June 8: Weekly Long-Term Care News and Updates
Todd Winking • June 8, 2022
Common autoimmune drugs reduce mortality, up clinical status in COVID-19: NIH
A recent clinical trial by the National Institutes of Health (NIH) reports that two commonly used autoimmune drugs have been shown to dramatically reduce deaths and improve clinical status in adults with COVID-19. To determine whether these drugs were effective at reducing the risk of overactive – and potentially life-threating – immune responses, patients were treated with infliximab (Remicade), and abatacept (Orencia).
When compared to placebo, the infliximab (Remicade) patients reduced their risk of dying by 40%, while increasing their odds of clinical improvement by 44%. Similarly, in trial patients treated with abatacept (Orencia), the odds of dying dropped by 37%, while the odds of clinical improvement increased by 34%. Neither of these two drugs appeared to speed up recovery time, however.
According to the agency, both of these medications could add to the therapeutic options available for the treatment of patients hospitalized with COVID-19. As part of a larger public-private effort, the NIH trial sought to test whether a specific set of existing drugs could reduce deaths and recovery times by minimizing the effects of immune response in COVID-19. Both infliximab and abatacept are widely used drugs used to treat autoimmune diseases, such as rheumatoid arthritis and ulcerative colitis, by reducing inflammation.
‘Counterintuitive to the Goal:’ Impending Five-Star Staffing Measures Don’t Address On-going Labor Challenges
In just a few short weeks, nursing home operators and other healthcare leaders will be holding their collective breathe for the much anticipated (and some say, highly insensitive) roll-out of the new Five-Star ratings system being put into place by the Centers for Medicare & Medicaid Services (CMS).
What’s conspicuous is the July timing, given the historic staffing shortage and soaring use of staffing agencies that facilities have been reporting on since January. One critical factor everyone will be keeping an eye is how much weight the CMS gives to these new staffing turnover measures, particularly in relation to other key ratings areas, like quality and regulatory requirements.
What we do know, however, is that CMS is be adding three specific new measures, including:
the percentage of registered nurses that have left over a year’s time frame;
the total number of nurses that have left over the year, including RNs, licensed practical nurses (LPNs) and nursing assistants;
the percentage of administrator turnover.
While some celebrate these new measures in general, others are quick to point out the very real, and more critical need, of helping the industry to actually figure out and solve the staffing shortage problem, not just report it. Counter-intuitive to the problem, they say, is government asking for more and more data information and collection, thereby taking critical leadership off the flow and away from the patient.
Implementation Remains Unclear
As it stands just a few weeks out, many facilities are left wondering just how much influence and impact these new measures will have on their overall score, and what, if any, concessions will be made with regard to the current staffing crisis.
Some, like Steven Littlehale, chief innovation officer for Zimmet Healthcare Services Group, assumes the measures will be folded into the staffing domain, but is less clear on exactly how these new measures will be weighted, and to what degree they will impact the overall five-star staffing rating.
Historically, he says, regulatory measures have been the most weighted, followed by staffing, and quality. It could be in the final moments that we truly understand how they’re using this data, he surmised.
What “doesn’t land nicely” with sector leaders, he says, is CMS’s timing in collecting this staffing data amidst the shortage that crippling the industry.
Data Opportunities and Alternate Measures
Beyond the new staffing turnover measures, some experts, like Vincent Mor, professor of health services, policy and practice at Brown University, believe retention would be a better quality measure, even though it’s harder to predict than turnover.
For his part, Littlehale voiced his choice for customer satisfaction for having better representation in the five-star measure. In the end, what it comes down to is CMS have the ability to squeeze all these variables into one staffing level metric. But for operators who want to take a deeper dive in comparing staffing data to their peers and find ways to improve it, the pathway and data exists through the Medicare.gov website.
As these new CMS measure come online, both Mor and Littlehale try to remain focused on the positive. Rather than seeing these new measures as a “regulatory penalty” or “bureaucracy,” both see them as an opportunity for facilities to look at their performance for comparison to their state, as well as the country at large.
And while the challenges to the nursing home sector are not new ones, the new staffing data can bring “tremendous insight” to operators in terms of better pinpointing how they compare with their competitors, pinpointing what they’re doing right with regard to staffing numbers, as well as shining a spotlight on problematic areas and data before they get worse.
In the end, the time to submit more focused and accurate data has arrived, not just because it’s being reported publicly, but because data-driven metrics can be a critical path forward.
Providers demand federal action as temporary nurse aide waiver comes to an end
With the end of the temporary nurse aide waiver coming to an end this today, providers are calling for the federal government address the long-term care workforce shortages.
The crisis, they say, has never been more dire, nor is it the time to let crucial supports and flexibilities end, especially for the heroic temporary nurse aides who served our vulnerable seniors during the pandemic.
In an April 7 memo, The Centers for Medicare & Medicaid Services announced it was eliminating 16 COVID-related waivers, the first sunsetting 30 days after issuance of the memo (May 7), and the second and final set in 60 days (June 7). Within this final set is the elimination of waiver for temporary nurse aides, which has allowed facilities to employ not-yet certified assistants for four months or longer, regardless of whether they have completed the necessary training and certification requirements.
As of today, that original four-month deadline will be back in place. What’s especially concerning to providers is the brief 4-month window, plus the insufficient capacity for states to accommodate the training and testing needs for hundreds of thousands of temporary nurse aides within that timeframe.
While the April 7 memo acknowledges the timing and capacity concerns, including potential delays for states that can’t handle training and testing volume in time, the CMS says providers and nurses’ aides can provide documentation of these delays and their attempts to complete their requirements.
However, to get more clarification on the specific type of documentation needed, LeadingAge has been trying to work with CMS, but to date, does not have any additional information. The timing is concerning, they say, because while the waiver will end, the workforce challenges will not. What’s more, there is no current plan in place to help nursing homes with staffing.
According to a survey of 60 skilled nursing and seniors housing executives by the National Investment Center for Seniors Housing & Care:
58% of respondents believe the waiver’s expiration will have a moderate impact on their organization’s ability to staff their facilities.
17% reported it would have a strong impact,
25% believe it will have a minimal impact on staffing.
Help on the way
Both AHCA and LeadingAge have applauded legislation (HR 7744), not only extends nurse aid certification requirements for 24 months after the public health emergency ends. But it would also allow temporary nurse aides to continue working in their current role, plus apply their on-the-job experience toward the 75-hour federal training requirement to become a certified nursing assistant.
But a lot must happen before HR 7744 become law. Without further action by Congress, hundreds of thousands risk losing their jobs, residents will lose the caregivers they have come to rely on, and the caregiving crises will only worsen. All of which is why an all-of-government approach is needed to address these nationwide staffing challenges.
Sign up and join us for BASE10’s upcoming webinar on Thursday, July 28th at 1PM CST: “Understanding Cardiovascular Disease Through a Different Lens with Precision Medicine.”
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