Now is the Time to Reimagine and Reinvest in America’s Nursing Homes

The COVID-19 pandemic exposed and exacerbated systemic issues in America’s long term care system, such as workforce shortages, chronic underfunding and aging physical plants. More than five million seniors and individuals with disabilities each year rely on the round-the-clock care and enriching social environment in long term care facilities. They deserve the highest quality care, and long term care industry officials are calling for meaningful, bold reforms. 

The American Health Care Association (AHCA) and LeadingAge have proposed the Care For Our Seniors Act to address some of the long-standing issues in America’s nursing homes and improve the overall quality of care. There are four main principles: 

  • ​Clinical: Enhance the quality of care in nursing homes by developing robust standards for infection preventionists, requiring that each nursing home have a registered nurse on-staff, 24 hours per day, and requiring a minimum 30-day supply of personal protective equipment in all nursing homes. 
  • Workforce: Strengthen and support our frontline caregivers by implementing a multi-phase tiered approach to attract, retain and develop more long term care professionals leveraging federal, state and academic institutions. 
  • Oversight: Establish a more resident-driven system that is focused on improvement to ensure nursing homes are in compliance and providing high quality care. This would include implementing a process to help turn around or close facilities that are chronic poor performers and adding customer satisfaction to the government’s five-star rating system to help guide potential residents and family members. 
  • Structural: Modernize nursing homes by conducting a national study on how to shift to more private rooms, which promote resident privacy, autonomy and dignity, as well as support infection control best practices. 
Lawmakers must support seniors no matter which setting they choose or is deemed most appropriate for their care needs. AHCA and its sister organization, the National Center for Assisted (NCAL), applauds the Biden Administration for taking steps to expand home- and community-based services (HCBS), such as in assisted living communities, in its American Jobs Plan. However, the plan does not provide support for nursing homes. It is critical that Congress and the Administration not only look at ways at expanding HCBS but support those settings that care for more clinically complex individuals. 

More than half of long term care residents are over the age 85 and suffer from multiple chronic diseases, including dementia. Residents depend on dedicated staff to help them with daily activities, monitor their clinical conditions, facilitate critical therapy, and offer life-affirming social activities. Not all individuals can receive this care at home, and what’s best for the individual is often what is most cost effective to government payers—as individuals who receive long term care in the appropriate setting are less likely to make frequent, expensive trips to the hospital. 

We can and must do both: expand HCBS and reimagine America’s nursing homes. But we need a proper investment in our nation’s seniors and individuals with disabilities to do it. Many of the challenges nursing homes are facing is due to chronic underfunding of Medicaid. With the proper government support, nursing homes can invest in their workforce, clinical services, and infrastructure to continue to improve residents’ quality of life. The Care For Our Seniors Act includes immediate and long-term strategies to address Medicaid underfunding for nursing homes. 

We must not let something like the pandemic happen in long term care ever again, and we must prepare for a growing elderly population. AHCA/NCAL is eager to work collaboratively with the Biden Administration and Congress to implement significant reforms that will protect and improve the lives of our nation’s seniors. 

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The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit