In the nursing care sector, quality is the most focused criteria and the most failed factor.Recent studies have clearly indicated the worsening of quality of care received by the residents due to cost cutting, wage reduction and lack of benefit structures for staffs.The new Affordable Care Act (ACA) has rules to bring in management transparency and protect long-term care recipients from abuse and crime.Following are some of the highlights of how this new law is affecting the nursing homes:
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Improving Nursing Home Quality, Transparency and Accountability:
The new law requires that all the management, direct or indirect ownership, operations, administration, finances and clinical services details should be disclosed. Previously with the private equity group participation in this sector, the quality of care worsened. This is because they would cut the staffs and other costs to maintain profitability. Federal and state regulators and ombudsman programs are authorized to collect all the information to bring about transparency in all the processes. Very soon these details would be made available to general public to make informed decision when selecting a nursing home.
A new system has to be brought in place to collect and report payroll data on direct care staffing levels with nursing hours, turnover and retention rate. If the nursing home facilities need to meet the highest rating on nursing home five-star quality rating system, then minimum nurse staffing level of 4.1 hours should be maintained by a nursing home facility.
The cost incurred data like all the expenditures, capital assets, administrative costs are required to be reported in the newly designed medicare cost reports.This will provide transparency on how the nursing care facility is spending its money.
All the information including staffing, health inspections, penalties and consumer complaints need to be added to nursing home compare website available at www.medicare.gov. A new system of nursing home five-star quality rating is introduced, which provides individual and composite ratings for nursing homes based on their health inspections, nurse staffing hours, and selected quality measures is made available on the website.
ACA has made it mandatory to have the following made available on nursing home compare website;
- Each nursing home’s staffing data from payroll records, daily hours, staff turnover and tenure.
- Complaint form and details on ombudsman programs.
- Details on all the complaints received.
- Links to state websites, inspection and complaint reports to be present.
- Survey results to be submitted to CMS (Centers for Medicare & Medicaid Services) quarterly.
- Nursing home comparative performances to be available.
- Details of the number of residents on anti-psychotics drugs to prevent the misuse.
A standardized complaint form and a resolution mechanism need to be developed. In 2009, a large number of complaints were received which point to serious harm done to nursing home inmates.To bring a control on this, a standardized complaint form is made available on the nursing home compare website with details on how to file a complaint and also how to contact state survey and certification agencies and the state long-term care ombudsman program.
A compliance program to be established to prevent and detect criminal, civil, and administrative violations.
ACA has authorized 3 new programs-
- Mandatory internal compliance program to prevent and detect criminal, civil,and administrative violations and promote quality.
- CMS (Centers for Medicare & Medicaid Services) provided nursing homes and chains with quality assurance and program Improvement (QAPI) standards and technical assistance in developing best practices to meet the standards.
- A demonstration project to develop an independent monitoring program to oversee interstate and large intrastate chains of nursing homes.
Targeted Enforcement:
The ACA authorizes CMS(Centers for Medicare & Medicaid Services) to require providers to place CMPs (Civil Monetary Penalty) in escrow pending the outcome of a formal appeal. If the facility prevails, the funds are returned with interest. The funds must be placed in an escrow account within 90 days of the imposition of the penalty or the completion of the independent IDR (Informal Dispute Resolution), whichever is first. Facilities that waive their right to a hearing and promptly report and correct deficiencies may receive a 50 percent reduction in a CMP, unless the violation caused immediate jeopardy to residents, was part of a pattern or widespread harm, resulted in a resident’s death, or was the cause of a previous CMP.
Nursing homes are required to notify the CMS 60 days prior to the nursing home closure for appropriate relocation of residents.CMS will determine the exact date of closure. Administrators who fail to comply can be fined up to $100,000 and excluded from working in a federal health program.If a facility chose to close, then it cannot take new residents. Notification should also have the relocation plan on the basis of resident choice and interest.
CMS must establish and fund national demonstration projects on culture change and the use
of information technology to improve resident care.Training to be given for dementia care and residents abuse prevention.This is given importance because 50% residents have Alzheimer’s disease and they require maximum care. CMS is providing to each Medicare and Medicaid nursing home a six hour curriculum called “Hand in Hand,” which can be used for initial and in-service training of nursing assistants and other staff. The new curriculum requirement is a major step in improving nursing assistant training.
Prevention of Abuse and Other Crimes Against Nursing Home Residents:
Affordable care act requires new state programs to be developed to check criminal background of applicants who have direct access to nursing home residents and long-term care services.The law provides for applicants to appeal decisions and for a 60-day provisional employment period while background checks are conducted. States must specify crimes that disqualify applicants and also develop procedures to notify employers if active employees are convicted of a crime.
Nursing homes that receive federal funds must report suspected crimes against residents to law enforcements.Suspected crimes that result in serious bodily injury must be reported within two hours; other suspected crimes must be reported within 24 hours. If covered individuals fail to file, they would be fined up to $200,000 or up to $300,000 if their failure to report increases the harm to the victim or another person. Individuals failing to file a report can also be banned from working in a facility participates in the Medicare or Medicaid programs. Facilities are required to post a notice in a prominent place that describes procedures employees should follow to file a complaint if they are retaliated against.
Once all the new provisions are implemented, this will help improve the quality of care and transparency of nursing home operations.
