Beyond the obvious call for more direct care workers and adequate funding of care, today’s aging population needs a broader range of living arrangements than what is offered now within the care continuum.
In other words, more options that keep residents connected to their community and family while still receiving the right level of clinical care.
The Convergence Center for Policy Resolution on Wednesday released such recommendations from its latest report titled “Improving Care for Older Adults: Convergence Dialogue on Reimagining Care for Older Adults Final Report.”
Convergence members – long-term care leaders from across the political spectrum – came 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 pitfalls of the five-star quality rating system; namely, how quality care is measured. Participating members urged federal agencies to base five-star ratings instead on resident and family lived experience.
Other recommendations included a “constellation of care settings” that offer adaptable and viable business models; ensuring there are enough qualified direct and family caregivers; and adequately funding care.
“One of the Convergence report’s big ideas is a recognition of both nursing homes’ vital role within the health care continuum as well as their connection to the community in which they operate,” Robyn Stone said in an email to Skilled Nursing News. “Nursing homes in many cities and towns are significant employers, for instance. There’s opportunity for growth here, that would have multiple benefits.”
Stone, a Convergence member, is senior vice president for LeadingAge and co-director of 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 for an issue, supported this time by the John A. Hartford Foundation and SCAN Foundation.
Redesigning five-star
In its current state, the five-star rating system doesn’t accurately capture lived experiences of residents and their family members, according to the report.
The five-star “stool” is made up of three legs, including staffing, quality and regulatory measures. Historically, regulatory measures have been the most weighted, followed by staffing and then quality.
A redesigned system should include input from diverse residents, family members and demographics, authors said. To be “most usable,” lived experiences would be one pillar along with staffing and safety metrics; comparisons could be made within and across states using five-star.
Convergence members are urging the Centers for Medicare & Medicaid Services (CMS) to delve further into patterns of ownership change, forms of ownership, staffing and types of capital investment when measuring quality as well.
“As quality measures are improved, the payment system for care should increasingly incorporate value-based models,” authors said.
All hands on deck
In order to increase the nursing home workforce, the report notes that the Department of Health and Human Services (HHS) and Department of Labor (DOL) should lead a taskforce of agencies across states and state boards of nursing to review recruiting methods and explore ways to increase the caregiver pipeline.
Agencies could make greater use of volunteers and workers over the age of 55 – like the Grand-Aides and Clinton-era National Senior Service Corps. – to fill the gaps.
Grand-Aides, for one, provide care at a reduced cost and with the supervision of health professionals; Grand-Aides are still certified nurse aides. The National Senior Service Corps was a network of federally-supported programs to help individuals 55 and older find service opportunities during the Clinton administration.
Restoring financing for the Health Professional Opportunity Grant Program, revising credentialing requirements and expanding apprenticeship opportunities are other avenues to bolster the nursing home workforce, according to the report.
But it’s not enough to bring workers in. Federal and state training need to be more streamlined for a start; CMS and DOL need to establish a minimum set of core competency standards across all long-term care settings.
“In tandem with establishing core competency standards in training, the federal government and states should devise standards that would enable care workers to be licensed to work across different care settings: such universal ‘location-agnostic’ training would provide a base of knowledge for direct care workers to be able to deliver person-centered care in any LTSS setting,” authors said.
“Location-agnostic” training will further help with deepening connections between nursing homes and the communities where they reside.
Nursing homes as a bigger part of the community
Convergence members called for the need to better meld nursing homes into the community as a way to help with resident isolation. Facility integration could foster future partnerships too, making nursing homes part of institution networks like local health clinics and community-based organizations, according to the report.
“Today, some nursing homes and assisted living facilities are only minimally integrated into their surrounding communities,” 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 leaders and community figures need to figure out ways to “open up the walls” for not only staff training but overall community wellness opportunities. These would be great next steps, she said, for nursing homes to become even more integrated into their communities.
Some facilities are even opening up their gyms and other health services to the local community, while others look into becoming Program of All Inclusive Care for the Elderly (PACE) providers and offer temporary respite services for exhausted family caregivers.
“Some even offer housing to students in exchange for hours worked. But payment systems and regulations can impede these efforts,” authors noted.
A first step for HHS would be to survey existing examples of nursing homes successfully integrating into their community, then develop pilot programs for other communities and facilities to participate.
A call for more housing options
A constellation of living arrangements would still include nursing homes, according to the report, but members recommended a “wider array” of financially viable housing and living arrangements for seniors.
Living at home is ideal but not feasible for frail people; that opens the door for community or neighborhoods as a locus of care.
“New models of housing arrangements and supports [are needed], as well as residential institutions that are more integrated into the community and that can offer better ways to support and supplement family caregivers,” report authors said.
In order to create such models, HHS, the Department of Housing and Urban Development (HUD) and Department of Veterans Affairs (VA) need to review regulations and grants that affect health-housing partnerships.
One way to strengthen these partnerships would be through revising Fair Housing Act policies – for nursing homes, such policies create barriers to diversifying and expanding 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 efficient use of Medicaid assisted living waiver funds,” report authors added.
Companies featured in this article:
Convergence Center for Policy Resolution, Grand-Aides, LeadingAge, National Senior Service Corps.
