In an April 20 letter (pdf) to stakeholders, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicaid and State Operations, Survey and Certification Group invited comments, suggestions, or concerns about the nursing home provisions included in the Patient Protection and Affordable Care Act.

The Group is responsible for implementing some of the nursing home provisions. Some of these provisions require particularly quick action on the part of CMS. Initial feedback was requested by May 5, but it is expected that feedback from stakeholders will be sought throughout the implementation process.

PHI Responds

Seizing this opportunity to improve the law to better protect direct-care workers, PHI National Policy Director Steve Edelstein submitted the following comments to Survey and Certification Group Director Thomas Hamilton:

• Quality Assurance and Performance Improvement Program — should include specific workforce measures, such as reduction of staff turnover, promotion of consistent assignment, and staff satisfaction.
• Nursing Home Compare Website and Ensuring Staffing Accountability — the digitization of valuable data on workforce size and volume should be provided across a full complement of staff — all levels and all positions. Additional staffing data, including turnover and tenure, should be submitted in a uniform format.
• Civil Money Penalties (CMP) — prioritize projects that invest in the frontline workforce and promote “person-directed care” in guidance to states on the use of CMP funds.
• National Demonstration Projects on Culture Change and Use of Information Technology in Nursing Homes — prioritize projects that incorporate direct-care workers in key roles in these projects’ operations.
• Dementia and Abuse Prevention Training — identify and promote existing, proven curricula and trainings that are grounded in “adult learner-centered” methodologies.
• Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers — provide states with assistance coordinating efforts at the state level and in identifying those public and private stakeholders who are critical members of any workgroup to develop the background check program.
• National Training Institute — ensure that that the Institute be a strong resource for more guidance on “person-centered care” and training on culture change, which continues CMS’s efforts to train surveyors in the recent past.
• National Nurse Aide Registry — broaden its responsibility purview beyond that of exploring the feasibility of a national nurse aide registry to also include training certification issues directly related to quality of care.
• Grants and Incentives for Long-Term Care Staffing — under the Elder Justice Act, CMS should direct funding towards best practices such as apprenticeships, peer mentoring, coaching supervision, and retention specialists.

“Enacting health reform was a big step but it was only the first step,” Edelstein said. “Long-term care stakeholders and workforce advocates must work closely with the agencies implementing reform to fully realize the law’s potential to strengthen the quality of direct-care jobs and improve the quality of long-term services and support.”

– by Meghan Shineman, PHI New York Policy Analyst