National Academies Release Recommendations for Improving Nursing Home Quality

The National Academies of Sciences, Engineering, and Medicine on April 6 released a highly-anticipated and comprehensive study of the challenges facing nursing homes in the United States.

The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff examines how our nation delivers, finances, regulates, and measures the quality of nursing home care with particular emphasis on challenges that have arisen in light of the COVID-19 pandemic. 

The National Academies (NASEM) are private, nonprofit institutions that work to provide independent analysis of complex problems to inform public policy decisions. A committee convened by NASEM met over eighteen months. A resulting 600-page report identifies seven broad goals and an interrelated set of recommendations to provide an overarching framework for improving the quality of care in nursing homes. 

The committee notes that how the U.S. finances, delivers, and regulates care in nursing home settings is "ineffective, inefficient, fragmented, and unsustainable" and calls for immediate action and fundamental changes "to move the nation closer to making high-quality, person-centered, and equitable care a reality for all nursing home residents, their chosen families, and the nursing home staff who provide care and support them in achieving their goals."

This highlights resource summarizes the committee’s conclusions and goal statements, and this summary details thirty-five specific recommendations. The goals are both short- and long-term. The report calls for all stakeholders – federal and state governments, nursing homes, health care and social care providers, payers, regulators, researchers, and others – to take action.

The Committee’s recommendations cover a wide range of ground, including:

  • Research to identify the most effective care-delivery models and actions to ensure emergency management agencies involve and support nursing homes when needed.
  • Payment of competitive wages to nursing home workers, establishment of minimum staffing standards, and advancement and expansion of the role of the CNA.
  • Action to ensure that Medicaid payments are at an adequate level to cover the delivery of comprehensive, high-quality, and equitable care by all providers to nursing home residents across all domains of care.
  • CMS efforts to ensure that state survey agencies have adequate capacity, organizational structure, and resources to fulfill their current nursing home oversight responsibilities for monitoring, investigation, and enforcement.
  • Incorporation of additional quality measures into Care Compare, including resident and family experience.
  • Providing financial incentives to nursing homes for certified electronic health record (EHR) adoption that supports health information exchanges to enhance person-centered care.

As policymakers consider how to enact the report's recommendations, they must back their actions with sufficient funding to make changes a reality. Medicaid, the dominant payer of long-term care services, doesn't fully cover nursing homes' costs, especially the cost of providing quality care. Without meaningful funding support, the committee's work will be in vain. LeadingAge Minnesota looks forward to working with our national partner LeadingAge and leaders throughout the field to ensure that nursing homes and all aging services providers can provide the high-quality care our nation's older adults need to live with dignity and respect.

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