The independent role of nursing homes raises Capitol Hill questions – as well as a GAO study

In his State of the Union speech last month, President Joe Biden focused on looking at how nursing homes have a personal responsibility to the health of citizens.

“When Wall Street businesses took over the nursing homes, the quality of those homes went down and prices went up. That put an end to my watch,” Biden said.

Those comments are related to the growing interest from Congress.

For example, the Office of Accountability is investigating the role of nursing homes, including independent nonprofits, and intends to issue a report on the fallout, said Chuck Young, GAO executive director. of the public. “We haven’t set out the full scope of what we’re going to cover, but the work will be based on knowledge [the Centers for Medicare & Medicaid Services] about the nursing home and how the office will use that information, ”Young wrote in an email.

The trial came in response to a pre-pandemic request from House Ways and Means Committee Chairman Richard Neal (D-Mass.). However, chronic kidney disease has been shown to be the main focus of hospital care, in light of the lives lost to covid-19.

Rep. Bill Pascrell (DN.J.) submitted a second petition to the GAO in 2021 regarding private equity investments in health care. It’s on the GAO line, but work hasn’t started yet, Young said.

The rapid growth of these private equity assets in recent years “has been associated with a number of factors that have adversely affected Americans” – including an increase in the number of deaths. nursing home, writes Pascrell, who sat on the Ways and Means Oversight Subcommittee. He recognized the need to “better understand” the consequences of the involvement of social equity in health care and the “long -term impact” of “bankruptcies or substitutes after the purchase of PE. . “

Pascrell said in a statement to KHN that the data GAO gathers is important in evaluating the feasibility and impact of such publications: “My hope is that GAO will shed more light and provide the Learn more about Wall Street’s growth in nursing homes and long -term care facilities. “

Neal and Pascrell asked the GAO for information highlighting the lack of data on foster home care. A June 2021 report by the Medicare Payment Advisory Commission found information on the impact of personal responsibility on nursing home finances and quality of care and the results were mixed. of studies.

Democratic House workers told KHN that because personal interest has increased in his interest in the profession, it is more important to understand the nature of the health effects of citizens and the working conditions of workers. compared with those in buildings that do not have private functions.

From 2010 to 2019, there was a significant increase in private equity firms buying nursing homes, as well as other investments in health care. The exact number is not difficult because it is difficult to track private sales, but it is estimated that there are companies in every area from 5% to 11% of nursing homes in the country.

Research shows that health outcomes in private sectors are better than those in other sectors. A February 2021 study from the National Bureau of Economic Research found that visiting a home owned by a private equity firm increases a citizen’s chances of dying by 10%, compared to living in a home. Other types of houses. That study was held from 2005 to 2017.

A Cornell University study of November 2021 found that more residents of private nursing homes had emergency rooms or nursing homes than residents of other nursing homes. Both studies found that Medicare costs more per capita, which means more tax money is spent on private agencies.

Commercial private companies have released this information, saying the studies do not provide a complete picture of how the management of private homes differs from that of other buildings.

“The main focus on the personal responsibility of nursing homes is red herring,” said Mark Parkinson, president and CEO of the American Health Care Association / National Center for Assisted Living business. He added that the funds moved to other “better” health care services. There is evidence that personal equity is increasing investments in home health care and hospices, even though more Americans are choosing to age instead.

“If politicians want to talk about social justice, then this is talk for the entire health care system, not just hospitals,” Parkinson said.

The American Investment Council, an advocacy group for independent investment, opposes this research findings with other arguments. Some reported that private nursing homes were better off under covid, and others found that living in private nursing homes was not associated with better care (although this used research historical data and the amount is limited).

However, it is not disputed that private equity firms are selling nursing homes because they make a profit, said Robert Tyler Braun, an assistant professor of health sciences at Cornell University. author of the study November 2021.

“The great thing is that the margins are lower and they get real value with the sale,” Braun said. “Also, the way these agreements are set up, you can bring in organizations that have private equity services, such as girls services. [and] medical services, ”and pay higher prices than the market.

Earnings can be increased by reducing staff levels or hours, which are related to the care of residents, said Eileen O’Grady, research and advertising officer for Private Equity Stakeholder Project, an independent equity stakeholder organization.

The Biden administration seeks to improve the quality of the nursing home – for example, by directing Medicare to set higher standards for housing and educating the Department of Health and services. people look at privacy. But some action will require the help of Congress, which has now been slow to move on. Efforts continued at the data collection level.

The most recent GAO report on the privacy of nurses ’careers, released in 2011 – more than 10 years ago – found some differences in caregiving and care. as well as making money between real estate and non -property owners. Meanwhile, the National Academies of Science, Engineering, and Medicine released a widely published 600-page report calling for more information about how the nursing home works and how it can be funded. to understand the impact of nursing care, including recommendations for improving the overall nursing home system. .

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