Bill Overview
Title: Ensuring Seniors’ Access to Quality Care Act
Description: This bill repeals certain restrictions under Medicare and Medicaid that prohibit the approval of nurse-aide training and competency evaluation programs in skilled nursing facilities that have been subject to specified regulatory actions (e.g., civil penalties) for substandard quality of care. The Centers for Medicare & Medicaid Services (CMS) must still disapprove such programs for up to two years; however, the CMS must rescind the disapproval upon completion of corrective action and may require additional oversight of the program for purposes of rescission. The bill also allows Medicaid and Medicare providers (e.g., skilled nursing facilities) to access, through the National Practitioner Data Bank, disciplinary information for affiliated physicians and other health care practitioners, as reported by state licensing authorities.
Sponsors: Sen. Warner, Mark R. [D-VA]
Target Audience
Population: Seniors receiving care in skilled nursing facilities
Estimated Size: 1400000
- The bill targets regulations affecting skilled nursing facilities, specifically in relation to nurse-aide training and competency evaluation programs.
- Nurse-aide training is essential for ensuring quality care in skilled nursing facilities, which primarily serve elderly patients.
- The primary beneficiaries of improved care due to better-trained nurse aides will be seniors, i.e., individuals typically aged 65 and older.
- Globally, the elderly population is increasing, with significant proportions in developed countries, which have substantial numbers of skilled nursing facilities impacted by this regulation.
- Access to disciplinary information in the National Practitioner Data Bank aims at enhancing care quality by allowing oversight of healthcare practitioners.
Reasoning
- The Skilled Nursing Facility (SNF) residents will likely benefit from improved nurse-aide training, enhancing care quality, affecting their wellbeing positively.
- Nurse aides working in SNFs may see changes in job training and may feel more confident in their roles, impacting job satisfaction and wellbeing.
- Impact will vary based on facility compliance, prevalence of prior regulatory actions, and speed of implementation of corrective actions.
- The enhanced access to data on healthcare professionals might improve perceived safety and quality among residents and families.
- Facilities with prior penalties might face higher implementation costs, affecting operations differently.
- Initial impacts might be stronger in facilities with existing issues, but long-term, all facilities may experience benefits with better-trained personnel.
Simulated Interviews
Retired teacher (Florida)
Age: 82 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I think having better-trained staff is always good. It makes me feel safer knowing they have more knowledge.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 7 | 2 |
Retired engineer (Texas)
Age: 76 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I welcome any policy that ensures my wife gets the best care. Knowing there's oversight and better training makes me hope for improvements.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
Nurse Aide (Ohio)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- Having continuous access to training will make our jobs easier and improve patient care.
- It's good to know even facilities with past issues can have a chance to improve training programs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 4 |
Retired (New York)
Age: 85 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I feel assured that there will be more trained aides to help with my care needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 2 |
| Year 10 | 6 | 2 |
| Year 20 | 6 | 1 |
Retired (California)
Age: 66 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- I like knowing there will be a database for checking who is providing care. It's about time more information is available.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 4 |
Volunteer (Pennsylvania)
Age: 73 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- Better training means more competent staff, which I think is crucial for good care.
- This policy gives facilities a chance to make positive changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Administrator at a skilled nursing facility (Illinois)
Age: 53 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- The policy helps facilities like ours hit by past penalties to get a second chance to improve training and care.
- There will be some costs involved, but it's necessary for long-term improvement.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 3 |
Retired farmer (Minnesota)
Age: 89 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 1.0 years
Commonness: 3/20
Statement of Opinion:
- I'm thankful there's a push to ensure the staff knows what they're doing, even if it might be too late for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 4 | 3 |
| Year 3 | 4 | 3 |
| Year 5 | 4 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 4 | 2 |
Retired nurse (Arizona)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- I think this will set a higher standard for the care industry.
- Access to practitioner information improves transparency, a step in the right direction.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Family caregiver (New Mexico)
Age: 63 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 9/20
Statement of Opinion:
- Seeing changes like these rolled out reassures me that the care system is becoming safer for my parent.
- The trust in facilities has diminished over the years, but initiatives like this might restore that trust.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $250000000 (Low: $200000000, High: $300000000)
Year 2: $100000000 (Low: $80000000, High: $120000000)
Year 3: $100000000 (Low: $80000000, High: $120000000)
Year 5: $100000000 (Low: $80000000, High: $120000000)
Year 10: $100000000 (Low: $80000000, High: $120000000)
Year 100: $100000000 (Low: $80000000, High: $120000000)
Key Considerations
- The initial implementation phase may require significant adjustments within skilled nursing facilities administration.
- Monitoring the outcomes of the policy change is critical to ensure it leads to the intended improvement in care quality.
- Coordination with state licensing authorities will be necessary to ensure proper use of the National Practitioner Data Bank.