National Academy of Science Calls for Bold Reform of Nursing Home Care

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On April 6, 2022, the National Academy of Sciences, Engineering and Medicine’s Committee on the Quality of Care in Nursing Homes released a 605 page report – The National Imperative to Improve Nursing Home Quality; Honoring Our Commitment to Residents, Families and Staff – that is meant to be a blueprint for desperately needed reform of nursing home care. The Committee, which began its work in the fall of 2020, considered the daily travesties occurring in nursing homes during the pandemic and the decades of dangerously poor care and staffing that preceded it. Declaring that “as a nation we have made promises for better care in nursing homes, and those promises have not been kept,” it calls for “moral courage” to implement a wide-ranging set of recommendations.

The report concludes that “the way the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented and unsustainable.” It seeks immediate action to initiate fundamental change.

Many of its recommendations are very similar to President Biden’s nursing home reform agenda released on February 28. The Committee recommends studying and setting minimum federal staffing standards, requiring 24-hour RN coverage 7 days a week, and mandating full-time social workers with a minimum of bachelor’s degrees in social work. Multiple recommendations address empowering, training and supporting CNAs, along with ensuring that they and other nursing home workers receive competitive wages and benefits. It seeks incentives to provide smaller, more home-like environments and to ensure nursing homes are better prepared to respond to emergencies and natural disasters. There are detailed sets of recommendations on improving oversight, enforcement, and transparency of ownership and financing. And many more.

The New York Times published a thought-provoking interview with Betty Ferrell, a palliative care expert in California who chaired the Committee for the National Academies. Dr. Ferrell told the Times the nation cannot look away any longer on what is going on in nursing homes, while expressing outrage that the nursing home industry is able to profit in such a significant way without providing quality care. Encouragingly, she spoke in favor of reforms to prevent owners with poor track records from acquiring more nursing homes and to ensure funding to nursing homes is going toward the care of residents. California legislators are currently considering bills to establish such reforms through CANHR-sponsored AB 1502 on ownership reform (Muratsuchi and Wood) and CANHR-supported AB 2079 on direct care spending (Wood).

Read the April 14, 2022 New York Times interview: Nursing Homes Are in Crisis. We Can’t Look Away Any Longer.