Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Appendix E
Recommendations Timeline
While all of the recommendations in this report target areas that require immediate attention, the committee recognizes that some recommendations can be fully implemented immediately while others will require planning, coordination, and larger scale effort. Given this recognition of an incremental approach to the integrated set of recommendations, the committee has categorized each of the components of their recommendations according to an estimated implementation timeline. Recommendations that are
- marked for immediate implementation are urgent, and largely can move ahead using existing structures.
- identified for short- and intermediate-term implementation require action in the short-term to get started, but will require some amount of planning or coordination (such as the planning or coordination needed to initiate new studies or demonstration projects).
- characterized as long-term implementation also require initiation in the shorter term, but the committee recognizes that full implementation may take several years (e.g., action dependent upon new research to be conducted or collaboration by multiple agencies across state and federal authorities).
The committee emphasizes that even those recommendations requiring intermediate or longer-term timeframes for complete implementation still need to be initiated now.
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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| Recommendation | Rec |
|---|---|
| Immediate Implementation | |
| Documentation of resident’s preferences in care plan and review and evaluation of its implementation | 1A |
| Inclusion of explicit references to nursing homes in Emergency Support Functions | 1C |
| Representation of nursing homes in all emergency and disaster planning and management sessions and drills | 1D |
|
1D |
| Pathways for ready access to PPE | 1D |
| Development of formal relationships between nursing homes and local, county, and state-level public health and emergency management departments | 1D |
| Competitive wages and benefits for all nursing home staff | 2A |
Enhancement of the current minimum staffing requirements for every nursing home to include
|
2B |
| Coverage of certified nursing assistant (CNA) time for completing education and training programs | 2E |
| Compliance with existing statute to determine adequacy of Medicaid payments to cover comprehensive care | 4B |
| Adequate capacity and resources for state survey agencies to fulfill current oversight responsibilities | 5A |
| Strong, consistent, responsive, and transparent process for grievances and complaints | 5A |
| Greater use of variety of existing enforcement remedies | 5B |
| Short-Term Implementation | |
| Addition of documentation of emergency plans and staff training to Care Compare | 1D |
| Enactment of state licensure decisions to ensure that all new nursing homes are constructed with single-occupancy bedrooms and private bathrooms for most or all residents | 1E |
| Incentives for nursing homes to hire qualified licensed clinical social workers at the M.S.W. or Ph.D. level and advanced practice registered nurses (APRNs) for clinical care, including allowing Medicare billing and reimbursement for these services | 2D |
| Free entry-level training and continuing education for CNAs (paid for by state and federal governments together with nursing homes) | 2E |
| Minimum education and national competency requirements for all staff | 2F |
| Annual continuing education for all nursing home staff | 2G |
| Resources and training to support inclusion of chosen family members as part of caregiving team | 2G |
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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| Recommendation | Rec |
|---|---|
| Ongoing diversity and inclusion training for all nursing home staff (including leadership) | 2G |
| Data collection on baseline demographics, training and expertise, and staffing patterns for staff providing direct care | 2H |
| Detailed facility-level data on the finances, operations, and ownership of all individual nursing homes | 3A |
| Study of federal benefit design | 4A |
| Specific percentage of payments designated for direct-care services (including staffing, behavioral health, and clinical care) | 4C |
| Extension of bundled payment initiatives to all conditions | 4D |
| Elimination of certificate-of-need requirements and construction moratoria | 5E |
| Increased weight of staffing measures within five-star composite rating on Care Compare | 6B |
| Identification of pathway to provide financial incentives for certified EHR adoption | 7A |
| Short-Term Implementation (Initiation of Research and Grants) | |
Translational research and demonstration projects to identify the most effective nursing home care delivery models
|
1B |
| Research to identify and rigorously test specific minimum and optimum staffing standards for all direct-care staff | 2C |
| Training grants to advance and expand the role of the CNA and develop new models of care delivery that leverage the role of the CNA as a member of the interdisciplinary care team | 2E |
| Research on recruitment, training, and retention of all nursing home workers (particularly CNAs), including gender, ethnicity, and race-related outcomes of job quality indicators | 2I |
| Demonstration projects to explore use of alternative payment models for long-term nursing home care tied to quality metrics | 4E |
| Development and evaluation of strategies to improve quality assurance process | 5B |
| Measures of disparities in nursing home care within and across facilities at national, state, and ownership levels | 6D |
| Development of policies and culturally tailored interventions for disparities | 6D |
Development of new measures, including
|
6C |
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Development of new structural measures, including
|
6C, 7B |
| Development and ongoing implementation of workforce training emphasizing core HIT competencies | 7C |
| Research on use of HIT, existing structural disparities in HIT adoption, and their impact on resident outcomes | 7D |
| Research on innovative HIT applications for resident care and assessment of clinician, resident, and family perceptions of HIT usability | 7D |
| Intermediate-Term Implementation | |
| Incentives to support innovative, smaller, home-like designs | 1E |
| Consulting or employment relationships with qualified licensed clinical social workers at the M.S.W. or Ph.D. level, APRNs, clinical psychologists, psychiatrists, pharmacists, and others | 2D |
| Career advancement opportunities and peer mentors for CNAs | 2E |
| Pathways for current workers to achieve minimum education and competency requirements | 2F |
| Inclusion of geriatrics content in education programs for all health care professionals | 2F |
| Real-time, readily usable, and searchable database that can evaluate and track quality of care for facilities with common ownership or management company | 3B |
| Assessment of the impact of nursing home real estate ownership models and related-party transactions on quality of care | 3B |
| Refine, expand, and report oversight performance metrics of state survey agencies | 5A |
| Use of existing strategies of enforcement by CMS when states fall short of expected standards (based on performance metrics) | 5A |
| Increased funding for long-term care ombudsman programs | 5C |
| Imposition of oversight and enforcement actions on common owner (based on ability to track quality by owner [Recommendation 3B]) | 5D |
| Collection of data for CAHPS measures and reporting on Care Compare | 6A |
| Reporting of quality performance by common owner on Care Compare | 6B |
| Improved validity of Minimum Data Set–based clinical quality measures on Care Compare | 6B |
| Improved differentiation in five-star composite rating | 6B |
| Development of overall health equity strategy for nursing homes | 6D |
| Establishment of state-based technical assistance programs | 6E |
| Minimum Data Set to identify and describe disparities in nursing homes (collected and reported annually) | 6D |
| Measurement of levels of HIT adoption and interoperability and reporting of results in Care Compare | 7B |
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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| Recommendation | Rec |
|---|---|
| Long-Term Implementation | |
| Construction and reconfiguration (renovation) of nursing homes to provide smaller, more home-like environments, and/or smaller units within larger nursing homes | 1E |
| Updated regulatory requirements for staffing standards in nursing homes to reflect completed research on minimum and optimum staffing standards for all direct-care staff | 2C |
| Implementation of state demonstration projects based on study of federal benefit design | 4A |
| Ongoing psychometric testing of CAHPS in nursing homes | 6A |
| Adoption of new measures for reporting on Care Compare (as described under short-term implementation (initiation of research) | 6C, 7B |
| Reporting of new measures of disparities in nursing home care | 6D |
| Identification of thresholds for action on disparities, and promising pathways to reduce or eliminate disparities | 6D |
| Evaluation of state-based technical assistance programs | 6E |
| Measurement and reporting of clinician, resident, and family perceptions of HIT usability | 7B |
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
Suggested Citation:"Appendix E: Recommendations Timeline." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
×
