Health Care Reform to Improve Long-Term Care for Both Consumers and Direct Care Workers

Becka Livesay

Although health care reform continues to spark debate and controversy across the nation, when President Obama signed the Patient Protection and Affordable Care Act, it marked the beginning of the most significant improvements to long-term care in a generation. Several components of the legislation, including Nursing Home Transparency and Improvement and the Elder Justice Act, will not only improve the care America’s long-term care consumers receive but will also improve and better the working conditions and training for direct care workers.

NCCNHR, The National Consumer Voice for Quality Long-Term Care, works to improve the quality of care and life for long-term care consum­­ers and their families as well as working conditions and training for direct care workers.  When health care reform passed Congress, nearly a dozen policy resolutions adopted by NCCNHR were addressed, including developing a standardized form for reporting nursing service hours and turnover and retention rates, requiring states to address retaliation against resident representatives who complain about poor care, and safeguarding nursing home residents when nursing home ownership is transferred.  Health care reform will also address several ongoing problems faced by both consumers and workers.

Inadequate training

Inadequate training continues to be an issue for both workers and care recipients. In 1987, the Nursing Home Reform Act mandated 75 hours of initial training for certified nursing assistants and home health aides who work in Medicare- or Medicaid-certified nursing homes and home health agencies.  Since then, the skills needed to provide quality care have increased while the federal requirement remained the same.  Furthermore, recent years have seen a growing demand for workers trained in dementia care and complex care needs.  While some states have increased training requirements, there remains a need for strong national training standards for all direct care workers.  Health care reform will help address the demand for training in caring for those with Alzheimer’s disease and other dementias, and provide new opportunities for direct care workers to advance into more specialized training, hopefully increasing certification and wages.

Incorporating deep culture change as an important component of quality care

Groups, including NCCNHR and the Pioneer Network, work to spread culture change principles and practices across all long-term care settings.  These principles improve the quality of life and care for residents by moving facilities away from the traditional medical-model institution.  In order for culture change to be a success, direct care workers must be valued for their work and relationships with residents and receive increased autonomy, so they can deliver the individualized care desired by long-term care consumers and their families.  Health care reform will create demonstration projects to identify the best practices in culture change.

Nursing Home Transparency and Improvement and the Elder Justice Act
Both Nursing Home Transparency and Improvement and the Elder Justice Act are part of health care reform, and once fully implemented, will improve long-term care for both consumers and workers through increased transparency, improved data collection, and training.
The provisions of Nursing Home Transparency are the first comprehensive improvements to nursing home quality since OBRA ’87.  The law will provide consumers and workers with a substantial amount of new information about facilities.  Nursing Home Transparency and Improvement will provide several quality-improving components, including public disclosure of nursing home owners, operators and other entities and individuals; establishment of internal procedures by nursing homes to improve quality assurance; collection of staffing data electronically and public reporting; improved public information on Nursing Home Compare, including staffing data and summaries of complaints against facilities; and establishing of a consumer rights information page on the Nursing Home Compare website.

Additionally, Nursing Home Transparency will require dementia care and abuse prevention in nurse aide training. Although the minimum 75 hours of initial training will not be increased, there will be a study to determine whether it should be.  The law also authorizes demonstration projects to identify best practices in culture change and information technology.

Provisions of the Elder Justice Act include the establishment of an Elder Justice Coordinating Council; and authorization of $400 million in dedicated funding for Adult Protective Services; $100 million for state demonstrations grants to test methods to detect and prevent elder abuse; $26 million for the establishment of Elder Abuse, Neglect and Exploitation Forensic Centers;  and $32.5 million in grants to support the Long-Term Care Ombudsman Program and an additional $40 million in training programs for national organizations and state long-term care ombudsman programs.  The Elder Justice Act will also require operators and employees of long-term care facilities that receive federal funds to report any reasonable suspicion of abuse or neglect to law enforcement, or the facility will face serious fines.  The law also says that facilities can be fined for retaliating against a worker who reports crime.

The Elder Justice Act will also authorize $67.5 million in grants to enhance the long-term care workforce through training, recruitment, and incentives for workers in either a facility or community-based setting.

Other provisions of the health care reform law require a study of implementing a national nurse aide registry and establish a national system to conduct criminal background checks on any employee of a long-term care provider who comes into contact with patients or residents. NCCNHR will continue to provide summaries and timelines showing when key long-term care provisions of health care reform will be implemented.