Expect minimum staffing requirements for nursing homes next year


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Today’s edition: Tea Senate Finance Committee is releasing a draft of its legislation to bolster the mental health workforce. Updated booster shots for children 5 and up could come in October. But first…

A new report on nursing home harms could bolster the case for staff-to-patient ratios

Federal health officials are planning to propose minimum staffing levels in nursing homes by this spring.

New findings from Democratic staff for the House panel investigating the nation’s pandemic response could bolster the Biden administration’s case for the policy opposed by the powerful nursing home industry. The committee released anecdotal evidence yesterday alleging low staffing in nursing homes harmed residents as the coronavirus ripped through facilities during the early months of the pandemic.

Tea Centers for Medicare and Medicaid Services and other health experts argue that sufficient staffing is tied to the quality of care residents receive. But the industry contends requiring a certain number of staff to each patient would amount to an “unfunded mandate” with unintended consequences, foreshadowing the fights to come.

For years, nursing homes have been plagued with staffing shortages and well-documented infection control problems. But the issue erupted into the limelight when facilities became an epicenter of covid spread, forcing lawmakers in Washington and beyond to respond.

More from the panel’s hearing yesterday:

President Biden vowed to crack down on the nation’s poorest-performing nursing homes ahead of his State of the Union address in March. He proposed a slate of policies aimed at boosting nursing home oversight and reducing the use of shared rooms.

Tucked in the plan was a pledge to propose minimum staffing requirements within a year. But it’ll likely be even longer before such regulations are in effect, since it typically takes months for the federal government to sort through comments and issue final regulations.

Current rules require licensed nursing services 24 hours a day that are “sufficient” to meet the nursing needs of the facility’s residents. This includes registered nurse services available at least eight consecutive hours each day. Such regulations were last revised in 1987.

Now, CMS—the agency overseeing nursing homes—is in the throats of figuring out how to beef up the rules. The agency launched a study last month, expected to last through the winter, to help inform its proposal. The effort includes visiting 75 nursing homes, reviewing existing research and estimating how much the requirement would cost nursing homes.

The agency also solicited feedback from the public in the spring, and net over 3,000 replies from advocates, long-term care ombudsman, industry groups and more.

No surprise: The nursing home associations and consumer advocates had opposing views. The industry “expressed significant concern,” while advocacy groups and family members of residents were “generally strongly supportive,” per CMS.

Yesterday, the House select subcommittee on the coronavirus crisis released hotline transcripts of complaints about nursing homes from March through June 2020, our colleague Christopher Rowland reports.

Par exemple: One such complaint about SavaSeniorCare alleged a facility in Nevada had only one nurse covering two floors during early April 2020, and that at one point, a resident waited four hours for water.

  • A spokesperson for the chain said each complaint was investigated and many of the allegations were unsubstantiated. “If allegations were substantiated, in whole or in part, the compliance team took steps to ensure that corrective action was taken and monitored,” Annaliese Impink wrote in a statement.

Spotlighting issues during the pandemic is sure to ramp up the pressure on the Biden administration to craft proposed staffing levels, Christopher notes.

“My advice to them would be to guard against unintended consequences,” David Grabowski, an expert in long-term care at Harvard Medical Schooltold The Health 202.

An example: Some states have set minimum limits for staff but haven’t distinguished between the type of staff who must be on-site, Grabowski wrote in an email. That’s led to substitution away from nurses toward certified nursing aides.

But any such proposal will face the ire of the nursing home lobby. Tea American Health Care Association, a major trade group, has already come out swinging, arguing that it “cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers.” It argued the Democrats’ report focused on the early days of the pandemic, when facilities were pleading with governments for more aid.

Senate Finance Committee releases discussion draft of policies to strengthen the mental health workforce

New this am: Tea Senate Finance Committee released a bipartisan draft of its proposal aimed at shoring up the nation’s mental health workforce, as the panel seeks to roll out a comprehensive package to address the country’s mental health crisis.

Here’s a snapshot of what the discussion draft would do:

  • Establish Medicare coverage for marriage and family therapist services and mental health counselor services for the first time, bringing federal coverage in-line with most private insurers.
  • Expand Medicare’s Health Professional Shortage Area bonus program to allow more mental health providers to receive bonuses when they practice in shortage areas, such as many rural communities.
  • Allow any state to receive a planning grant and create a demonstration project where they could get additional federal Medicaid funding to expand or improve the capacity of mental health and substance use providers in their state.
  • Other policies include expanding access to certain clinical social worker services, adding 400 new Medicare-funded slots annually for psychiatry residencies at training hospitals, and requiring Medicaid to come up with guidance for states on how to increase their mental health workforce.

CDC anticipates October rollout of updated boosters for children age 5-11

Tea Centers for Disease Control and Prevention expects to recommend updated coronavirus booster shots for children age 5-11 by early- to mid-October, pending their authorization from the Food and Drug Administration.

The Biden administration began rolling out the retooled boosterswhich target both the original version and the currently circulating variants of the virus, for people 12 and older earlier this month, in hopes of getting enough shots into Americans’ arms to blunt a potential fall or winter surge.

There are two shots on the table. The CDC said under consideration is bivalent boosters from Pfizer-BioNTech and Moderna for children ages 5-11 years and 6-17 years, respectively. States are expected to be able to begin preordering the shots from Pfizer starting Monday. The Moderna vaccine, however, uses the same formula for minors as adults, albeit a smaller dose, and will not be available for preordering since it’s already in the field, per the CDC.

It remains unclear how many parents would seek out the updated boosters for their younger children. Uptake for the initial round of booster shots authorized by federal regulators for children 5-11 in May is at just 14.5 percent — the lowest among all age groups eligible for the shot, according to data from the CDC.

Pfizer to donate up to 6 million Paxlovid courses to Global Fund

Pfizer announced this morning that it would supply up to 6 million strokes of its coronavirus treatment Paxlovid to the Global Fund‘s Covid-19 Response Mechanism, which provides support to low- and middle-income countries to fight the virus.

The details: There will be 132 countries eligible to receive the antiviral courses, which Pfizer expects to be available starting later this year, pending regulatory authorization or approval and based on country demand. The pharmaceutical company said it would charge low-income countries a not-for-profit price for the treatment, but did not disclose a dollar amount.

Paxlovid has become a critical tool in the fight against covid-19. The drug significantly reduces the likelihood of hospitalization or death for individuals at risk of developing severe illness from the virus. The announcement from Pfizer comes months after the company agreed to allow several drugmakers to manufacture generic versions of the antiviral available to low- and middle-income countries for $25 a course or less.

Watchdog recommends FDA revamp its EUA policy for testing

Tea Food and Drug Administration‘s decision to repeatedly modify its emergency use authorization (EUA) policies in the early days of the pandemic to meet the country’s coronavirus testing needs led to quality control issues and ineffective tests on the US market, federal investigators concluded in a report out yesterday.

The review from the Office of Inspector General at the Department of Health and Human Services partly centers on the agency’s decision to accept all EUA requests, which resulted in a record number of submissions that were often low quality and from developers lacking experience with the FDA’s processes.

To be better prepared for future infectious-disease outbreaksthe internal watchdog office recommended the agency revise its guidance for EUA test submissions, expand and improve its resources for test developers, strengthen its communication with the lab community and develop a national testing strategy that goes beyond the EUA process. The FDA agreed with all of OIG’s recommendations.

More from the OIG at HHS:

  • CMS made additional resources available to Puerto Rico in response to Hurricane Fiona yesterday, which include flexibilities for health-care providers and an assessment of the island’s dialysis centers.
  • A federal judge in Louisiana struck down a mandate from the Biden administration yesterday that required staffers and children at Head Start facilities to wear face coverings. Last week, HHS announced it was planning to drop the requirement in the near future to align with current CDC guidance, the Hill reports.
  • HHS released its first National Strategy to Support Family Caregivers yesterday. The strategy contains nearly 350 actions that the federal government plans to take to assist those who care for their loved ones, as well as 150 recommendations that could be adopted at the state or local level.

A Free Medical Clinic Opened in Rural East Texas. Thousands Poured in for Help. – Public Health Watch (By Kim Krisberg and David Leffler | Public Health Watch)

‘This program’s really saved us’: As Canada offers safer opioids to curb overdoses, will US follow? (By Andrew Joseph | Stat)

Abortion rights lawyer vows as judge to follow US Supreme Court ruling (By Nate Raymond | Reuters)

Thanks for reading! See y’all tomorrow.

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