How many more workers nursing homes can afford remains a mystery even though the industry is the most tightly regulated type of health care provider. For-profit nursing homes, which are the majority, often appear poorer than they are because their owners shift money to themselves through rent or management fees paid to corporations they also control. These convoluted networks are often impossible to untangle with the information the government collects.
Much of Biden’s plan promises to dig deeper into the finances of homes and make that information publicly available. “It’s just been so complicated,” said David Grabowski, a professor of health care policy at Harvard Medical School. “They’re going to finally determine who owns this building, what the arrangements are there, how the dollars really flow. That’s essential. We should have done this years ago.”
The proposal would also task the government with examining the role of private equity and real estate investment trusts in buying and selling facilities. Some studies have concluded that ownership by those types of investors leads to smaller budgets and worse care. And Biden is calling for tracking the quality and finances of nursing home chains, in addition to facility by facility as is the current practice.
“We’ve been urging that for 15 or 20 years,” said Charlene Harrington, a professor emeritus at the University of California-San Francisco School of Nursing. Harrington, who has long pushed for staffing increases and better financial disclosure, said, “Everything’s going to hang on the implementation, but I’m so happy they’re going to focus on the transparency issues.”
The administration said it wanted Congress to give it the authority to ban from the Medicare and Medicaid programs facilities owned by people or corporations with terrible track records of running facilities. And Biden is asking Congress to give CMS almost $500 million more for inspections, a 25% increase, and hike the maximum fine for an individual violation from $21,000 to $1 million. That particularly targets habitually poor-performing facilities, which are subjected to more intense oversight through the Special Focus Facility program. A 2017 KHN investigation found that more than half of homes in the program harmed patients or put them in serious jeopardy after CMS declared them improved.
Most of the changes will not require congressional approval. And the administration said it would “explore” increasing the use of fines deployed each day a home is in violation, an approach that the Trump administration had limited.
For past coverage of issues about nursing home quality see these stories from KHN’s “Neglect Unchecked” series:
Care Suffers As More Nursing Homes Feed Money Into Corporate Webs
‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records
Medicare Takes Aim At Boomerang Hospitalizations Of Nursing Home Patients
Infection Lapses Rampant In Nursing Homes But Punishment Is Rare
Half The Time, Nursing Homes Scrutinized On Safety By Medicare Are Still Treacherous
[Correction: This article was revised at 10:25 a.m. ET on March 2, 2022. It originally said the Biden administration would increase the maximum fine for nursing home violations without congressional approval. The administration said it is asking Congress for that change.]
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