Long-term care facilities are a long-term concern

We rely on federal, state and local governmental agencies to assure that our long-term care facilities are providing state-of-the-art care for our most venerable and vulnerable population. What we are currently experiencing locally is a failure to mitigate the morbidity and mortality of COVID-19 at these facilities.

Hopefully, our physician governor’s refocused efforts will be effective. Revision of the previous policy of the attorney general to now allow release of data to the public on facility specific COVID-19 involvement, and dedication of $246 million directed to COVID-19 mitigation should help.

Unfortunately, long-term care facilities have been a long-term concern. In 2003, the Institute of Medicine noted, “Serious deficiencies remain in the implementation of government programs to assess and enforce standards of quality in long-term care.”

In July 2019, nurse.org under the heading, “Nursing staffing ratios in long term care facilities are unsafe,” stated that “federal standards haven’t updated since the reform law was implemented over 30 years ago.”

In July 2020, The Daily Press reported that “Virginia lawmakers reject setting standards for nursing home staff for now.”

The Herculean task of mitigating COVID-19 in long-term care facilities has produced many committees and many documents outlining many rules, regulations, procedures and best practices, but this effort has not consistently produced good outcomes.

The policy of limiting on-site visitation, intended to keep COVID-19 out, has had the unintended consequence of limiting on-site governmental oversight, resulting in self-policing, which has proven to be ineffective.

CMS, the CDC and the Virginia Department of Health have relied on nursing home managerial staff to return self-assessment documents as the primary means of providing oversight, which is not likely to be objective, especially when there is little on-site presence of governmental supervision and a lack of strong nursing or physician involvement.

It seems obvious that improving outcomes will require sufficient funding to make it financially practical for nursing homes to comply with improved federal and state standards that impose more oversight and require better staffing at the bedside.

C.R. Massey, III, M.D.


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