Senate Democrats on Tuesday introduced legislation aimed at bolstering nursing home staffing, transparency, accountability and oversight, after COVID-19 wreaked havoc on seniors in long-term care facilities.   

The bill, from a group led by Sens Ron Wyden (D-Ore.) and Bob Casey (D-Pa.), proposes a series of comprehensive changes to an industry that advocates and lawmakers have said is in need of reform.

Nursing home residents make up only a tiny fraction of the U.S. population, but they were disproportionately killed by COVID-19. According to federal figures,almost one in three COVID-19 deaths in the U.S. were connected to nursing homes. 

Nursing homes across the country essentially locked down in March 2020, but health experts believe staff still unwittingly brought infections into the facilities, unleashing rapid outbreaks. Residents were not truly protected until vaccines became available, almost a year since the first reported outbreak.

Even now, low vaccination rates among nursing home staff are threatening the progress the nation has made in protecting the vulnerable elderly. 

“Families must have faith that loved ones receiving long-term care or care after a hospital stay will be safe and receive good-quality care,” Wyden said in a statement. 

“The pandemic, myriad reports of abuse, and critical failures during natural disasters have shattered that foundation of trust and safety. This legislation represents a big step towards nursing home care that is safer, higher quality, more accountable and more supportive of the workers who care for our most vulnerable."

Among other provisions, the legislation would end the practice of advance binding arbitration agreements, where nursing homes require families and residents to waive their rights to sue over disputes involving care, as a condition of admittance and residency.

The bill would also require nursing homes to meet minimum staffing standards to avoid quality problems. It would require a registered nurse to be available 24 hours a day instead of the current eight, and require nursing homes to hire a full-time infection control and prevention specialist.

The bill would provide temporary additional federal resources through Medicaid to increase wages and support the recruitment and retention of staff, as well as support improvements in resident care. 

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), a leading nursing home trade group, has been lobbying for more federal funding in order to fix what they say are chronic issues facing the industry. In a statement, AHCA said it welcomed "the initial steps offered in this bill," particularly the enhanced Medicaid funding, but said more is needed.

Specifically, the group questioned the effectiveness of minimum staffing requirements without a permanent funding source.

"Providers will not be able to meet staffing requirements if we can’t find people to fill the open positions. There must be a comprehensive approach to staffing beyond just numbers."  Mark Parkinson, the group's president and CEO, said in a statement. 

The group also said it was strongly opposed to the restrictions on arbitration agreements, which are in place in the majority of nursing homes across the country. 

Advocates argue that arbitration agreements largely favor the corporations that operate nursing homes, as the hearings are held behind closed doors and the results are often obscured by privacy clauses. 

The industry argues arbitration is more efficient and less costly than civil trials.

In 2016, the Obama administration banned nursing homes from including arbitration agreements as part of admissions paperwork. Legal challenges from the industry prevented the rule from taking effect, and President Trump formally revoked the ban shortly after taking office.