When COVID-19 first came onto our radar in early 2020, long-term care residents and the frontline workers caring for them served as canaries in the pandemic coal mine. As a nation, we experienced the collective trauma from this situation in myriad ways. Whether it was as family members “visiting” our loved ones through windows, or as bystanders scrolling through horrific headlines detailing the tens of thousands of deaths that occurred due to COVID-19, it was really the nurses and ancillary staff that bore the brunt of cobbled-together crisis management.

COVID-19 cracked open the problems in our healthcare delivery system in many eye-opening ways. Perhaps that’s one of the silver linings: any and every systemic failure swept under the rug before was thrust into the light for all to see. Now as we finally get the space to catch our breath, the Biden administration has tasked the Centers for Medicare and Medicaid Services (CMS) with assessing how inadequate nursing home standards contributed to the more than 200,000 souls who died from COVID-19 in nursing homes during the pandemic. 

It all comes down to safe staffing

Announced in February of 2022, the Biden administration’s plans for nursing home and assisted living facility reform aim to “improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care.” Fortunately for the thousands of nurses and nursing aides who work in these facilities, a major focus of the initiative will focus on staffing. 

It’s no secret that nurses are experiencing extreme levels of burnout. Much of this is due to widespread staffing shortages. Many falsely attribute this to a nationwide nursing shortage, but that doesn’t tell the whole picture. More precisely, there is a nationwide shortage of nurses who are willing to provide direct bedside care. 

Rather than working with nurses to create safe staffing by increasing wages and focusing on nurse retention, many organizations instead chose to dismiss their once-loyal staff nurses and continue operating via a patchwork of traveler and agency nurse replacements. Ask any bedside nurse—increasing staff turnover rates have affected nearly every health system. Unsafe staffing is often the number one factor that drives long-term care nurses to consider leaving their jobs.

Though in the past, CMS has failed to step in to mandate safe staffing, the data is clear that allowing long-term care facilities to craft and enforce their own staffing standards has failed across the board. We’ve all seen the posts on social media about nurses caring for three times a normal patient load, or read reports of facilities where patients are being abandoned altogether. Who can blame those nursing staff for leaving? Especially in today’s litigious culture, nurses need to protect their licenses more than ever. 

How the plan will roll out

As part of the information gathering phase of the plan, CMS conducted a request for information (RFI) specifically soliciting staffing feedback in April 2022. The information obtained was then used to design their site study plan. Beginning in August 2022, the site inspections will be seeking “primary data…including interviews, surveys, and observation data in nursing homes,” according to the official release. 

Seventy-five skilled nursing facilities across 15 states (CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY) will be included in the study. In addition to management and nursing leadership, direct care staff will be interviewed in an effort to get honest accounts of staffing and how shortages affect care. 

Part of the analysis will also focus on financial transparency within certain facilities. Many long-term care facilities receive government funding, but a growing number have been acquired by private equity funds that then use creative financial strategies to manage profit margins. The financial murkiness associated with these facilities contributes directly to a growing resentment among nursing staff; while shareholders continue to report large profits, somehow raises—even living wages—always fall short for those actually caring for the residents paying to be there. Worse still, recent studies show that residents at privately-owned facilities consistently suffer from significantly worse clinical outcomes. 

Unveiling the finances at these facilities and others will hopefully allow the CMS to advocate for significant wage increases. Not only will this help with staff retention, but it is critically significant for the women of color who tend to make up the majority of long-term care staff. 

Raise your voice

Government oversight is not always the best way to improve a system, it’s true. But the attention and focus being directed at a field of nursing that has long been due for improvements is a net positive. We owe it to our aging population to ensure that these facilities provide safe and dignified care — and we certainly owe it to the care workers who have been there for them all along. 

If you are a long term care worker and were able to take part in a CMS survey, tell us about it! We love to hear firsthand accounts on NurseSocial in order to connect and support those of us out there doing this hard work