Producing a Just Culture of Safety and Quality in Nursing Homes

By Anne Montgomery and Sarah Slocum: For Entire Post, Go Here…

As the peaks and valleys of COVID-19 cases and deaths create chaos in the health care sector and dominate news feeds across the globe, the pandemic is shining an intense spotlight on nursing homes – what they do and how well they do it. The highly infectious virus is fueling conversations among families about their elderly loved ones, and fostering policy debates about additional reforms, including calls for alternatives. The voices of nursing home residents – always hard to hear- have been effectively silenced by the isolation imposed to stop (or slow) the virus’ spread through populations of elderly adults living in congregate residences, many of whom have multiple physical frailties, chronic conditions, and cognitive impairment. For residents who are accustomed to pursuing active lives, the inability to entertain visitors, to leave the premises or even one’s room; has been frustrating, debilitating, and depressing as per survey results published in late September reveal.

Under increasing pressure from families and advocates across the country the federal government stepped up to provide needed national leadership in restoring visitation rights to nursing home residents in a recent memo. Residents’ rights to have visitors of their choice have long been guaranteed in regulation – but were set aside, as ordered by Centers for Medicare and Medicaid Services (CMS) by most facilities starting in mid-March as the spread of COVID-19 accelerated dramatically in the long-term care residential sector. Also excluded from visitation were state long-term care ombudsman, often thought of as the “eyes and ears” of residents, and who are legally bound to serve residents’ interests. The federal memo underscores that facilities cannot bar ombudsman from communicating with residents, either in-person or via other safe and private communication channels. Similarly, Protection and Advocacy organizations must be permitted access.

Well beyond visitation, much deeper levels of accountability are needed in nursing homes. The federally appointed Coronavirus Commission on Safety and Quality in Nursing Homes released its final report in mid-September. It includes a call for “a person-centered, resilient system of care that is better for the next generation – one that more deeply values and respects older adults and individuals with disabilities as vital to the fabric of American society.” Similar rallying cries have been presented during many congressional hearings over the years, White House Conferences on Aging, and other national venues.

It is time to call the question on implementing real nursing home reform. Are the urgent circumstances of 2020 a call to action to reform the nursing home model of care? We believe the answer is yes – not just for the next generation – and can point to several encouraging signs that real nursing home reform is possible.

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