CMS Revises Nursing Home Visitation Guidance While LTCs Grapple with Worker Shortage

The Centers for Medicare and Medicaid Services (CMS) updated its guidance for nursing home visitations during the COVID-19 pandemic this week. Although the guidance relaxes previous regulations, the agency notes its concern for the vaccination rates of nursing home employees. Unfortunately, unlike most other areas of the medical industry, staffing levels in nursing homes have failed to recover to pre-pandemic levels, according to data from the Bureau of Labor Statistics (BLS).

The CMS changes to Nursing Home Visitation COVID-19 and COVID-19 Survey Activities memo was published last Thursday and lifts restrictions on nursing home visitations. Now, visitations will be allowed at all times with preventative measures like visitor screenings taken by each facility per visit. From the CMS News Alert:

Together with infection prevention safeguards, including the recent staff vaccination regulation, this guidance will promote resident health and ensure continued safety as facilities continue to open.

The agency instructs surveyors to also take a more critical look at nursing staff competency, use of antipsychotics and potential abuse or neglect issues, McKnight’s reports. It instructs surveyors to give special attention to facilities with higher infection rates and lower COVID-19 vaccination rates. It also states that long-term care facilities are not allowed to restrict access to surveyors for proof of vaccination status as a condition of entry into the facility.

Nursing home advocates may be concerned about the higher level of CMS scrutiny on long-term care facilities, especially following new information from the Bureau of Labor Statistics, compiled into an alarming report by the American Health Care Association and National Center For Assisted Living (AHCA/NCAL). The report demonstrates that long-term care facilities are experiencing the worst labor crisis and job loss than any other health care sector due to the COVID-19 pandemic, Managed Healthcare Executive reports.

Long Term Care Industry Facing Worst Job Loss Among All Health Care Providers, AHCA/NCAL November 2021. Source: Bureau of Labor Statistics (BLS) March 2019 – October 2021.

Nursing homes alone have experienced an industry-wide employment level drop of 14% — 221,000 jobs — since the beginning of the pandemic. From Mark Parkinson, president and CEO of AHCA/NCAL:

As many caregivers are getting burned out by the pandemic, workers are leaving the field for jobs in other healthcare settings or other industries altogether. Chronic Medicaid underfunding, combined with the billions of dollars providers have spent to fight the pandemic, have left long term care providers struggling to compete for qualified staff.

Fierce Healthcare notes that nursing homes and assisted living facilities experienced issues with staffing prior to the pandemic, which has since led to employee burnout and early retirements. A recent report from Mercer estimates that 29 states won’t be able to keep up with demand for registered nurses over the next five years.

Staffing concerns are having real-time demonstrable impacts on nursing home investors and operators, Skilled Nursing News reports. For example, Ohio-based operator ProMedica reported a $101.4 million operating loss for the first nine month of the pandemic, and points to staffing issues as a major factor in increased costs. A ProMedica spokesperson told SNN in an email that the difficulty attracting staff is “dramatically increasing our costs” while reducing occupancy.

Payment model adjustments for skilled nursing and long-term care facilities could assist the industry with reimbursement levels and subsequently staffing and overall facility expenses. Health Affairs proposes a new payment model for post-acute care. HA notes that while the majority of nursing home reimbursement is paid through Medicaid, a successful Medicare pilot could translate to state operated Medicaid programs.

Targeted payment reform should emphasize aligned financial incentives for nursing homes and acute care hospitals. A comprehensive care initiative within Medicare could incentivize quality care for beneficiaries transferred from hospitals to nursing homes and address the current nursing home funding gap.

Find the full CMS memo here.