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WASHINGTON -- Nursing home care in the U.S. needs improvement, and the Biden administration is taking steps to do just that, the White House announced Monday.

"All people deserve to be treated with dignity and respect and to have access to quality medical care. And in no case should a health care facility be causing a patient harm," the White House said in a fact sheet released Monday in advance of Tuesday's State of the Union address. The fact sheet noted that the reforms, which were developed by the Department of Health and Human Services (HHS), will "improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care."

The four reforms announced by the administration include:

• Establishing a minimum staffing requirement. The fact sheet noted that of Connecticut nursing homes found that every 20-minute increase in nurse staffing (per resident day) was associated with 22% fewer confirmed COVID-19 cases and 26% fewer COVID-19 deaths. "CMS [the Centers for Medicare & Medicaid Services] intends to propose minimum standards for staffing adequacy that nursing homes must meet," the fact sheet continued. "CMS will conduct a new research study to determine the level and type of staffing needed to ensure safe and quality care and will issue proposed rules within 1 year ... Nursing homes will be held accountable if they fail to meet this standard."
• Reducing resident room crowding. Although most residents prefer private rooms, "shared rooms with one or more other residents remain the default option," the fact sheet said. "These multi-occupancy rooms increase residents' risk of contracting infectious diseases, including COVID-19. CMS will explore ways to accelerate phasing out rooms with three or more residents and to promote single-occupancy rooms."
• Strengthening the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. This program gives financial incentives to nursing homes based on how well they meet quality standards. "CMS has begun to measure and publish staff turnover and weekend staffing levels, metrics which closely align with the quality of care provided in a nursing home," the White House said. "CMS intends to propose new payment changes based on staffing adequacy [and] the resident experience, as well as how well facilities retain staff."
• Improving safeguards against unnecessary treatments and medications. Use of antipsychotic drugs in nursing homes has dropped dramatically in recent years thanks to CMS's , the fact sheet noted. "However, inappropriate diagnoses and prescribing still occur at too many nursing homes. CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications."

CMS will also take several actions to improve nursing home transparency, including creating a database of nursing home owners and operators; collecting and reporting "more robust" data on corporate ownership and operations; improving the , which is designed to help families choose a nursing home for their loved one; and more closely examining the role of private equity in nursing homes, the White House said. The agency also is planning to continue its pandemic preparedness activities such as providing COVID-19 tests, vaccines, and boosters on-site at nursing homes, and increasing requirements for on-site infection preventionists.

In the State of the Union address, Biden will call on Congress to take other actions to enhance nursing home care, the White House noted. These include allocating $500 million to increase the number and frequency of health and safety inspections at nursing homes; expanding financial penalties and other sanctions for poor-performing homes; and expanding CMS's enforcement authority at the ownership level, especially when it comes to chain nursing home ownership.

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