster, and that 94% have received their primary series. He said 95% of staff had received their primary series and 40% were up to date with boosters. 

"I have to admit that it's getting harder and harder to get people to take the boosters," he said. 

McKenzie offered several theories for this. He said some staff had already gotten a booster and been infected with the virus, which makes them think they are immune and don't need it, which may not be the case.

Others, he said, have told him that it could be a branding issue – that staff would respond better to the booster if it were called an annual vaccine.  

McKenzie added that it has also been a challenge to address the misinformation on social media and elsewhere on the internet about the vaccines, and that his center has worked from the very beginning of the pandemic to establish itself as a reliable source of information for its residents and their families. 

"We wanted them to trust us as a resource for information," he said. "We constantly kept them updated. We constantly tried to find the very best sources for information and then disseminate that. . . . It didn't necessarily happen overnight, but over time I think we built a lot of trust."

McKenzie concluded the interview with a story of vaccine success, noting that his facility recently had its worst Covid-19 outbreak since vaccinations became available – but not one of his residents had died from it and most of those who were infected had mild symptoms or none at all. "It was miraculous," he said. 

The Kaiser foundation stressed the importance of making sure seniors are vaccinated and boosted, pointing to a recent report from the Centers for Disease Control and Prevention that found a second Covid-19 booster dose was 90% effective against death and 74% effective against severe Covid-19 related outcomes for nursing home residents. 

More than one-fifth of all U.S. Covid-19 deaths occurred in long-term care facilities and that death rates from the virus are rising for people ages 65 and older, a recent analysis by the foundation found.

"The number of Covid-19 deaths per month among people 65 and over doubled between April 2022 and July 2022, exceeding 11,000 for the months of July and August," Priya Chidambaram and Alice Burns report for Kaiser. 

The foundation calls for creating new opportunities for on-site vaccinations and updating the federal health-care-worker vaccination mandate to reflect current CDC guidance, saying those steps could increase the number of nursing facility residents and staff who are up to date with their Covid-19 vaccinations.

The CDC’s new definition of “up-to-date” is having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago. Nursing homes started using this new definition in their reporting on Sept. 26, according to the foundation.

Agency that handles Medicare and Medicaid says it will propose a rule next spring for minimum levels of staffing in nursing homes

Photo from RTI.org

Efforts to require minimum levels of nursing-home staffing, which have failed in Kentucky and some other states, are now focused on the federal level, where the Biden administration is working on it.

The Centers for Medicare and Medicaid Services says it will issue a draft rule in spring 2023 after studying the issue and gathering opinions of stakeholders.

CMS says it has received more than 3,000 comments from "advocacy groups; long-term care ombudsmen; providers; labor unions and organizations; nursing home staff and administrators; industry experts and researchers; family members; and caretakers of nursing-home residents," reports Bridget Early of Inside Health Policy.

"A vast majority of the comments CMS received from families, beneficiary advocates and caretakers of nursing home residents highlighted deep concerns about unsafe care stemming from a lack of staff," Early reports. CMS said, “Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers.”

The nursing-home industry told CMS "that staffing in nursing homes has not rebounded from the Covid-19 pandemic and recruiting is a challenge -- and facilities will allegedly have to close because they are unable to meet minimum staffing levels," Early reports.