Care For Our Seniors Act

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The COVID-19 pandemic has exposed and exacerbated long-standing challenges impacting the long term care profession. The sector is dedicated to learning from this experience, renewing our commitment to our seniors, and offering solutions that will improve the quality of care in our nation’s nursing homes.

AHCA and Leading​Age ​are advocating for meaningful action now to protect seniors and prepare for a growing elderly population that deserves a robust, quality LTC system. We have prioritized four principles for nursing homes that can be applied to support better pandemic management, help prevent such devastation from happening again and strengthen nursing home care. These policy proposals may be considered by Congress and other policymakers either as a complete, legislative package, or individual policy proposals may be incorporated into other relevant legislation, so long as the necessary resources for each proposal are tied together.

The reforms fall into four categories: 
  1. ​clinical improvements to enhance quality of care
  2. workforce improvements to strengthen and support our frontline caregivers
  3. oversight reforms to make systems more resident-driven
  4. structural modernizations focused on resident dignity and safety

Read the Morning Consult Opinion: ​"Applying the Lessons of the COVID-19 Pandemic to Improve Nursing Homes"​
by Mark Parkinson, AHCA/NCAL President & CEO; and Katie Smith Sloan, LeadingAge ​President & CEO


The Provisions of the Care for Our Seniors Act 


​​​​Enhance Quality of Care

Enhanced Infection Control Preventionist: Effective infection prevention and control practices in nursing homes provide a safer, healthier environment for residents and improve quality of life. The Care For Our Seniors Act recommends establishing an updated guideline for staffing infection preventionists in each nursing home based on proven, successful strategies. This includes proper funding and workforce availability to effectively implement meaningful, sustained changes.  

Funded by: Medicaid payment policy.

24-Hour Registered Nurse (RN): Research shows a positive association between RN hours and overall quality. The Care For Our Seniors Act supports a new federal requirement that each nursing home have a RN on-staff 24 hours a day and will provide recommendations on how to effectively implement this requirement.  

Funded by: Medicaid payment policy and Medicare rates.

Minimum Personal Protective Equipment (PPE): Current regulations for nursing homes do not require a minimum PPE supply. The Care For Our Seniors Act supports efforts to require a minimum 30-day supply of PPE in nursing homes, which will be supported by ongoing federal/state stockpiles with PPE that is acceptable for health care use.   

Funded by: Federal and state governments.


​​Strengthen and Support our Frontline Caregivers

Recruit and Retain a Long Term Care Workforce Strategy: The Care For Our Seniors Act supports implementing a multi-phase tiered approach to supply, attract and retain the long term care workforce leveraging federal, state, and academic entities. This includes loan forgiveness for new graduates who work in LTC, tax credits for licensed LTC professionals, programs for affordable housing and childcare assistance, and increased subsidies to professionals’ schools whose graduates work in nursing homes for at least five years.  

Funded by: Federal and state governments.


Improve Systems to be More Resident-Driven

Survey Improvements for Better Resident Care: The current nursing home survey process does not serve residents’ best interests and is too focused on a punitive approach rather than improvement. The Care For Our Seniors Act supports development of an effective oversight system and processes that support improved care and protect residents, consistent with the Centers for Medicare and Medicaid Services (CMS) standards.  

Funded by: Current CMS and state survey agency funding (budget neutral).

Chronic Poor Performing Nursing Facilities and Change of Ownership: Chronic poor performing nursing homes often do not meet the needs of their residents. The survey system needs a process to help turn these facilities around or close the facility. The Care For Our Seniors Act is proposing a five-step process to aid such providers: (1) Identify chronic poor performing facilities via calculated score; (2) Conduct an analysis to determine the reason for chronic poor performance; (3) Develop a turn-around plan; (4) Monitor progress; and (5) Determine if the plan of correction goals have been met or the need for plan revisions.
Funded by: CMS, states and providers responsible for process improvement.

Customer Satisfaction: Nursing homes are the only health care setting in which CMS collects and publicly reports quality data that does not include customer satisfaction. The Care For Our Seniors Act recommends adding customer satisfaction to the government’s five-star rating system to help monitor the quality of a facility for family members and guide consumer choice.  

Funded by: Current CMS funding (budget neutral).


Modernize for Patient Dignity and Safety​​

Shift to Private Rooms: The average nursing home is around 40 to 50 years old. The traditional care models are no longer considered appropriate to provide person-centered care. One central aspect of this shift is a greater emphasis on auton​omy, dignity and privacy. The value of increased privacy is central to this debate. Private rooms also support infection control best practices. The Care For Our Seniors Act ​supports the​ development of a national study producing data on conversion costs and a recommended approach to make this shift.  

Funded by: Medicaid payment policy. 

​The Cost of Meaningful Change​

 Financing the Care for Our Seniors Act

​Real, long-lasting transformation that will truly protect our residents requires a considerable investment in the LTC profession. Long term care providers stand ready to make meaningful change that can help our residents, our staff and our country. But it won’t be possible without a commitment from policymakers to provide the necessary and consistent financial support for our elderly residents.  

For too long, nursing homes have faced chronic Medicaid underfunding and unfunded government mandates, leaving many unable to afford enhancements in their care delivery, workforce and infrastructure. COVID-19 has exacerbated these economic challenges. Nursing homes have spent tens of billions responding to the pandemic specifically PPE, testing, additional staff and bonus pay. Coupled with significant losses due to fewer new residents, the nursing home industry expects to lose $94 billion over the course of the pandemic (2020-2021). As a health care provider that relies almost entirely on government reimbursement (Medicare and Medicaid), nursing homes cannot make substantial reforms on their own. They need the support of federal and state policymakers and resources.  

AHCA and LeadingAge have developed four interrelated, investment strategies that will help ensure a robust and quality long term care system. 

  1. Enhanced Federal Medical Assistance Percentages (EFMAP): Increased federal Medicaid funds are provided to states to pay for the mandatory nursing facility benefit, with requirements that additional federal funds be used for nursing facility rates.  
  2. Federal Framework for “Allowable Cost” or “Reasonable Cost”: Establish federal guidelines for state allowable cost definitions. 
  3. Medicaid Rate Adequacy Requirement: Medicaid rates are brought up to equal the cost of care and subsequently updated regularly to keep pace with increases in costs of care.  
  4. State Nursing Facility Value-Based Purchasing (VBP) Committee & Required Design Report: The state will be required to form and maintain a state, health plan, and nursing facility VBP committee with specific guidelines and deadlines to submit reports. This offers the potential for additional resources. ​