WEBVTT 00:01.866 --> 00:03.933 align:left position:10% line:77% size:80% AMNA NAWAZ: The Biden administration has proposed new staffing standards 00:03.933 --> 00:08.566 align:left position:20% line:77% size:70% to improve care for the 1.3 million Americans living in nursing homes. 00:08.566 --> 00:12.600 align:left position:10% line:77% size:80% And while it is the biggest change to regulations in three decades, 00:12.600 --> 00:16.666 align:left position:20% line:77% size:70% many patient advocates say it still falls short of what's needed. 00:16.666 --> 00:18.833 align:left position:10% line:89% size:80% Stephanie Sy has the details. 00:18.833 --> 00:21.766 align:left position:20% line:83% size:70% STEPHANIE SY: The COVID pandemic spotlighted how 00:21.766 --> 00:26.400 align:left position:20% line:77% size:70% understaffing and low pay in nursing homes led to many tragic outcomes, 00:26.400 --> 00:31.300 align:left position:10% line:77% size:80% with a disproportionate number of nursing home residents and workers dying. 00:31.300 --> 00:35.966 align:left position:20% line:77% size:70% The new proposed rule called for more nursing care, the equivalent 00:35.966 --> 00:40.933 align:left position:10% line:77% size:80% of about three hours of care per day per resident, with 33 minutes of that care 00:42.866 --> 00:46.633 align:left position:10% line:77% size:80% being delivered by a registered nurse, the rest by nurse's aides. Currently, 00:48.566 --> 00:51.966 align:left position:10% line:77% size:80% three-quarters of nursing homes do not have enough staff to meet these minimums. 00:53.366 --> 00:55.566 align:left position:10% line:83% size:80% David Grabowski is a health care policy expert and 00:55.566 --> 00:59.833 align:left position:10% line:77% size:80% professor at Harvard Medical School. He joins me now to share his reaction. 00:59.833 --> 01:02.566 align:left position:10% line:83% size:80% David, thank you for being on the "NewsHour" again. 01:02.566 --> 01:07.566 align:left position:10% line:71% size:80% There are currently, from what I understand, no enforceable standards for nursing home staffing. 01:09.666 --> 01:13.600 align:left position:20% line:71% size:70% Is it widely agreed that this was needed? And do you think it's enough to address the problem? 01:13.600 --> 01:17.133 align:left position:10% line:77% size:80% DAVID GRABOWSKI, Harvard Medical School: So, I think it was absolutely needed. 01:17.133 --> 01:22.133 align:left position:10% line:77% size:80% We have been talking about this as far back as the 1986 Institute of Medicine report, 01:24.033 --> 01:26.566 align:left position:10% line:77% size:80% so this has been longtime coming. We have had a number of us nursing 01:26.566 --> 01:31.566 align:left position:10% line:77% size:80% homes that are understaffed, too much turnover, low safety, poor quality. 01:33.633 --> 01:37.433 align:left position:10% line:77% size:80% Is it enough, to the second part of your question? I don't think so. You said the numbers there, 01:39.400 --> 01:42.800 align:left position:10% line:77% size:80% three hours per resident per day. These individuals are medically complex. They 01:44.800 --> 01:48.433 align:left position:10% line:77% size:80% have a lot of functional limitations, a lot of needs. So, three hours is a great 01:50.466 --> 01:52.566 align:left position:10% line:77% size:80% start. The administration deserves a ton of credit for putting this rule forward. 01:52.566 --> 01:57.433 align:left position:10% line:77% size:80% It's probably the biggest reform in nursing homes in decades, but we still have a ways to go. 01:59.433 --> 02:02.800 align:left position:10% line:77% size:80% STEPHANIE SY: But the reality is, as you know, the nursing home industry is already having 02:02.800 --> 02:06.633 align:left position:10% line:77% size:80% a hard time attracting and retaining staff as it is, without the standard. 02:06.633 --> 02:10.200 align:left position:20% line:83% size:70% So, even with this rule, can it be implemented? 02:10.200 --> 02:15.200 align:left position:10% line:77% size:80% DAVID GRABOWSKI: Timing is everything, and we're in the middle of a staffing shortage. 02:17.033 --> 02:20.533 align:left position:10% line:77% size:80% So this is a terrible time to implement a staffing standard in U.S. nursing homes. 02:22.466 --> 02:25.233 align:left position:10% line:77% size:80% That said, it's never been more needed than it is today. So that's really the 02:25.233 --> 02:29.400 align:left position:10% line:77% size:80% balancing act that the administration is facing. I think the administration built 02:29.400 --> 02:34.200 align:left position:10% line:83% size:80% in a lot of measures within this policy to help out nursing homes 02:34.200 --> 02:38.400 align:left position:20% line:77% size:70% that are suffering from staffing shortages in their local markets. 02:38.400 --> 02:43.400 align:left position:10% line:77% size:80% So they have given any facility that can't find staff at the prevailing wages, 02:45.333 --> 02:48.200 align:left position:10% line:77% size:80% and they meet a series of criteria, they have been given an exemption under this policy. 02:48.200 --> 02:53.166 align:left position:10% line:77% size:80% They have also given a long implementation period in nursing homes, three to five years. 02:55.233 --> 02:58.266 align:left position:20% line:71% size:70% And then, finally, the administration has put $75 million into this growing the next 03:00.433 --> 03:05.400 align:left position:10% line:77% size:80% generation of nursing home caregivers. So, is that enough? No. We need to figure out 03:07.333 --> 03:12.300 align:left position:10% line:77% size:80% ways to grow this work force. But I think these measures are a way to sort of help 03:14.100 --> 03:18.500 align:left position:10% line:77% size:80% nursing homes that are really facing an unprecedented work force shortage. 03:20.200 --> 03:23.100 align:left position:10% line:77% size:80% STEPHANIE SY: Part of the problem Biden administration officials have 03:23.100 --> 03:28.100 align:left position:20% line:77% size:70% pointed to are private equity firms' buyouts of private nursing homes. 03:29.966 --> 03:33.533 align:left position:10% line:77% size:80% They say that that's contributing to the staffing shortages, because they imply 03:36.100 --> 03:38.633 align:left position:10% line:71% size:80% those firms put profit over patient care. Have you seen evidence of that? Is that a big factor here? 03:40.300 --> 03:43.433 align:left position:10% line:83% size:80% DAVID GRABOWSKI: I think that's a big part of the story. 03:43.433 --> 03:48.433 align:left position:10% line:77% size:80% Ownership -- we don't have a lot of those mom-and-pop-owned nursing homes that we had 20, 03:50.466 --> 03:53.466 align:left position:10% line:77% size:80% 30 years ago. There are -- these are corporations. They're often very complex 03:53.466 --> 03:58.433 align:left position:10% line:77% size:80% corporations with many layers. And it's hard for policymakers to follow the dollars. 04:00.466 --> 04:03.400 align:left position:10% line:77% size:80% And, so, many of those dollars don't end up in direct resident care. They 04:03.400 --> 04:07.366 align:left position:10% line:77% size:80% don't end up in the pockets of staff. They unfortunately end up in other 04:07.366 --> 04:11.333 align:left position:10% line:77% size:80% parts of the organizations through what are called related party transactions. 04:11.333 --> 04:16.333 align:left position:10% line:77% size:80% So, private equity, real estate investment trusts and lots of other complicated ownership 04:18.300 --> 04:22.433 align:left position:10% line:77% size:80% structures have emerged in this industry and really, I think, helped push along the kinds 04:25.600 --> 04:30.600 align:left position:10% line:71% size:80% of reforms that we're now thinking about, like a minimum staffing standard, where I think 20, 04:32.700 --> 04:37.100 align:left position:20% line:71% size:70% 30 years ago this -- we were talking about this policy, but it wasn't as needed as it is today, 04:38.566 --> 04:41.333 align:left position:10% line:83% size:80% because we didn't have the same set of owners that we do today. 04:43.300 --> 04:47.833 align:left position:10% line:77% size:80% STEPHANIE SY: And should the government be ponying up more money to pay nursing home staff? 04:49.833 --> 04:52.500 align:left position:10% line:77% size:80% DAVID GRABOWSKI: If you talk to individuals in the industry, it's a billion-dollar question. 04:52.500 --> 04:57.033 align:left position:10% line:77% size:80% So, there are some nursing homes that haven't put enough dollars back into 04:57.033 --> 05:01.800 align:left position:10% line:77% size:80% direct resident care and. This policy will help discipline those nursing homes. They can 05:01.800 --> 05:06.800 align:left position:10% line:77% size:80% no longer siphon off dollars away from direct resident care, those private equity groups we 05:08.800 --> 05:11.333 align:left position:10% line:77% size:80% were just talking about. They will have to put those dollars back into direct resident care. 05:11.333 --> 05:16.200 align:left position:10% line:71% size:80% Other nursing homes may really struggle. I said earlier this policy is hopefully a start. It's not 05:16.200 --> 05:21.200 align:left position:10% line:77% size:80% just a start with staffing. I hope it's a start towards a more comprehensive set of reforms. 05:22.066 --> 05:23.233 align:left position:10% line:89% size:80% STEPHANIE SY: We will see. 05:23.233 --> 05:25.133 align:left position:20% line:83% size:70% David Grabowski at Harvard Medical School, 05:25.133 --> 05:27.833 align:left position:10% line:83% size:80% thanks so much for sharing your expertise with the "NewsHour." 05:27.833 --> 05:30.000 align:left position:20% line:83% size:70% DAVID GRABOWSKI: Thank you, Stephanie.