ISSUE. Prior to the coronavirus pandemic, many nursing homes struggled to provide high-quality care and retain a sufficient workforce. The pandemic magnified their challenges, which are tied to how the U.S. pays for, regulates, and delivers nursing home services. GOALS. To assess how nursing home policies might be strengthened to improve health outcomes and experiences for residents and improve the work environment for staff. METHODS. Review of proposals related to nursing home payment, regulation, staffing, quality reporting, and delivery of care. KEY FINDINGS. There are several options for strengthening nursing homes. Medicare payment rates could be brought in line with costs, and Medicaid could pay higher rates commensurate with the costs of delivering care to frail older adults. Additional dollars could be given to direct caregivers. The payment system could encourage more resident-centered models of care. Regulatory reform might encompass increased enforcement and standards consistent with what residents and their family members want from nursing homes. State Medicaid programs could further invest in home- and community-based programs that help keep individuals out of nursing homes. CONCLUSION. A number of possible nursing home reform options exist to better protect nursing home residents and the individuals who care for them.
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