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 AHCA Head Vows to Continue Upward Trajectory on SNF Quality, Safety

Mark Parkinson, president and chief executive officer of the American Health Care Association (AHCA) told a July 23 hearing of the Senate Finance Committee focused on abuse and neglect in skilled nursing facilities (SNFs) that even one case of a resident being endangered is one too many. He said the profession wants to partner with lawmakers to ensure safe, quality care.

Speaking as a witness at the committee’s “Promoting Elder Justice: A Call for Reform” hearing, he said negative findings in a newly released Government Accountability Office (GAO) report will be studied and responded to in due time. The GAO report follows an Office of Inspector General (OIG) report from June that also cited lax safety protocols and reporting standards across the country at SNFs.

Parkinson said as a former nursing facility owner and operator he knows well the challenges of providing quality care to residents but stressed “no level of abuse and neglect can be tolerated” in facilities where the important work of caring for the nation’s frail elders occurs.

“Abuse and neglect have no place in the nursing home setting or in any health care setting,” he said. “While even one report of abuse or neglect is one too many, the facts show that such instances are rare, and the overwhelming majority of nursing home staff provide high-quality resident care.”

Parkinson said that in the past seven years, both the quality of care and methods used in SNFs   have improved dramatically. “We will continue to work with stakeholders to identify reforms that will further improve the lives of America’s elderly, including policies that help facilities retain more high-quality staff, bring more transparency to abuse and neglect reporting, and provide consumers additional information to help them make informed decisions,” he said.

In testimony, Parkinson said to further increase the security of SNF residents there are legislative and regulatory changes AHCA supports to make it easier for providers to avoid hiring potential bad actors, for example. While states can identify possible problem hires in their own state, they cannot for those people moving from state to state, he said.

“We have asked repeatedly for facilities to have access to the National Practitioner Data Bank so that we can better vet individuals before hiring them. No one—not you, not I, not anyone—wants sexual predators or those with tendencies to injure the frail to be employed by any nursing facility,” Parkinson said.

He said there is also the need for federal action to standardize what abuse and neglect means across the health care spectrum and end the current setting-by-setting definitional differences. 

In calling the hearing, Senate Finance Committee Chair Charles Grassley (R-Iowa) said more needs to be done for protecting elders. Author of the Elder Abuse Prevention and Prosecution Act signed into law in 2017, the senator said additions to the act may include improved background checks as one of the reforms.

Grassley said the new GAO and OIG reports show that even more needs to be accomplished at the federal level to make sure oversight of SNFs is working.

John Dicken, director, health care, GAO, said the new GAO report, “Nursing Homes: Improved Oversight Needed to Better Protect Residents from Abuse,” GAO-19-433, testified that “while nursing home abuse is relatively rare, our review shows that abuse deficiencies cited in nursing homes are becoming more frequent, with the largest increase in severe cases.”

He said this increase may be because of more awareness of such issues or more severe staffing challenges and noted that “it is imperative that CMS [Centers for Medicare & Medicaid Services] have more complete and readily available information on abuse to improve its oversight of nursing homes.”

Dicken also said it is essential that CMS require state survey agencies to immediately report incidents to law enforcement if they have a reasonable suspicion that a crime against a resident has occurred in order to ensure a prompt investigation of these incidents.

From the OIG point of view, Megan Tinker, senior advisor for legal review, Office of Counsel to the Inspector General, said the three key takeaways from her testimony are that CMS, states, and providers should use data to ensure potential abuse and neglect is being identified.

Second, she said CMS, states, and providers must ensure potential abuse and neglect is reported to enable oversight and prevention, and lastly, states must ensure deficiencies are corrected.

As to further steps the SNF profession would like to see to improve quality of care, Parkinson cited previous recommendations AHCA made to the Finance Committee as a starting point for discussion.

Among the suggested changes backed by AHCA is that CMS more quickly probe abuse and neglect when initial problems surface. “Indeed, if there is abuse, CMS should want to capture it quickly rather than allow a situation to fester. The nursing home community agrees,” he said.

AHCA also sees workforce challenges as a root cause for many of the abuse and neglect incidents, notably in rural areas where the strong economy has made it all the more difficult for SNFs to hire, engage, and retain skilled, talented, and suitable staff to care for this frail and vulnerable population.

“We need your help [lawmakers]; we cannot solve this problem alone. We are thinking creatively about solutions, such as a loan forgiveness program,” Parkinson said. “At the same time, and as reported by the Medicare Payment Advisory Commission in 2018, nursing homes have no extra room to increase costs compared to the reimbursement they receive from Medicaid and Medicare—which cover three-fourths of residents in nursing homes.”

Indeed, during the hearing, committee member Sen. Mark Warner (D-Va.) said SNF margins of less than one half of one percent on Medicaid reimbursement certainly play a significant role in the ability of providers to find good workers. He said that talk of cuts to Medicaid funding, possibly through block granting of federal outlays, would put further downward pressure on margins and make it all the harder to find and retain quality employees.

Parkinson said a final AHCA recommendation is the need for a mechanism for public reporting on resident and family satisfaction. Nursing facilities are the only sector without a CMS reporting requirement on satisfaction.

“Making consumer satisfaction information available to families and future residents will go a long way toward enhancing transparency regarding the operation of a nursing home,” he said.

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