‘Whole System Is Broken’: Nursing Home Operators in National Coalition Say Long-Term Care Will Need a Generation to Fix

In the aftermath of issuing a series of action plans, the Moving Forward Nursing Home Quality Coalition – a national coalition of 120 nursing home stakeholders – held a meeting Wednesday to share more details about the action plans to improve quality in nursing homes, with providers present saying that the coalition’s work is a much-needed start to fix a broken system.

“[Nursing administrators] are all appreciative of the movement,” said Cindy Fronning, director of education for nursing administrators’ advocacy group the National Association of Directors Administration in Long-Term Care (NADONA), which is deeply involved in Moving Forward’s work. “Certainly there are still barriers out there. There are still concerns that we are facing with staffing issues and things, but I think for the most part they see this as a good step for them and for our residents.”

Moving Forward’s chair, Alice Bonner, said the action plans are centered on practice, policy and workforce action. In other words, the plans are aimed at improving implementation of practices, enhancing policy through better partnership between policy makers, nursing homes and residents and various advocacy groups, as well as improving the workforce.

She spoke to Skilled Nursing News on Tuesday regarding the diversity of voices represented on the coalition’s steering and working committees.

In the last year since its inception, the coalition has worked with the Department of Housing and Urban Development (HUD) and lender groups along with nursing home policy experts to address the issue of improving living conditions for residents, Bonner said.

The housing committees determine, for instance, “what would an incentive program look like that would support better or more funding to be able to do some of these [building] conversions because there’s been a lot of focus on smaller homes and household models and making nursing homes more person centered,” Bonner said.

As an illustration of how the coalition’s action plans focus on policy, Bonner said the coalition was involved in improving financing in the sector for more personalized spaces that offer “dignity” and “privacy” to the residents.

And some of the coalition’s efforts in housing and other areas are starting to pay off as the coalition begins the second year of its work, but much remains to be done, providers present at the meeting said.

‘A generational change’ needed

According to CEO of Aldersbridge Communities Richard Gamache, who was tapped to be part of Moving Forward’s committee that focuses on looking at new ways to fund long-term care, the coalition’s work “is just a start” of what it will take to fix the myriad problems plaguing long term care. 

“It’s really a generational change. It’s going to take longer than two years,” said Gamache. “Although we’re hopeful and cautiously optimistic that we’ll have success in this area, I think for all of us on that committee, and probably all of us on this call, we know that what we’re doing is just one small piece of what we need to change because this whole system is broken …. Organizations like mine and not-for-profits are tremendously underfunded, and can’t afford to do the things that our residents deserve.”

Aldersbridge is a non-profit organization with skilled living, assisted living and independent communities based in Rhode Island.

Gamache said that he really valued his work on the coalition’s committee, and urged such work to continue beyond two years.

“As we worked through … what we found to be maybe the lowest hanging fruit was to work with HUD and to try to get the criteria changed so that when they guaranteed loans to nursing homes and assisted living, that they prioritize in some way,” he said.

For improving policy, in addition to working with HUD, the coalition plans to deepen its relationships with state and federal policymakers and agencies, Bonner said. These organizations include Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Quality Improvement Organization (QIO), Licensing and Regulatory Affairs (LARA), Elder Justice Coordinating Council, among others.

The coalition is also actively seeking solutions for workforce initiatives. As an example, Bonner shared how the group was improving career pathways for certified nursing assistants (CNAs). It has moved forward with the plan to work with key stakeholders to develop a standardized CNA career pathway model under the Registered Apprenticeship program framework, and has plans to pilot and evaluate it in one state.

Kari Sederburg, VP and programs director at Healthy Aging at Michigan Health Endowment Fund, a partner of Moving Forward in Michigan, told SNN that the national coalition group will be building on important work being done by others in Michigan, such as the direct care worker group IMPART Alliance, which is looking to develop certifications and career pathways for direct care workers.

“Moving Forward’s action plans should help strengthen efforts like this one that are already underway,” Sederburg said in an emailed statement. “We have enthusiastic partners throughout the state who are ready to get to work on Michigan-specific strategies to improve the quality of life for nursing home residents, even as some of those strategies are still taking shape. That’s why we value our partnership with Moving Forward — it will help convene those partners and identify the recommendations that are most appropriate for our state.”

Over the next six months, in Michigan the coalition’s initiatives will gather a team of state government leaders, experts, clinicians, advocates and residents along with national coalition leaders to address nursing home quality improvement opportunities.

As for how the action plans can improve practices, Bonner shared the coalition’s directives on care plan documentation.

“It turns out that when people are admitted to the nursing home, there’s an opportunity for nursing home staff to work to take that information and document it, to make sure it gets put into the care plan during the care planning process,” she said. “And then making sure that if it’s in the care plan, that the people who are delivering the care – the direct care workers such as certified nursing assistants and others – actually know what’s in the care plan and included when care is delivered.”

Bonner said that the coalition’s committees have benefitted from having residents and providers alike to advise, and are focused on how to better integrate these practices through use of technology as well.

“They’re looking at developing a tech-enabled way to capture the information from residents so that the residents and a care partner could work together on that,” she said. “And the other part of this is doing it with the staff … in terms of some data that they’re reviewing.”

Challenges are steep but tackling them is imperative, in her view.

“Improving nursing home resident quality of life may not be easy, but it must be done and we have strong, national support for these efforts,” Bonner told SNN.

Nursing home advocates encourage participation

As Moving Forward proceeds with its second year, LeadingAge, the largest association of nonprofit providers of aging services and an organization that is involved in the coalition, applauded its work.

“Moving Forward’s next phase offers an important opportunity for a wide range of participants, including nursing home residents, families, researchers and other thought leaders – and of course providers themselves – to make a meaningful contribution to the future of nursing homes,” said Katie Smith Sloan, president and CEO of LeadingAge. “Active involvement by these and other diverse stakeholders will help to achieve the changes we all aspire to make, so we encourage all providers – members and nonmembers alike – to get involved.”

Meanwhile, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) also hailed the diversity of the coalition and encouraged participation by nursing homes in its initiatives.

“We are glad to see multiple stakeholders gather together through this Moving Forward Coalition to help advance our nation’s commitment to nursing home residents, staff and families. We agree with many of their recommendations as they align well with our nursing home reform agenda that we released more than two years ago,” AHCA/NCAL said in an emailed statement. “These reforms require considerable investment and prioritization of the long term care profession, and we will continue to encourage policymakers to support nursing homes in making real, long-lasting improvements.”