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The article discusses the effectiveness of COVID-19 vaccination in preventing SARS-CoV-2 infection among nursing home residents. The study analyzed data from November 20, 2022, to January 8, 2023, and found that being up-to-date with COVID-19 vaccination was associated with a 31.2% reduction in the risk of SARS-CoV-2 infection compared to not being up-to-date.

The study defined "up-to-date" as having received a bivalent vaccine dose or completing a primary series less than 2 months earlier. The analysis included data from over 9 million resident-weeks and found that the crude infection rate was significantly lower among residents who were up-to-date with their vaccination (12.3 per 1,000 resident-weeks) compared to those who were not up-to-date (16.6 per 1,000 resident-weeks).

The study used a zero-inflated negative binomial mixed model to estimate the rate ratio (RR) and vaccine effectiveness (VE). The results showed that being up-to-date with COVID-19 vaccination was associated with a significantly reduced risk of SARS-CoV-2 infection (RR: 0.69, 95% CI: 0.67-0.71).

The article concludes that staying up-to-date with COVID-19 vaccination is crucial for preventing SARS-CoV-2 infections among nursing home residents. The findings emphasize the importance of ongoing vaccination efforts in this vulnerable population.

Key statistics from the study include:

• 31.2% reduction in the risk of SARS-CoV-2 infection among residents who were up-to-date with their vaccination
• Crude infection rate: 12.3 per 1,000 resident-weeks among up-to-date residents, compared to 16.6 per 1,000 resident-weeks among not-up-to-date residents
• Rate ratio (RR): 0.69 (95% CI: 0.67-0.71)
• Vaccine effectiveness (VE): 31.2% (95% CI: 29.1-33.2)

The Centers for Medicare & Medicaid Services (CMS) has finalized minimum staffing requirements for nursing homes that participate in Medicare and Medicaid. The final rule, which was proposed in September, requires nursing homes to provide a minimum of 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse per resident day and at least 2.45 hours of care from a nurse aide per resident day. Additionally, the rule mandates 24/7 onsite RN services.

The American Hospital Association (AHA) has expressed strong opposition to the final rule, arguing that it creates more problems than it solves and could jeopardize access to care across the continuum, especially in rural and underserved communities. The AHA believes that a skilled, caring workforce is integral to delivering high-quality, safe care, but that safely staffing any healthcare facility requires clinical judgment and flexibility to account for patient needs, facility characteristics, and the expertise and experience of the care team.

The AHA warns that the final rule could lead nursing homes to reduce capacity or close outright, resulting in a loss of beds that could adversely impact patients who need continuing care in nursing facilities. This, in turn, could lead to longer lengths of stay for hospital patients waiting for post-acute care placements and disrupt care for other patients awaiting elective surgeries or scheduled procedures. Furthermore, the AHA believes that the final rule could exacerbate existing shortages of nurses and skilled healthcare workers across the care continuum.

The AHA has called on Congress and the Administration to advance sustainable approaches to bolstering the healthcare workforce and delivering high-quality, safe, and accessible care. The organization is working with lawmakers to develop legislation that would prevent enforcement of the nurse staffing mandate and instead focus on developing more patient- and workforce-centered approaches to ensuring safe staffing in nursing facilities.

This text appears to be a report from the Kaiser Family Foundation (KFF) analyzing the impact of proposed staffing requirements for nursing facilities in the United States. The main points are:

1. One in five nursing facilities would currently meet proposed requirements: According to the analysis, about 20% of nursing facilities would already meet the proposed requirements for nurse staffing hours.
2. Adequate funding is a concern: The report notes that adequate funding for nursing facility inspections and enforcement is uncertain, which may affect the implementation of the new staffing requirements.
3. Enforcement of RN requirement is unclear: There are questions about how CMS will enforce the 24/7 RN requirement, as current data only shows total RN hours per day, not when those hours occur.
4. Costs and financing are concerns: The report estimates that complying with the proposed rule would cost $40 billion over 10 years, which may be passed on to payers, including residents and their families.
5. Comparison to proposed rule is uncertain: Changes made to the staffing requirements in response to stakeholder comments could affect how many facilities can comply.

The analysis uses data from Nursing Home Compare as of August 2023, which provides information on quality of care and characteristics for approximately 14,900 Medicare and/or Medicaid-certified nursing facilities. However, there are limitations to the data, including:

• Urban and rural facilities have different timelines: The analysis does not take into account that urban and rural facilities have different timelines to come into compliance with the rule.
• No data on 24/7 RN requirement: Due to limitations of publicly available data, the analysis does not examine facilities that meet the requirement to have an RN on staff 24 hours a day, seven days a week.

Overall, the report highlights concerns about the feasibility and financing of implementing new staffing requirements for nursing facilities.

The Centers for Medicare and Medicaid Services (CMS) has proposed making National Healthcare Safety Network (NHSN) reporting permanent, which would require nursing homes to continue reporting data on COVID-19, influenza, and RSV. The proposal comes despite concerns from long-term care providers that the reporting requirements are too frequent and redundant, taking up staff time and increasing the potential for fines.

The NHSN reporting requirements were initially implemented in May 2020 as a temporary measure during the COVID-19 pandemic. However, CMS is now seeking to extend them indefinitely under a proposed rule for the Home Health Prospective Payment System. The proposal would require nursing homes to report data on cases, vaccination rates, and hospitalizations for major respiratory diseases.

Long-term care providers have expressed concerns about the burden of NHSN reporting requirements, arguing that they are redundant and take away from resident care. Denise Winzeler, RN, of the American Association of Post-Acute Care Nursing, noted that vaccination rate reporting will become redundant by October 1, 2024, when it will be reported through the Minimum Data Set (MDS). LeadingAge, a nonprofit nursing home group, has also expressed concerns about the proposal, stating that it ignores their advocacy efforts to modify NHSN reporting.

CMS is seeking comments from providers on how to minimize the reporting burden of the NHSN requirements. However, providers are skeptical about whether CMS will take their comments into consideration, given that they have already asked for modifications or elimination of the requirements. The American Health Care Association has also expressed concerns about redundant data reporting and the impact it has on resident care.

The proposal has sparked debate among long-term care providers about the balance between transparency and reasonable data collection versus the need to focus on delivering care to residents. Providers are urging CMS to reconsider the proposal and find alternative ways to achieve its goals without adding to their reporting burdens.