1 00:00:01,866 --> 00:00:03,933 AMNA NAWAZ: The Biden administration has proposed new staffing standards 2 00:00:03,933 --> 00:00:08,566 to improve care for the 1.3 million Americans living in nursing homes. 3 00:00:08,566 --> 00:00:12,600 And while it is the biggest change to regulations in three decades, 4 00:00:12,600 --> 00:00:16,666 many patient advocates say it still falls short of what's needed. 5 00:00:16,666 --> 00:00:18,833 Stephanie Sy has the details. 6 00:00:18,833 --> 00:00:21,766 STEPHANIE SY: The COVID pandemic spotlighted how 7 00:00:21,766 --> 00:00:26,400 understaffing and low pay in nursing homes led to many tragic outcomes, 8 00:00:26,400 --> 00:00:31,300 with a disproportionate number of nursing home residents and workers dying. 9 00:00:31,300 --> 00:00:35,966 The new proposed rule called for more nursing care, the equivalent 10 00:00:35,966 --> 00:00:40,933 of about three hours of care per day per resident, with 33 minutes of that care 11 00:00:42,866 --> 00:00:46,633 being delivered by a registered nurse, the rest by nurse's aides. Currently, 12 00:00:48,566 --> 00:00:51,966 three-quarters of nursing homes do not have enough staff to meet these minimums. 13 00:00:53,366 --> 00:00:55,566 David Grabowski is a health care policy expert and 14 00:00:55,566 --> 00:00:59,833 professor at Harvard Medical School. He joins me now to share his reaction. 15 00:00:59,833 --> 00:01:02,566 David, thank you for being on the "NewsHour" again. 16 00:01:02,566 --> 00:01:07,566 There are currently, from what I understand, no enforceable standards for nursing home staffing. 17 00:01:09,666 --> 00:01:13,600 Is it widely agreed that this was needed? And do you think it's enough to address the problem? 18 00:01:13,600 --> 00:01:17,133 DAVID GRABOWSKI, Harvard Medical School: So, I think it was absolutely needed. 19 00:01:17,133 --> 00:01:22,133 We have been talking about this as far back as the 1986 Institute of Medicine report, 20 00:01:24,033 --> 00:01:26,566 so this has been longtime coming. We have had a number of us nursing 21 00:01:26,566 --> 00:01:31,566 homes that are understaffed, too much turnover, low safety, poor quality. 22 00:01:33,633 --> 00:01:37,433 Is it enough, to the second part of your question? I don't think so. You said the numbers there, 23 00:01:39,400 --> 00:01:42,800 three hours per resident per day. These individuals are medically complex. They 24 00:01:44,800 --> 00:01:48,433 have a lot of functional limitations, a lot of needs. So, three hours is a great 25 00:01:50,466 --> 00:01:52,566 start. The administration deserves a ton of credit for putting this rule forward. 26 00:01:52,566 --> 00:01:57,433 It's probably the biggest reform in nursing homes in decades, but we still have a ways to go. 27 00:01:59,433 --> 00:02:02,800 STEPHANIE SY: But the reality is, as you know, the nursing home industry is already having 28 00:02:02,800 --> 00:02:06,633 a hard time attracting and retaining staff as it is, without the standard. 29 00:02:06,633 --> 00:02:10,200 So, even with this rule, can it be implemented? 30 00:02:10,200 --> 00:02:15,200 DAVID GRABOWSKI: Timing is everything, and we're in the middle of a staffing shortage. 31 00:02:17,033 --> 00:02:20,533 So this is a terrible time to implement a staffing standard in U.S. nursing homes. 32 00:02:22,466 --> 00:02:25,233 That said, it's never been more needed than it is today. So that's really the 33 00:02:25,233 --> 00:02:29,400 balancing act that the administration is facing. I think the administration built 34 00:02:29,400 --> 00:02:34,200 in a lot of measures within this policy to help out nursing homes 35 00:02:34,200 --> 00:02:38,400 that are suffering from staffing shortages in their local markets. 36 00:02:38,400 --> 00:02:43,400 So they have given any facility that can't find staff at the prevailing wages, 37 00:02:45,333 --> 00:02:48,200 and they meet a series of criteria, they have been given an exemption under this policy. 38 00:02:48,200 --> 00:02:53,166 They have also given a long implementation period in nursing homes, three to five years. 39 00:02:55,233 --> 00:02:58,266 And then, finally, the administration has put $75 million into this growing the next 40 00:03:00,433 --> 00:03:05,400 generation of nursing home caregivers. So, is that enough? No. We need to figure out 41 00:03:07,333 --> 00:03:12,300 ways to grow this work force. But I think these measures are a way to sort of help 42 00:03:14,100 --> 00:03:18,500 nursing homes that are really facing an unprecedented work force shortage. 43 00:03:20,200 --> 00:03:23,100 STEPHANIE SY: Part of the problem Biden administration officials have 44 00:03:23,100 --> 00:03:28,100 pointed to are private equity firms' buyouts of private nursing homes. 45 00:03:29,966 --> 00:03:33,533 They say that that's contributing to the staffing shortages, because they imply 46 00:03:36,100 --> 00:03:38,633 those firms put profit over patient care. Have you seen evidence of that? Is that a big factor here? 47 00:03:40,300 --> 00:03:43,433 DAVID GRABOWSKI: I think that's a big part of the story. 48 00:03:43,433 --> 00:03:48,433 Ownership -- we don't have a lot of those mom-and-pop-owned nursing homes that we had 20, 49 00:03:50,466 --> 00:03:53,466 30 years ago. There are -- these are corporations. They're often very complex 50 00:03:53,466 --> 00:03:58,433 corporations with many layers. And it's hard for policymakers to follow the dollars. 51 00:04:00,466 --> 00:04:03,400 And, so, many of those dollars don't end up in direct resident care. They 52 00:04:03,400 --> 00:04:07,366 don't end up in the pockets of staff. They unfortunately end up in other 53 00:04:07,366 --> 00:04:11,333 parts of the organizations through what are called related party transactions. 54 00:04:11,333 --> 00:04:16,333 So, private equity, real estate investment trusts and lots of other complicated ownership 55 00:04:18,300 --> 00:04:22,433 structures have emerged in this industry and really, I think, helped push along the kinds 56 00:04:25,600 --> 00:04:30,600 of reforms that we're now thinking about, like a minimum staffing standard, where I think 20, 57 00:04:32,700 --> 00:04:37,100 30 years ago this -- we were talking about this policy, but it wasn't as needed as it is today, 58 00:04:38,566 --> 00:04:41,333 because we didn't have the same set of owners that we do today. 59 00:04:43,300 --> 00:04:47,833 STEPHANIE SY: And should the government be ponying up more money to pay nursing home staff? 60 00:04:49,833 --> 00:04:52,500 DAVID GRABOWSKI: If you talk to individuals in the industry, it's a billion-dollar question. 61 00:04:52,500 --> 00:04:57,033 So, there are some nursing homes that haven't put enough dollars back into 62 00:04:57,033 --> 00:05:01,800 direct resident care and. This policy will help discipline those nursing homes. They can 63 00:05:01,800 --> 00:05:06,800 no longer siphon off dollars away from direct resident care, those private equity groups we 64 00:05:08,800 --> 00:05:11,333 were just talking about. They will have to put those dollars back into direct resident care. 65 00:05:11,333 --> 00:05:16,200 Other nursing homes may really struggle. I said earlier this policy is hopefully a start. It's not 66 00:05:16,200 --> 00:05:21,200 just a start with staffing. I hope it's a start towards a more comprehensive set of reforms. 67 00:05:22,066 --> 00:05:23,233 STEPHANIE SY: We will see. 68 00:05:23,233 --> 00:05:25,133 David Grabowski at Harvard Medical School, 69 00:05:25,133 --> 00:05:27,833 thanks so much for sharing your expertise with the "NewsHour." 70 00:05:27,833 --> 00:05:30,000 DAVID GRABOWSKI: Thank you, Stephanie.