Warner, Scott introduce bill to improve hiring, retention of senior caregivers

U.S. Sens. Mark Warner (D-VA) and Tim Scott (R-SC) introduced the Ensuring Seniors Access to Quality Care Act to help senior living facilities caring for aging adults to better screen, hire, and retain quality staff.

The Ensuring Seniors Access to Quality Care Act would provide nursing home operators with access to the National Practitioner Data Bank (NPDB) – an existing national criminal background check system – a move that would give employers greater ability to screen and vet potential employees to ensure that caregivers do not have a history that would endanger the seniors under their care.

“Anyone with a loved one in a senior living facility should have the peace of mind of knowing that they are receiving care from compassionate, dependable, and well-qualified staff as they live out their golden years,” said Sen. Warner. “This bipartisan legislation will help provide these facilities with the tools they need to hire experienced staff and to continue to meet the demands of high quality care without losing staffing levels.”

Our senior citizens, and their families, know the importance of having well-qualified, compassionate and trustworthy caregivers in senior living facilities,” said Sen. Scott. “The Ensuring Seniors Access to Quality Care Act will help these facilities more efficiently hire the best candidates, and, in turn, provide better care for seniors everywhere.”

Currently, senior living facilities are not authorized to use the NPDB and instead must rely on state-level criminal background checks that can often omit key details about an employee’s background.

Additionally, the bipartisan legislation amends overly restrictive regulations that bar certain senior living facilities from conducting training programs for in-house Certified Nurse Assistants (CNAs) – individuals who assist patients with their daily activities – for a two-year period after a care facility is found to have deficiencies, such as poor conditions or patient safety violations.

Under existing regulations by the Centers for Medicare and Medicaid Services (CMS), senior living facilities that receive a civil monetary penalty (CMP) over $10,000 are automatically prohibited from conducting CNA staff training programs for a period of two years.

According to the Bureau of Labor and Statistics, the need for nursing assistants to care for the growing aging population is projected to rise 9 percent from 2018 to 2028. With this growing need for caregivers, in-house CNA education at senior living facilities often helps meet the need for CNAs.

But with the existing two-year lockout period, it can make it more difficult for senior care facilities to properly train new employees and retrain existing employees. Research by CMS also indicates that there is a direct correlation between facilities that are staffed adequately and the high-quality care they provide.

Specifically, the legislation would allow senior living facilities to reinstate its CNA training program if:

The facility has corrected the deficiency for which the CMP was assessed;
The deficiency for which the CMP was assessed did not result in an immediate risk to patient safety and is not the result of patient harm resulting from abuse or neglect;
And the facility has not received a repeat deficiency related to direct patient harm in the preceding two year period.
“CNAs are essential to the quality care provided in long term care facilities. In addition, the jobs provided by nursing homes and assisted living communities are important to many communities, especially rural areas, where they are often a major employer,” said Mark Parkinson, President and CEO of the American Health Care Association/National Center for Assisted Living. “This bill does two important things. First, it will help ensure that long term care providers have the ability to provide training programs for CNAs. Just as important, it will allow skilled nursing facilities access to the National Practitioner Data Bank, providing a better way to conduct background checks on potential employees. We applaud Senator Warner and Senator Scott for taking this important step to address the worker recruitment and retention challenges facing providers.”

“Workforce development is crucial to our members’ ability to provide top-notch care. The loss of nurse aide training authority is an obstacle to quality improvement for nursing homes, and particularly when increased staffing levels are needed,” said Katie Smith Sloan, President and CEO, LeadingAge. “We have for years advocated for changes to the training lockout mandated under the Nursing Home Reform Act of 1987. This legislation, like similar legislation in the House (H.R. 4468), offers a much-needed solution to help alleviate the severe workforce shortage in long term care. CNAs, who provide direct care to residents, are the backbone of every nursing homes’ team.”

“LeadingAge Virginia applauds Senators Mark Warner and Tim Scott for introducing legislation that will enable training of certified nursing assistants (CNAs). Under federal law, nursing homes are inspected annually and fines are assessed for any deficiencies in compliance with federal regulations. If these fines exceed a certain level, a nursing home automatically loses its authority to train CNAs for two years,” said Melissa Andrews, President and CEO of LeadingAge Virginia. “This ‘CNA Training Lockout’ runs counter to a nursing home’s ability to provide the highest quality of care and we appreciate the Senators for introducing legislation to overcome this barrier.”

“Having started my career in long term care as a nursing assistant, I know how critical they are to providing direct care to thousands of patients and residents every day. Ending the CNA training lockout will have a tremendously positive impact on our ability to train more caregivers to work in our nursing homes,” said David Tucker, Chairman of Virginia Health Care Association – Virginia Center for Assisted Living (VHCA-VCAL) and President and COO of Commonwealth Care of Roanoke.

“Westminster Canterbury Richmond believes that a qualified workforce is crucial for the overall success of a nursing home to provide the highest quality of care. The training lockout is an obstacle to achieving this goal, and we believe this legislation is a positive step forward,” said John Burns, President and CEO of Westminster Canterbury Richmond, and a member of the LeadingAge Virginia Board of Directors.

“At a time where we need more individuals to choose the important and meaningful work of service to older adults throughout this country, limiting the ability to train future generations of care workers is not the answer,” said Rob Liebreich, President and CEO, Goodwin House Incorporated.

“Having access to the National Practitioner Data Bank would be extremely beneficial for us. It would help prevent bad actors from hopping from state to state,” said Melissa Green, Chief Clinical Officer of Trio Health Care, LLC, Hot Springs, VA and a nursing home operator who has facilities close to neighboring states. She cites an incident when it was revealed that an employee had stolen an identity to work as a nurse—without access to the NPDB there was no way to know the actual nurse’s identity was stolen even though the nursing home completed the required background checks.

“Because of the CNA training lockout, we’ve reduced the number of qualified CNAs entering in the workforce, which has had a trickle-down effect on a facility the size of ours,” said Keith Denson, Administrator, Snyder Nursing Home, Inc., Salem, VA. “If we’re not training our people to take care of our unique and wonderful residents, who will do it? Training programs in the community lack the continuity of care and the CNA to resident experience that provider programs offer. I am very appreciative of the trust Sen. Warner has in our ability to train our staff to take care of our residents.”

Sen. Warner has been a longtime advocate of improving long-term care for seniors. In 2000, Sen. Warner’s mother was diagnosed with Alzheimer’s, passing away in 2010 after battling the disease. Her diagnosis and the family’s subsequent struggle to find qualified care and support resources inspired Sen. Warner to launch SeniorNavigator.com, an online information and referral network for older Virginians and their caregivers.

In the Senate, Sen. Warner serves as a Co-Chair of the Alzheimer’s Caucus and has helped lead efforts to secure robust funding for Alzheimer’s research, prevention, and treatment. He’s also introduced bipartisan legislation designed to give people with serious illnesses new tools to plan for their care, and empower them to have those choices honored.

Sen. Warner has also sponsored legislation that allows seniors with multiple chronic conditions to receive enhanced care in their homes – an effort to decrease hospital readmissions – and expand telehealth services for seniors to increase access to primary care services in rural communities. The Senate unanimously passed this bill in September of 2017, and the bill was signed into law in 2018.

The text of the Ensuring Seniors Access to Quality Care Act is available here.