A Push To Improve America's Nursing Homes

Diane Rehm: On My Mind

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🗓️ 28 September 2023

⏱️ 39 minutes

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Summary

Earlier this month, the Biden administration proposed new staffing standards for nursing homes to help improve conditions for the 1.3 million Americans living in facilities across the country.

Advocates have pushed for this change for decades, but the pandemic highlighted just how critical the situation has become. More than 200,000 nursing home residents and workers died, or about one-fifth of the country’s overall Covid-19 deaths. And by all accounts, overall care plummeted.

“This could be a game changer,” says David Grabowski, professor of health care policy at Harvard Medical School. His research examines the economics of aging, with a particular interest in the areas of long-term and post-acute care. He joins Diane to talk about what this new proposal might mean for quality of care – and why it might not go far enough.

Transcript

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0:00.0	Hi, it's Diane. On my mon, the state of US nursing homes. Earlier this month, the Biden administration
0:15.6	proposed new staffing standards for the industry. Advocates have pushed for this change for decades,
0:23.4	but the pandemic highlighted just how critical the situation has become.
0:30.0	This is probably the most important policy change for nursing homes in decades. So this is
0:35.6	potentially a game changer. David Grabalisky is a professor of health care policy at Harvard
0:42.6	Medical School. His research examines economics of aging with a particular interest in the area
0:51.2	that's long-term care. He joined me to talk about the proposed new standards and how they
0:58.8	might transform a quality of care. David, what is going on with nursing homes today in our country?
1:13.0	Give me some of the problems they're facing. Sure, they're facing a number of problems. So
1:20.9	first, a number of nursing homes are struggling to find staff to work in the building. So first and
1:27.6	foremost, nursing homes are largely about caring for older adults, assisting them with activities
1:34.3	of daily living. If they don't have enough staff, they can't provide this care. There's no
1:40.2	substitution towards technology. The only input into care in most instances is just human labor.
1:47.8	And give me an idea as to why we had these staffing shortages.
1:54.7	Absolutely. So nursing homes are largely reimbursed by Medicare and Medicaid. Medicare is a relatively
2:01.5	generous payer, but Medicaid is not. And so nursing homes have struggled to find workers at
2:09.7	the prevailing wages. Some nursing homes also have very, I'll call them, complicated ownership
2:16.0	structures, Diane, and do not put all of their dollars back into direct care. So we both have an
2:20.8	issue of public payment and maybe underfunding, but we also have an accountability issue in
2:26.9	terms of how nursing homes spend their money. On top of that, we have a job that's really challenging.
2:32.7	So most of the workforce are certified nurse aids. They make close to minimum wage.
2:40.8	They move in and out of healthcare jobs. So they might work at Amazon or McDonald's
	...

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