Rethinking long-term care starts with a 5-star redesign, adequate funding and a connection to the community


Beyond the obvious call for more direct caregivers and adequate care funding, today’s aging population needs a wider range of living arrangements beyond what is currently offered. in the continuum of care.

In other words, more options that keep residents connected to their community and family while receiving the right level of clinical care.

The Convergence Center for Policy Resolution released these recommendations from its latest report on Wednesday: Convergence Dialogue on Reimagining Care for Older Adults.

Convergence members — long-term care leaders from all political walks of life — have come together to propose changes to America’s care systems that better reflect the unique needs and realities of aging adults.

The report drew attention to the pitfalls of the five-star quality rating system; namely, how quality of care is measured. Participating members urged federal agencies to base five-star ratings instead on the lived experience of residents and families.

Other recommendations included a “constellation of care settings” that offer adaptable and viable business models; ensuring that there are enough qualified direct and family carers; and adequately fund care.

“One of the big ideas of the Convergence report is the recognition of the vital role of nursing homes in the continuum of health care as well as their connection to the community in which they operate,” Robyn Stone said in an email. at Skilled Nursing News. “Nursing homes in many cities and towns are major employers, for example. There is an opportunity for growth here, which would have multiple benefits.

Stone, a member of Convergence, is senior vice president of LeadingAge and co-director of the LeadingAge LTSS Center @UMass Boston.

The group serves as a leading organization to address critical national issues. This report is the latest in a series of dialogues that bring together a diverse group of leaders around an issue, this time supported by the John A. Hartford Foundation and the SCAN Foundation.

Five star revamp

In its current state, the five-star rating system does not accurately capture the lived experiences of residents and their family members, according to the report.

The five-star “stool” is made up of three legs, including personnel, quality and regulatory measures. Historically, regulatory measures have been the most weighted, followed by headcount and then quality.

A redesigned system should include input from various residents, family members and demographics, the authors said. To be “most usable”, lived experiences would be a pillar with staffing and security measures; comparisons could be made within and between states using five stars.

Convergence members urge the Centers for Medicare & Medicaid Services (CMS) to dig deeper into patterns of ownership change, forms of ownership, staffing, and types of capital investment when measuring quality as well.

“As quality measures improve, the healthcare payment system should increasingly incorporate value-based models,” the authors said.

Everyone on the bridge

In order to increase the nursing home workforce, the report notes that the Department of Health and Human Services (HHS) and the Department of Labor (DOL) should lead a task force of agencies in the States and state boards of nursing to review recruitment methods and explore ways to increase the pipeline of caregivers.

Agencies could make greater use of volunteers and workers over the age of 55 — like the Grand Helpers and the Clinton-era National Senior Service Corps. – to fill in the gaps.

The Grand-Aides, for their part, provide care at a lower cost and under the supervision of health professionals; Grand aides are always certified caregivers. The National Senior Service Corps was a network of federally supported programs to help people 55 and older find service opportunities during the Clinton administration.

Restoring funding for the Opportunity Grant program for healthcare professionals, revising credentialing requirements and expanding learning opportunities are other ways to strengthen the workforce, according to the report. nursing home workforce.

But bringing in workers is not enough. Federal and state training needs to be more streamlined to begin with; CMS and DOL should establish a minimum set of core competency standards in all long-term care facilities.

“Along with establishing basic competency standards for training, the federal government and states should design standards that would allow social workers to be licensed to work in different care settings: such universal training ‘independent of place “would provide a knowledge base for caregivers to provide person-centered care in any LTSS setting,” the authors said.

The “location-agnostic” training will further help deepen the connections between nursing homes and the communities where they reside.

Nursing homes as a larger part of the community

Convergence members have called for the need to better integrate nursing homes into the community to help with the isolation of residents. According to the report, the integration of facilities could also foster future partnerships, by making nursing homes part of networks of institutions like local health clinics and community organizations.

“Today, some nursing homes and assisted living facilities are poorly integrated into their surrounding communities,” the authors said. “However, other nursing homes and assisted living facilities are integrating into the community, and many are exploring other aging service lines.”

Stone told SNN that long-term care managers and community figures must find ways to “open the walls” not only for staff training, but also for overall community wellness opportunities. Those would be great next steps, she said, for care homes to become even more integrated into their communities.

Some facilities are even opening up their gymnasiums and other health services to the local community, while others are considering becoming providers of the Program of All-Inclusive Care for the Aged (PACE) and offering temporary respite services to exhausted family caregivers. .

“Some even offer accommodation to students in exchange for hours worked. But payment systems and regulations can get in the way of these efforts,” the authors noted.

A first step for HHS would be to investigate existing examples of nursing homes successfully integrating into their community, and then develop pilot programs for other communities and facilities to participate.

A call for more housing options

According to the report, a constellation of lifestyles would still include nursing homes, but members recommended a “wider range” of financially viable housing and lifestyles for older people.

Living at home is ideal but not feasible for frail people; that opens the door to the community or neighborhoods as a place of care.

“New models of housing and supports, as well as residential institutions that are more integrated into the community and that can offer better ways to support and complement family caregivers,” the report authors said.

In order to create such models, HHS, the Department of Housing and Urban Development (HUD), and the Department of Veterans Affairs (VA) must review regulations and grants that affect health-housing partnerships.

One way to strengthen these partnerships would be to revise Fair Housing Act policies – for care homes, these policies create barriers to diversification and expansion of services due to mortgage insurance rules.

“HUD should also encourage the use of project-based vouchers to support partnerships with long-term care providers to enable more effective use of Medicaid assisted living exemption funds,” added the authors of the report.


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