Shortcomings of the U.S. nursing home system, including inadequate care and staffing, risk the health and safety of millions of residents, according to a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM).

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Report details and key findings

In the report, a 17-member committee assembled by NASEM concluded that "[t]he way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable."  

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In response, the committee issued a set of recommendations to improve nursing home care in the United States. And while committee chair Betty Ferrell said the report "could profoundly change the delivery of care," the committee acknowledged that the recommendations represent an ambitious combination of both short- and long-term goals that would require the coordination of government agencies, providers, and many others in the industry.

"I will stress that this is a comprehensive package of reforms. Many stakeholders will want to grab their preferred recommendations and ignore the ones that are more challenging," said David Grabowski, committee member and Harvard University health care policy expert. "That is a mistake. We can't nibble around the edges and expect transformative change."

Notably, the committee highlighted the underinvestment of the nursing home sector that has been consistent "for decades" and noted that the implementation of their recommendations would likely require "a significant investment of financial resources at the federal and state levels," and from providers. 

"This report is a piercing wake-up call for policymakers," said LeadingAge President and CEO Katie Smith Sloan. "Decades of underfunding have left America's nursing home system in desperate need of an overhaul."

7 recommendations to improve the U.S. nursing home system

To create a more adequate approach to nursing home care, the committee made recommendations across seven key themes.

1. Provide comprehensive, equitable, patient-centered care

According to the report, nursing homes should implement improved care models that ensure the health, quality of life, and safety of residents while promoting autonomy and managing risk. In addition, residents' and families' preferences, goals, and values in care planning should be prioritized to help improve residents' quality of life. The report also recommended stronger emergency preparedness for nursing homes around the country.

2. Ensure workers are well-trained and appropriately compensated

The committee recommended competitive wages and benefits, higher minimum staffing standards, and expanded training requirements that include diversity, equity, and inclusion training.

3. Encourage transparency and accountability of finances, operations, and ownership

To increase financial transparency and accountability, the committee recommended U.S. lawmakers collect, audit, and publish detailed facility-level data that discloses the finances, operations, and ownership of all nursing homes within an accessible real-time database.

4. Establish a rational and robust financing system

The committee suggested a strategy to transition to a federal long-term care benefit that would provide sufficient financial coverage for comprehensive nursing home care services.

5. Create a highly effective quality assurance system

The committee suggested giving state survey agencies adequate resources to allow them to increase oversight of state survey performance and evaluate strategies to improve quality assurance initiatives.

6. Grow and enhance quality improvement programs

According to the committee, quality measures that report resident and family experience and gauge what they want from nursing homes need to be developed and regularly reported.

7. Implement health information technology across all nursing home facilities

The committee suggested using financial incentives to support the adoption of health information technology in all nursing homes—a move that could contribute to improvements in care delivery and coordination, enhanced staff productivity, increased promotion of patient safety, and reduced health disparities. (Christ, Modern Healthcare, 4/6; Grabowski et al., STAT News, 4/6; Brown, McKnights Long-Term Care News, 4/6; Sedensky, AP/ABC News, 4/6)