Federal Nursing Home Commission Calls on CMS to Adopt 27 Recommendations, ‘Reduce Suffering’

A special federal commission on nursing homes and COVID-19 on Wednesday released its formal report, focusing foremost on testing, personal protective equipment, and visitation as the nation’s long-term care facilities continue to grapple with the novel coronavirus.

The Coronavirus Commission for Safety and Quality in Nursing Homes laid out 27 primary recommendations for the Centers for Medicare & Medicaid Services (CMS), with a specific emphasis on a national testing strategy, providing operators with access to at least three months’ worth of personal protective equipment, continuing to facilitate proper cohorting of COVID-19 residents, and expanding visitation access to nursing facilities.

“To reduce suffering and to save the lives of residents and staff, CMS can implement or initiate the Commission’s actionable recommendations in relatively short order,” the commission concluded. “In some cases, CMS will need to assume a greater leadership role working with its federal partners and state, local, tribal and territorial (SLTT) authorities to determine which entity has authority to accomplish the Commission’s recommendations and action steps.”

The solutions target a list of seven overarching problems or improvement areas that the group identified in its analysis:

• Ongoing supply and affordability dilemmas related to testing, screening, and personal protective equipment (PPE)
• Tension between rigorous infection control measures and quality of life issues that exist in cohorting and visitation policies
• A call for transparent and accessible communications with residents, their representatives and loved ones, and the public
• Urgent need to train, support, protect, and respect direct-care providers
• Outdated infrastructure of many nursing-home facilities
• Opportunities to create and organize guidance to owners and administrators that is more actionable and to obtain data from nursing homes that is more meaningful for action and research
• Insufficient funding for quality nursing home operations, workforce performance, and resident safety.

Outside of the top three issues of testing, PPE, and visitation, the report calls for better communication among nursing home staff, residents, and families; resources for beleaguered staffers; increased registered nurse and infection preventionist presence in facilities; more professional development opportunities for certified nursing assistants (CNAs); design improvements for aging physical plants; and clearer, standardized infrastructure for nursing home data collection and reporting.

In addition to the immediate impact of COVID-19, the report called on CMS to develop a stronger long-term care infrastructure for future seniors.

“The time has come for a turning point in nursing home care. The Commission envisions a person-centered, resilient system of care that is better for the next generation — one that more deeply values and respects older adults and people with disabilities as vital to the fabric of American society,” the commission wrote.

Katie Smith Sloan, president and CEO of non-profit senior care trade group LeadingAge, thanked the commission for including its input in the report, but called on the federal government to put the suggestions into practice.

“As the COVID-19 death toll in nursing homes reaches over 50,000, we hope the commission report leads to a more coordinated response, and delivery of resources that are backed with adequate funding,” Sloan said in a statement. “More than a million Americans require 24/7 stand-alone care from nursing homes, some of which have begun to close their doors as they rapidly deplete their reserves to keep up with the exorbitant costs they are incurring during this pandemic. The federal government must now focus on averting a wave of closures.”

Mark Parkinson, president and CEO of the American Health Care Association, thanked the commission for its work in a statement released late Wednesday.

“We are pleased to see the Commission acknowledge what we have been saying from the beginning — there must be shared responsibility with public health officials prioritizing our residents in long term care and helping facilities acquire necessary resources to combat this global pandemic,” Parkinson said. “The Commission’s review and findings lay out some of the important work that is needed to mitigate the impact of COVID-19 in nursing homes and further improve the quality of care we deliver.”

President Trump announced the formation of the task force at a White House press conference at the end of April, with the MITRE Corporation publicly named as the third-party contractor coordinating the initiative in mid-May. The commission’s report was due September 1.

“The commission will comprehensively assess the response,” CMS administrator Seema Verma said at the time of the announcement. “It will identify best practices, and also provide recommendations for how we go forward to protect our nursing home residents and make sure we are providing the best quality of life.”

Verma on Wednesday took something of a victory lap, commenting that the report largely validated the work that CMS has already done to respond to COVID-19 in nursing homes; the administrator in particular pointed to federal relief funding, the distribution of point-of-care testing units and kits, stricter COVID-19 reporting requirements, and focused infection control inspections at facilities across the country.

“In tasking a contractor to convene this independent Commission comprised of a broad range of experts and stakeholders, President Trump sought to refine our approach still further as we continue to battle the virus in the months to come,” Verma said in a statement. “Its findings represent both an invaluable action plan for the future and a resounding vindication of our overall approach to date. We are grateful for the Commission’s important contribution.”

CMS released a point-by-point response to the commission’s findings in conjunction with the report. Verma, Centers for Disease Control & Prevention (CDC) director Robert Redfield, Vice President Mike Pence, and select members of the commission will also gather at the White House Thursday to discuss the final report and recommendations.

The group’s roster boasted a wide swath of industry representatives:

• Neil Pruitt, Jr., CEO of Georgia-based nursing home operator PruittHealth
• Roya Agahi, chief nursing officer of operator CareRite and former chief nursing officer for the post-acute care service line of NYC Health + Hospitals
• Camille Rochelle Jordan, senior vice president of clinical operations and innovation for the Louisville, Ky.-based operator Signature HealthCARE
• Rosie Lyles, director of clinical affairs for the Illinois-based medical supply distributor Medline Industries
• Dallas Taylor, director of nursing for the Eliza Bryant Village senior housing and care campus in Cleveland
• Mark Burket, CEO of Platte Health Center Avera, a nursing facility in Platte, S.D.
• Debra Fournier, chief operating officer of Maine Veterans’ Homes
• Jeannee Parker Martin, president and CEO, LeadingAge California
• Janet Snipes, executive director, Holly Heights Nursing Home of Colorado

Other commission members included prominent Harvard long-term care researcher David Grabowski, National Association of Health Care Assistants CEO Lori Porter, Justice in Aging directing attorney Eric Carlson, National Consumer Voice for Quality Long-Term Care executive director Lori Smetanka, and nursing home resident Penelope Ann Shaw.

While 13 members of the commission signed off on all of the report’s findings with a formal endorsement, 11 took exception to certain portions by identifying specific “reservations”; Carlson of Justice in Aging did not endorse the report at all and issued a separate dissent, generally arguing that operators themselves should be responsible for staff development and compliance, with CMS’s role limited exclusively to funding and enforcement.

“Members wrestled with challenging, sometimes competing, issues such as weighing infection control practices against psychosocial needs of residents,” Dr. Jay Schnitzer, MITRE’s chief medical and technology officer and the commission’s moderator, said in a statement. “These complex issues do not have easy solutions, which made the diverse experience and insights of members integral to developing the recommendations and actions endorsed in the final report.”