June 7, 2021 – The COVID-19 pandemic exposed longstanding problems in nursing homes that have remained unaddressed, even as cases dwindle. Across the United States, nursing homes continue to be understaffed, underenforced, and unaccountable for so much of the harm that they are required to prevent. The devastating outcomes were not inevitable. The time for change has come.

We applaud President Biden’s commitment to improving care for seniors and people with disabilities and commend his appointment of Chiquita Brooks-LaSure as the Centers for Medicare & Medicaid Services (CMS) Administrator. We look forward to working with Administrator Brooks-LaSure to address the persistent issues that result in unnecessary suffering for our nursing home residents.

To help meet and overcome these challenges, we are announcing today the publication of a new policy brief with focused recommendations for addressing the longstanding gaps in nursing home quality assurance and accountability that have harmed vulnerable residents and devastated families across the United States. The brief focuses on steps that CMS can take to improve nursing home resident safety, dignity, & financial integrity. It highlights six policy issues that, if unaddressed, will inflict further harm on nursing home residents while burdening taxpayers with shouldering the costs of substandard or worthless services. These fundamental policy issues are:

  • Pervasive and Longstanding Inadequate Staffing
  • Inadequate Enforcement of Minimum Standards of Care
  • Insufficient Transparency on Nursing Home Quality and Safety
  • Ownership and Financial Accountability
  • Operational Biases Toward Facilities
  • Use of Civil Money Penalty Funds to Benefit Residents

Each policy issue is accompanied by a series of recommendations that can be implemented with sensible action from CMS. Examples of these recommendations include:

  • 75% of U.S. nursing homes fail to maintain sufficient staffing to meet the basic clinical needs of their residents. CMS should adopt a minimum staffing standard of 4.1 hours of nursing staff time per resident day to, finally, fulfill the promise of the 1987 Nursing Home Reform Law.
  • Though state health departments are responsible for ensuring resident safety every day of the year, poor care and degrading conditions persist in too many of our nursing homes. CMS should increase the required frequency of state inspections (surveys) and ensure that surveyors are educated about resident care needs and free from bias.

While intended for CMS, these recommendations can help consumers, media, and other policymakers identify key issues for quality improvement on both the state and federal levels. Visit NursingHome411.org for more information on nursing home quality, staffing and safety, and other free resources.