华盛顿——乔·拜登总统将利用他的国情咨文演讲对养老院的质量进行一次大检查，包括最低人员配备水平和加强检查的措施，同时继续阻止新冠肺炎。

白宫官员周一概述了20多项单独的行动，其中许多行动是倡导者寻求的，遭到了业界的反对。

缺少的一个主要因素是:新的联邦资金来源来支付雄心勃勃的升级。

“总的来说，这些都是非常积极的发展，”哈佛说健康跟踪长期护理的政策教授大卫·格拉博克斯说。“如果你问这个行业，他们会告诉你这会让他们破产。如果你问一个倡导者，他们会说系统里有很多钱。我想真相大概在中间的某个地方。”

疗养院居民在冠状病毒疫情的死亡人数中占不成比例的比例，拜登政府一直在努力发展家庭和社区护理作为替代方案。美国政府还对投资者拥有、受利润驱动的设施的增长趋势保持警惕。

拜登疗养院计划的基石是最低人员配备水平的新要求。他命令医疗保险和医疗补助服务中心对人员配备进行研究，并在一年内公布拟议的法规。

专家表示，人员配备水平是养老院质量的最重要标志，许多机构缺乏足够数量的护士、护理助理和其他为患者提供直接护理的工作人员。疫情冠状病毒已导致许多工人离开该行业，尽管养老院提高了工资，因此新的联邦人员配置要求可能需要时间才能到位。

国会立法者一直在辩论立法，要求接受医疗保险和医疗补助支付的设施的最低人员配备标准，因为事实上所有的设施都接受支付。最初的计划是在拜登的国内议程法案中包括人员配置要求，但随着立法的停滞，政府似乎正在转向使用其监管权力来带来变化。

拜登的计划还呼吁将疗养院转向为其居民提供私人房间，指示联邦监管机构探索如何逐步淘汰让三名或更多居民住在同一房间的生活安排。

“尽管每年有数百亿联邦纳税人的钱流向养老院，但太多的人继续提供低劣、不合标准的护理，导致可避免的住院伤害，”一份概述拜登计划的白宫政策文件说。

在一份声明中，主要行业组织的负责人表示，养老院需要的是更多的资源，而不是相互指责。

“没有相应援助的额外监督不会改善居民保健，”美国卫生保健协会/国家辅助生活中心主席马克·帕金森说。

LeadingAge的总裁凯蒂·史密斯·斯隆代表非营利机构说:“医疗补助是长期护理服务的主要支付者，但它并不能完全支付养老院的费用...法规和执行，即使有最好的意图，也不能改变这个数学。"

加强监督是拜登的另一个优先事项。他的计划要求将养老院检查预算增加5亿美元，增幅近25%。疗养院的检查通常由各州按照医疗保险的指导方针进行。拜登正计划修改一个特别检查项目，重点是低性能的设施，提高对未能改善的养老院的罚款，如果必要的话，切断医疗保险和医疗补助的支付。

新冠肺炎疫情揭露了疗养院的问题，它是20世纪90年代被忽视的一部分健康护理系统。根据无党派凯泽家庭基金会的数据，超过20万居民和长期护理机构的工作人员已经死亡。虽然疗养院的居民和工作人员只占美国人口的一小部分，但他们却造成了超过五分之一的死亡。

拜登的计划呼吁政府将重点放在接种疫苗和促进疗养院居民和工作人员，以及定期检测上。虽然奥米克隆浪潮导致疗养院的病例和死亡人数增加，但疗养院基本上没有重复去年冬天的可怕经历。

由于感染控制被认为是许多机构的一个长期问题，拜登正指示医疗保险计划加强养老院雇用现场感染预防专家的要求。

美国超过一半的养老院由盈利性公司所有，政府希望关注私募股权公司抢购设施所有权的日益增长的趋势。

白宫表示，该行业的私募股权股份从2000年的50亿美元增长到2018年的1000多亿美元。

白宫政策文件称，“私募股权模式往往将利润置于人之前，在涉及弱势老年人和残疾人的健康和安全时，这是一种特别危险的模式。”。

官员们表示，联邦机构将被指示检查私人股本投资者在养老院行业中的作用，“并在企业实体没有为居民的最佳利益服务时通知公众。"

私人股本行业表示，投资者所有权可以改善养老院的管理，包括使用标准化的护理程序和对养老院管理者的评估。

白宫的声明让消费者权益倡导者欢欣鼓舞。

致力于改善长期护理的非营利组织约翰·a·哈特福德基金会(John A. Hartford Foundation)的主席特里·富尔默(Terry Fulmer)说:“这项计划是我们国家养老院质量和安全方面的一个重大进步。“这将是至关重要的，它得到迅速实施，并密切监测我们现在需要的改进。”

Biden to launch ambitious overhaul of nursing home quality

WASHINGTON -- President Joe Biden will use his State of the Union speech to launch a major overhaul of nursing home quality, including minimum staffing levels and steps to beef up inspections while continuing to keep COVID-19 at bay.

White House officials on Monday outlined more than 20 separate actions, many of them sought by advocates and opposed by the industry.

One major missing element: New sources of federal financing to pay for the ambitious upgrade.

“Overall these are very positive developments,” said Harvardhealthpolicy professor David Grabowksi, who tracks long-term care. “If you ask the industry, they'll tell you this will put them out of business. If you ask an advocate, they'll say there's plenty of money in the system. I think the truth is probably somewhere in the middle.”

Nursing home residents represent a disproportionate share of deaths in the coronavirus pandemic, and the Biden administration has been working to develop home- and community-based care as an alternative. The administration is also wary of a growing trend toward investor-owned, profit-driven facilities.

The cornerstone of Biden's nursing home plan is a new requirement for minimum staffing levels. He's ordering the Centers for Medicare and Medicaid Services to conduct a study on staffing and publish proposed regulations within a year.

Experts say staffing levels are the single most important marker for nursing home quality, and many facilities lack sufficient numbers of nurses, nursing assistants and other workers involved in providing direct care to patients. The coronavirus pandemic has led to many workers leaving the industry, even as nursing homes raised wages, so a new federal staffing requirement may take time to put into place.

Lawmakers in Congress have been debating legislation to require minimum staffing standards for facilities that accept payment from Medicare and Medicaid, as virtually all do. The original plan was to include staffing requirements in Biden's domestic agenda bill, but with that legislation stalled the administration seems to be shifting to using its regulatory powers to bring about changes.

Biden's plan also calls for moving nursing homes toward private rooms for their residents, directing federal regulators to explore how to phase out living arrangements that house three or more residents in the same room.

“Despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, substandard care that leads to avoidable resident harm,” said a White House policy document that outlined Biden's plan.

In a statement, the head of the major industry group said what nursing homes need is more resources and not finger-pointing.

“Additional oversight without corresponding assistance will not improve resident care,” said Mark Parkinson, president of the American Health Care Association/National Center for Assisted Living.

Representing nonprofit facilities, Katie Smith Sloan, president of LeadingAge, said: “Medicaid, the dominant payer of long-term care services, doesn’t fully cover nursing homes’ cost ... regulations and enforcement, even with the best intentions, just can’t change that math.”

Beefed-up oversight is another priority for Biden. His plan calls for increasing the nursing home inspection budget by $500 million, a boost of nearly 25%. Nursing home inspections are generally carried out by the states, following guidelines from Medicare. Biden is planning to revamp a special inspection program that focuses on low-performing facilities, to raise fines on nursing homes that fail to improve and, if necessary, cut off Medicare and Medicaid payments.

The COVID-19 pandemic has laid bare the problems of nursing homes, a neglected part of thehealthcare system. More than 200,000 residents and staff of long-term care facilities have died, according to the nonpartisan Kaiser Family Foundation. While nursing home residents and staff account for a tiny share of the U.S. population, they have accounted for more than 1 in 5 deaths.

Biden's plan calls for the government to keep a focus on vaccinating and boosting nursing home residents and staff, along with regular testing. While the omicron wave saw increased cases and deaths in nursing homes, facilities were largely spared a repeat of last winter's grim experience.

With infection control considered a chronic problem at many facilities, Biden is directing Medicare to strengthen requirements that the nursing homes employ on-site infection prevention specialists.

More than half of the nation's nursing homes are owned by for-profit companies, and the administration wants to shine a spotlight on a growing trend of private equity firms snapping up ownership of facilities.

The White House said the private equity stake in the industry grew from $5 billion in 2000 to more than $100 billion by 2018.

“Too often, the private equity model has put profits before people, a particularly dangerous model when it comes to the health and safety of vulnerable seniors and people with disabilities,” the White House policy document said.

Officials said federal agencies will be directed to examine the role of private equity investors in the nursing home industry “and inform the public when corporate entities are not serving their residents' best interests.”

The private equity industry says investor ownership can result in better management of nursing homes, including the use of standardized care procedures and evaluation of nursing home administrators.

Consumer advocates were cheered by the White House announcement.

“This plan is a major step forward for quality and safety in our nation’s nursing homes,” said Terry Fulmer, president of the nonprofit John A. Hartford Foundation, which works to improve long-term care. “It will be essential that it get implemented quickly and monitored closely for the improvements we need now.”