Federal law requires every nursing home to be perfect in meeting many regulations, assessing fines for serious and less serious infractions. The fines accumulate in a fund and can only be used to give grants to nursing homes to improve quality. There is now more than $23 million in that fund, and growing.

In theory, the fund is a wonderful idea, but the reality is that these resources are extremely difficult to access. North Carolina’s grant administrators have helped all of us access the fund as much as they possibly can.

Our organization, Lutheran Services Carolinas, has been fortunate to receive a number of grants for a variety of important quality improvements. However, as a whole, the federal requirements to receive money from the fund make it largely inaccessible, which is the main reason the fund has grown so large.

I have proposed a reset for North Carolina that I believe would best fulfill the intent of the fund. I have requested that the Centers for Medicare and Medicaid Services authorize a two-year expenditure of $20 million to the approximately 22,000 certified nursing assistants serving in each nursing home in the state. This would put the quality improvement funds in the hands of the people whose hands care for North Carolina’s elders.

I can think of no better quality improvement program than to offer a bonus at the end of the next two years to every eligible CNA in North Carolina. Full-time CNAs could be offered a bonus of $500 a year for two years. This would still leave $3 million in the civil money penalty fund, more than adequate to fund individual-facility-based quality improvements.

— Ted W. Goins Jr.

Salisbury

Goins is president and CEO of Lutheran Services Carolinas.