COVID Update #245
HFAM Update

It has been a busy Sunday, Monday, and Tuesday. Heck, the pace of the start of this week is basically what it has been over the last year. While it has been hectic, it has thankfully NOT been due to a COVID-19 tsunami in our setting and the community. With diligence, testing, PPE, and vaccinations, we are keeping COVID-19 isolated at its lowest point in months in our centers.
Together we have a positive story to tell as we navigate the way forward. We will continue to commit to quality care, data-driven policies, and accountability. The NYT article published over the weekend on the CMS Five-Star system was challenging to read.
Just as people should not be victims of abuse or crimes at home, at work, in the community, or other settings, they most certainly should not be victims of abuse or crimes in nursing homes or assisted living campuses. Based on the facts of individual cases and with due process, HFAM as an organization and I as a professional have been steadfast in support for oversight, protection, and punishment for wrongful acts. 
Please know that HFAM has submitted a short response to the NYT on behalf of our members and the sectorRelative to the NYT article, I'd say this:
  • Abuse and neglect have no place in a nursing home or any health care setting. One instance of abuse or neglect is one too many. The facts show that such cases are rare, and many nursing home staff provide high-quality resident care.
  • The notion that the CMS Five-Star rating system contributed to nursing homes being unprepared for the pandemic does not recognize the nature of this virus. 
  • I've visited two-star centers that were impressive and where I'd send a family member. I've seen five-star centers that were the opposite. The Five-Star system is just one tool and should not be used exclusively; it should be used with other sources of information such as visiting and working with hospital discharge planners.
  • COVID-19 is a deadly virus that is unbelievably contagious. People of all ages with pre-existing chronic conditions are more at risk of hospitalization. Older people with such conditions are more likely to die from the virus. These are precisely the type of people who both receive and provide care in Maryland nursing homes. 
  • The nature of the COVID-19 virus, patient and staff make-up, the physical layout of nursing homes, the lack of testing and the shortage of PPE in the earliest days of the pandemic, and COVID-19 hotspots in communities surrounding nursing homes account for the pandemic in our sector. Not the failure of CMS Five-Star. 
  • Financing structure, tax status (for- or not-for-profit status), and CMS Five-Star ratings are not effective measures of a nursing home's quality. Nor are staffing ratios alone. Whether resources are predominately coming from Medicare or Medicaid rates, health insurance, or REITS, it is not the funding source but rather the sustainability of the funding that is most important.
  • In terms of staffing, an important focus needs to be effective recruitment, retention, and promotion of the workforce. All of which were challenging even before the pandemic because of the sector's underfunding, the generally booming economy, and the demands of working in nursing homes.
Here is another NYT article about California suing Brookdale Senior Living for alleged Five-Star manipulation.
The Bottom Line: The vast majority of skilled nursing and rehabilitation centers and assisted living campuses in Maryland and across the nation are dedicated to quality; those organizations committed to quality will have longevity; those few that do not produce benchmark clinical outcomes and are not as committed to quality are not likely to survive over time.
AHCA/NCAL Reform Proposal
Yesterday, the American Health Care Association/National Center for Assisted Living, in partnership with LeadingAge, released a reform agenda to address long-standing challenges affecting America’s nursing homes' quality of care.

The COVID-19 pandemic has exposed and exacerbated systemic issues impacting the nursing home sector, such as workforce shortages, aging physical plants, and underfunded government reimbursements for care. Many of these issues were raised by AHCA, LeadingAge, and other stakeholders for years prior to COVID but were never fully addressed by policymakers.

Through the Care For Our Seniors Act, AHCA and LeadingAge are calling on federal lawmakers once again to help resolve systemic challenges, as well as reflecting on ways nursing home providers themselves can improve. The policy proposal has four main reform principles: clinical, workforce, oversight, and structural. Each policy proposal in the Care for Our Seniors Act must include government resources. AHCA and LeadingAge propose several interrelated investment strategies to reinvest in America’s nursing homes to ensure quality care.
Legislative Update – Senate Bill 894
Yesterday, HFAM submitted testimony on Senate Bill 894: Post Crisis Jobs Act of 2021, which is being heard by the Senate Finance Committee tomorrow. The aim of this legislation is to advance digital and virtual learning, better align current grant programs, and support apprentice applicants and employers.

With the support of the bill sponsor, Senator Rosapepe, and the assistance of Senator Klausmeier, HFAM submitted an amendment that would allow CNA applicants to be approved by the Board of Nursing if they complete an eight-hour online training (as has been accepted federally during the emergency) that includes core competency areas of learning. This online course must still meet the same accreditation requirements as existing training. Also, this amendment would allow an individual who has been working as a temporary CNA for at least 180 days during the pandemic and is in good standing to be allowed to continue working. To become a Certified Geriatric Nursing Assistant (GNA), those currently working must still complete the requirements to become a GNA under the regulations of MBON. 

As we all know, workforce issues have been challenging before the pandemic and have been exacerbated by the pandemic. Our proposed amendment would allow nursing assistants to enter the workforce more quickly and continue working in our setting.
As Always: 
  • People first, quality counts.
  • Be prepared to deploy people and PPE around your organization.
  • Our sector MUST double our efforts on infectious disease protocol, staffing, PPE, observation, and testing.
  • Train, train, and train teams again on infectious disease protocol.
  • Recognize that COVID-19 fatigue is an issue across the county, not just in our sector.
  • Overcommunicate with residents, patients, families, staff, and government partners.
  • Sound alarms early.
  • Know that WE WILL get through this and that you are saving lives!
  • Work with your hospital partners, and coordinate with local and state regulatory partners.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing. 
Joe DeMattos
President and CEO
2021 HFAM Conference
The 2021 HFAM Conference “Together We Re-Imagine” will be held in person October 4 – 7, 2021 at the Maryland Live Hotel and Casino in Hanover, Maryland. Hundreds of long-term care leaders will connect, share best practices and discuss actionable insights on how we can reflect, reform, rebuild, and revolutionize quality care. You and your teams will not want to miss this opportunity as we come together again.

Visit the conference website to learn more and register.
Did you miss HFAM's previous alerts?

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from our federal and state partners.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.