Including Medicaid in Economic Stimulus Bill Would Help Protect Key Staffing Jobs, Preserve Access to Quality Care

Washington, DC –The American Health Care Association (AHCA), which released an extensive new analysis of America’s nursing home workforce, today said that a significant national effort must be mounted to strengthen and stabilize a direct care workforce already battered by chronic Medicaid underfunding, and further threatened by state budget cuts due to the current economic downturn. The nation’s largest long term care advocacy organization expressed concern about those most imperiled by these circumstances—the nation’s oldest, most vulnerable seniors, who are growing in number and who require increasing levels of complex care that only nursing homes now provide.
 
“We are alarmed by the national shortage of direct care workers, which calls out for government help in addressing this building national crisis if we are to protect and preserve essential health care for our oldest, most vulnerable seniors,” warned Bruce Yarwood, President and CEO of AHCA. “Including badly-needed Medicaid relief in any economic stimulus package represents a solid first step in protecting seniors’ access to quality care; however, what is really needed over the long term is a singular focus on improving our ability to hire, train, and retain direct care workers—something that necessitates rectifying the yawning gap between the actual cost of providing quality care and what Medicaid actually covers.”
 
AHCA’s 2007 Nursing Position Vacancy and Turnover Study, which examined employment vacancy and turnover in nursing facilities nationwide, found that nearly 110,000 full-time equivalent (FTE) health care personnel were needed to fill vacant nursing positions. Approximately 19,400 registered nurse and 24,200 licensed practical nurse (LPN) positions were estimated to be vacant, but the majority of direct care staffing vacancies – nearly 60,300 positions – were for Certified Nurse Assistants (CNAs).
 
Yarwood also said that Senate Finance Committee Chairman Max Baucus (D-MT) recently-released blueprint for health care reform cites the need for a stable workforce to sustain high quality long term care and services. Baucus specifically notes, “Long-term care reform should include options to recruit, train, and retain a robust workforce that can ensure high-quality care.”
 
A recent Institute of Medicine (IOM) report, Retooling for an Aging America, outlines the workforce crisis, stating, “Recruitment and retention of all types of health care workers is a significant problem, especially in long term care settings. Unless action is taken immediately, the health care workforce will lack the capacity to meet the needs of older patients in the future.”
   
“The long term care community, with nearly 110,000 full-time vacant nursing positions at nursing facilities across the United States, would be able to offer dramatically more employment opportunities that better protect seniors’ care access, and have a direct, immediate impact on local economies if increased Medicaid Federal Medical Assistance Percentage (FMAP) is included in whatever economic stimulus package Congress passes,” Yarwood stated.
 
The AHCA leader added that he looks forward to working with key stakeholders, including providers, policymakers, Congressional leaders, and President-elect Obama to ensure that our nation has a stable, sustainable workforce, which can meet the growing needs of America’s 77 million baby boomers who are approaching retirement.
 
The nearly 110,000 direct care staff positions vacant in 2007, according to the workforce study, included 1 in 6 registered nurse positions, 1 in 9 licensed practical nurse positions, and 1 in 10 certified nurse assistant positions. Moreover, nursing facilities, which are seeking to hire staff to fill these positions, are finding that qualified candidates are not available.
 
The long term care leader that our workforce shortage is exacerbated by challenges in finding enough nurse educators, and that these high vacancy rates confirm that government policy and educational initiatives are needed to promote careers in long term care nursing. Yarwood concluded, “Promoting sound fiscal policies, designed to strengthen America’s long term care workforce and facilitate the continuing improvement in quality skilled nursing care, is imperative and should be a top national priority.”
 
To view a full copy and a one-page summary of the study, please visit our website at www.ahcancal.org

Collaboration Needed To Ensure Accurate Quality Index

Washington, DC – The American Health Care Association (AHCA) recently called on Congressional leaders to urge the Centers for Medicare and Medicaid Services (CMS) to delay the implementation of the Five Star nursing facility rating system, stressing that working together will be necessary to ensure the new quality index accurately represents the high-level care provided in our nation’s nearly 16,000 nursing facilities.
 
“A quality index based on the broken survey system does not give the public an accurate representation of the care our profession provides every day for millions of frail, elderly and disabled individuals,” state Bruce Yarwood, President & CEO of AHCA. “We, along with many Congressional leaders, want to ensure that the tools and resources measuring care in our nation’s nursing facilities provide accurate and timely information that will benefit the consumer. The dramatic inconsistency of our current survey system prevents it from being an accurate representation of actual care quality.”  
 
The nation’s largest long term care organization recently sent a letter to key Congressional leaders requesting that they urge CMS to analyze and delay the implementation of the Five Star rating system. The letter states, in part,
 
“The three primary components -  survey & certification results including complaint surveys, staffing data, and quality measures  - that will be used to rate nursing homes for the Five Star Program are flawed and do not provide useful information to the public. The survey process is broken and does not accurately reflect the care that is provided the residents/patients of nursing homes... self-reported staffing ratios from the Online Survey, Certification and Reporting (OSCAR) data network are known to include questionable data and may be unrepresentative of the entire year… [and] CMS’s measurement of quality relies on measures that do not adequately adjust for patient/resident acuity.”
 
“We urge our Congressional friends to recognize the need to work together with CMS and other willing partners to influence development of the program to create a system that is fair to facilities and appropriate for consumers,” Yarwood concluded. “The millions of patients and families who rely upon our nation’s nursing facilities every day for the long term care and services they need deserve accurate and useful data, instead of a flawed information that reaches an equally flawed conclusion.”

Even though the final document will not be released until March 2009, experts are urging skilled nursing facilities to begin preparing now for the October 1, 2009 implementation date.  You and your staff can now begin using two tools that will definitely be included in the MDS 3.0 – the PHQ-9 tool for depression, and the Pressure Ulcer Scale Healing (PUSH) tool for pressure sore healing.  Both tools are available on the Just for Members section of our website.  If you need the username and password, please call the office at 602-265-5331 or email johnlinda@azhca.org. 

Spring Leadership Conference
March 23 & 24, 2009
Marriott University Park Hotel in Tucson
 
Annual Conference & Trade Show
August 25 – 27, 2009
Renaissance Glendale Hotel
 
Exhibitor information will be available in December.