Nursing Homes: LeadingAge Tells Senate More Punishment Won't Work

Legislation | December 10, 2019

With increased congressional attention focused on the long-term services and supports field, LeadingAge has contacted the leadership of the powerful Senate Finance Committee to discuss the many regulatory and financial challenges facing nursing homes.

The committee's jurisdiction includes Medicare and Medicaid, giving it responsibility for nursing home payment systems at the federal level as well as the oversight system under OBRA '87. The committee's Chair and Ranking Member, Senators Charles Grassley (R-IA) and Ron Wyden (D-OR), both have long-standing interest in nursing home issues.

During this year, the committee has held two hearings on long-term care issues involving nursing homes. At both hearings, Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes on March 6 and Promoting Elder Justice: A Call for Reform on July 23, the preponderance of testimony and remarks discussed nursing homes in decidedly negative terms.

Meanwhile, a new Medicare skilled nursing facility payment system has gone into effect and nursing homes face the confusion of the third phase of the new requirements of participation, which are in effect but without guidance on compliance. Furthermore, increasing numbers of nursing homes throughout the country are finding it impossible to continue operating, at least partially due to inadequate Medicaid reimbursement rates. 

In addition to filing statements for the record of the Finance Committee hearings, we have written to Senators Grassley and Wyden, laying out the many challenges with which nursing homes are contending and recommending public policy solutions. These recommendations include greater federal attention to the ways in which states set Medicaid reimbursement rates and a reevaluation of the OBRA '87 oversight process, including the Five-Star rating system. Just as the Finance Committee is seeking more transparency from nursing homes as to their use of public funds, nursing homes need to see more transparency and accountability in the governmental processes under which they are financed and regulated, given the dominance of public programs as the source of nursing home revenues. Layering on more regulation and fines will not lead to enhanced quality of care.

The recommendations set out in our letter to Senators Grassley and Wyden are the policy goals we will continue to pursue for the rest of this Congress. As stated in our letter, nursing homes are a vital part of the safety net for people as they age, and we are making every effort to see that our sector can continue to survive and thrive as the baby boom generation comes to need these kinds of services.