As the nursing home crisis was swept up in the politics and finger-pointing of Albany, it was easy to lose sight of the individual residents and their families at the heart of the tragedy.
Now, the focus must return to them.
So, as Gov. Andrew M. Cuomo and state lawmakers propose reforms to the nursing home industry, they must focus on how to improve patient care, expand oversight and accountability, give loved ones the information they need and deserve, and create a system that will better serve everyone, in a post-pandemic era and in future public health emergencies.
The proposals come as Cuomo has come under fire for his handling of nursing homes during the pandemic, and for not providing complete and accurate data regarding where nursing home residents died. These reforms are not directly tied to the controversy or Cuomo’s emergency powers but they are vital to improving care in these facilities.
Several of the bills that moved forward in the State Senate Monday on visitation, infection control, staffing, and more openness in data reporting and the publication of federal ratings and health violations are issues dramatically framed by the pandemic.
But real reform must look beyond the pandemic itself. The Senate has proposed legislation that would require facilities to spend 70% of their revenue on direct patient care, including 40% of total revenue on staff wages and benefits. Those standards are also among the set of reforms Cuomo proposed as part of the state budget process. Cuomo’s proposals include caps on a facility’s profits and management salaries, important steps that rightly could ensure money is spent on patient care.
Enormously important is the attention on nurse-to-patient ratios, which the legislature has addressed through a proposal known as the "safe staffing" act.
Over all of these conversations hangs the continued question of funding. Nursing homes almost universally depend on taxpayer funds, and nursing home owners continue to say they need more money. Getting to the bottom of the funding formula, assessing whether facilities are spending those funds appropriately, and determining what’s really needed, will be difficult but necessary.
Any reform, however, is meaningless without enough state regulation, oversight and enforcement, and without the nursing home industry acting as a partner in change.
All of this must be a starting point for far larger discussions about how we care for our most vulnerable residents, and how that care should change in the months and years to come. These facilities could look different, perhaps with smaller, residential locations joining the landscape, or by better using technology to treat patients, communicate with families and address staff shortages. Even then, the importance of nurses and other high-level staff can’t be underestimated, and finding new ways to incentivize nurses and others to work in nursing homes and other long-term care facilities will be key.
To honor the 15,000 nursing home and assisted living facility residents who have died of COVID-19, we must make sure the industry is ready for whatever comes next.
— The editorial board