Coronavirus commission for safety and quality in nursing homes – Final report

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Breaking News: The report that all of LTC has been waiting for has just been posted: Coronavirus Commission for Safety and Quality in Nursing Homes - Commission Final Report ... September 2020.  This is a 186-page report.

The Centers for Medicare & Medicaid Services (CMS) tasked MITRE, the operator of the CMS Alliance to Modernize Healthcare (Health FFRDC), with an urgent assignment: Convene a commission of experts to address safety and quality in nursing homes in relation to the public health emergency. The main purpose of the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) was to solicit lessons learned from the early days of the pandemic and recommendations for future actions to improve infection prevention and control measures, safety procedures, and the quality of life of residents within nursing homes. CMS outlined four objectives for the Commission:

  1. Identify best practices for facilities to enable rapid and effective identification and mitigation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission (and other infectious diseases) in nursing homes.
  2. Recommend best practices as exemplars of rigorous infection control practices and facility resiliency that can serve as a framework for enhanced oversight and quality monitoring activities.
  3. Identify best practices for improved care delivery and responsiveness to the needs of all nursing home residents in preparation for, during, and following an emergency.
  4. Leverage new data sources to improve upon existing infection control policies and enable coordinated actions across federal surveyors and contractors (as well as state and local entities) to mitigate the effects of SARS-CoV-2 and future emergencies.

The 25 Commission members hailed from around the country with diverse expertise and viewpoints ranging from nursing home resident, consumer advocates, and nursing home owners and administrators to infectious disease experts, academicians, state authorities, and others. The Commission convened nine times between June 23 and August 19. The Commission used the four objectives provided by CMS and its collective knowledge of the nursing home system, to frame its discussions. Analysis of public input solicited via the Commission’s website and discussion of relevant CMS and other federal actions to date also informed the Commission’s work. Figure 1 illustrates the Commission process and outputs.

The Commission emerged from its convenings with 27 recommendations and accompanying action steps organized into 10 themes. These themes intersect with the Commission’s four objectives, and reflect responses to:

  • Ongoing supply and affordability dilemmas related to testing, screening, and personal protective equipment (PPE)
  • Tension between rigorous infection control measures and quality of life issues that exist in cohorting and visitation policies
  • A call for transparent and accessible communications with residents, their representatives and loved ones, and the public
  • Urgent need to train, support, protect, and respect direct-care providers
  • Outdated infrastructure of many nursing-home facilities
  • Opportunities to create and organize guidance to owners and administrators that is more actionable and to obtain data from nursing homes that is more meaningful for action and research
  • Insufficient funding for quality nursing home operations, workforce performance, and resident safety.

Each of the 27 Principal Recommendations are deliberately paired with specific action steps. The intent is that CMS would implement each principal recommendation in conjunction with its associated action steps to understand and realize the Commission’s vision.

Beginning on page 154, you’ll find very visual Key Takeaways and Recommendations, arranged in Themes.  Members of the Commission are found on page 153. Page 183 showcases the CMS Actions to Date Reference List (still being validated; updated through 8/11).

I have just started to review this much-anticipated report.  I hope you’ll also take a close look at this report and share it with your colleagues!  Before I go back to reading, take a look at the Table of Contents to further whet your interest in this report.  You might also join me in hoping (and encouraging) that this report along with the Commission’s recommendations is taken seriously by the current Administration and CMS.  The time to act is now!

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