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How Existing Legal Authorities Can Help Fix America's Nursing Home Crisis

March 26, 2024

Often the conversation about addressing the chronic poor care that exists in far too many of today's nursing homes is framed around new laws or regulations. Yet, there are steps that can be taken now - using existing federal and state legal authority - to improve care and conditions in our country's nursing homes. In our conversation, we will discuss four levers of opportunity for increasing quality and accountability in nursing homes with the author of Using What We Have: How Existing Legal Authorities Can Help Fix America's Nursing Home Crisis.

Special Guest: Nina Kohn, J.D., the Solomon Center Distinguished Scholar in Elder Law at Yale Law School, the David M. Levy Professor of Law at Syracuse University College of Law, and a leading authority in elder law and the civil rights of older persons.

Listen on Spotify and Apple Podcasts!

Subscribe to the Pursuing Quality Long-Term Care podcast on Spotify and Apple Podcasts

You can also listen on YouTube, SoundCloud, Facebook, or our website.

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President Biden's Proposed 2025 Budget

March 20, 2024

On March 11, 2024, President Biden revealed his proposed budget for Fiscal Year 2025. While short on details, the budget laid out various proposals that would affect both nursing home care and Home and Community Based Services (HCBS).  President Biden continues his previous efforts to improve and expand HCBS, while requiring increased quality measure reporting. Like previous budgets, President Biden proposes increasing scrutiny on nursing home ownership, particularly private equity, increasing per-instance civil monetary penalties, and holding facilities accountable for “noncompliant closure and substandard care.”  Consumer Voice strongly supports these proposals and is eager to work with the Biden Administration on their implementation.

Consumer Voice is concerned, however, about a new proposal that would “reduce survey frequency for high-performing (LTC) facilities.” An idea long supported by the nursing home industry, Consumer Voice has opposed the reduction of survey frequency for nursing homes, regardless of their past performance. Nursing homes must undergo a re-certification survey at least every fifteen months.  Reducing that frequency would place many nursing home residents at risk of harm.

This proposal is particularly troubling in light of last year’s Senate Aging report, “Uninspected and Neglected,” documenting the failures of the current nursing home survey and inspection system. Years of flat funding for nursing home surveys and enforcement have resulted in significant delays and unreliable survey results. However, the solution is not to reduce the amount of oversight and protection for nursing home residents. Instead, the administration should explore other alternatives, including using data to focus surveys, supporting efforts by state agencies to hire and train more survey staff, and making clear to Congress that flat funding for nursing home surveys is not acceptable.

Read President Biden’s complete proposed budget. The proposals discussed above occur on page 146.

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Tell Your Members of Congress to Oppose H.R. 7513

March 04, 2024

Residents need your help! In the coming days, the House of Representatives will be considering H.R. 7513, a bill that would prohibit federal regulators from ever creating rules about safe staffing in nursing homes. 

Since President Biden announced his intention to implement a minimum staffing standard in nursing homes, the nursing home industry has been spending millions of dollars to oppose its implementation. The industry's latest effort is a bill in Congress that would prevent the federal agencies from EVER regulating staffing in nursing homes. Nursing home residents' lives are at stake. 

Please stand with nursing home residents and workers and tell your members of Congress to reject H.R. 7513 and to support safe staffing in nursing homes. Use our online form to send a letter to your House member. We have already created a message for you to send. All you have to do is enter your name and address. We encourage you to share your own insight and experience!

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New Report on the Impact of Understaffing on the Daily Lives of Nursing Home Residents

March 05, 2024

Consumer Voice has published a new report, The Impact of Understaffing on the Daily Lives of Nursing Home Residents. Since the Biden Administration announced its intention to propose a minimum staffing standard in nursing homes, the focus has been on how a staffing standard would hurt nursing home owners and operators. 

Often lost in the discussion are residents, the people who suffer the consequences of understaffing. To bring the focus back on residents, Consumer Voice surveyed over 120 nursing home residents in the fall of 2023, asking for their perspectives on staffing and how they are affected by staffing levels daily. 

The results were striking. The majority of residents who responded to the survey, 88%, stated their facilities lacked the staff necessary to meet the needs of the residents living in their facilities.

Read the report.

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New Podcast Episode on Family Caregivers and Family Councils

February 22, 2024

Family caregivers have always played an integral role in promoting and achieving quality care for their loved ones living in a long-term care facility. The importance of the informal care and support provided by family members for a resident's physical, mental, and emotional well-being became abundantly clear during the pandemic when those essential supports were taken away during the pandemic. Yet, advocacy and engagement by family members benefits not only their own loved ones, but ultimately all residents in a long-term care facility. In our conversation with Marcella Goheen, a family member and advocate, we discuss how families can individually and collectively, through family councils, be a strong voice for quality and for change in nursing homes.

Find more resources for family members.

Listen on Spotify and Apple Podcasts!

Subscribe to the Pursuing Quality Long-Term Care podcast on Spotify and Apple Podcasts

You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Call for Proposals: Financial Transparency in Nursing Homes Project

February 15, 2024

For many nursing home residents, the quality of care they receive leaves much to be desired. Research, data, and investigative reports show that nursing homes do not have enough staff to meet the needs of their residents. Additionally, residents, families, advocates, and others bemoan the lack of, and low quality, food and supplies provided.  Yet, nursing homes receive each year nearly $100 billion from Medicare and Medicaid alone. Nursing home owners and operators, however, claim lack of resources and inadequate reimbursements for why they cannot hire more staff or provide better care and resources. Where does the money go?

Consumer Voice has received a two-year grant from Arnold Ventures to provide direct support, technical assistance, and training to two states interested in advocating at the state level for increased transparency and accountability in nursing home finances and ownership.  Consumer Voice will work closely with selected state advocates to help them develop and implement state-level advocacy strategies to achieve increased transparency and accountability in nursing home finances and ownership.  Learn more about the project and apply.

Applications are due by March 15, 2024.

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New Reference Guide on Related Party Transactions

February 06, 2024

Consumer Voice has published a new reference guide, Related Party Transactions and CMS's Role in Regulation. Each year, nursing homes funnel Medicare and Medicaid dollars meant for nursing home resident care through companies they own with little to no scrutiny on how this money is used. In the early 2000s, nursing home owners began creating separate, single-purpose corporations to avoid civil liability for negligent care.  An additional benefit of this practice for owners was that they could use the corporation that owned the real estate (which they own) to charge unrestricted rent and lease fees to the nursing home (which they also own). This practice was expanded upon even further as companies set up several related party organizations with which they do business, for instance, management companies, physical therapy companies, staffing companies, and others. This practice can often translate into millions of dollars in payments by a single nursing home to companies that are in fact owned by the owners of the facility. According to some estimates, 75% of nursing homes engage in related party transactions.

Critically, related parties can serve to mask profits. When high amounts are paid to the related party, the nursing home looks much less profitable, even though they are paying the nursing home owners themselves. As a result, nursing homes can assert that their facilities are not making a profit, or are even losing money, when high amounts are being paid to related party companies.

The Nursing Home Reform Act of 1987 provides the Secretary of Health and Human Services broad regulatory authority to ensure that Medicare and Medicaid dollars are spent appropriately. Additionally, the Medicare Provider Reimbursement Manual provides in-depth guidance as to how related parties must be reported. The Centers for Medicare & Medicaid Services (CMS) requires nursing home providers to be “prudent buyers." In other words, owners must not inflate costs paid to related parties but pay only what they would if they purchased the goods or services on the open market.

Consumer Voice recommends that CMS should:

  • Require nursing homes to submit consolidated cost reports;
  • Routinely review and audit cost reports;
  • Require increased disclosure requirements for related parties to determine whether costs charged to nursing homes for goods and services are reasonable and prudent;
  • Make information on cost reports more easily accessible to consumers; and
  • Conduct targeted surveys of nursing homes with unreasonable and excessive related party transactions.

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Consumer Voice Seeks a Policy and Program Specialist

January 10, 2024

The National Consumer Voice for Quality Long-Term Care (Consumer Voice) seeks a Policy and Program Specialist with at least three years of experience and a passion for consumer empowerment and justice for long-term care residents to join our team. The successful candidate will work to improve quality care and quality of life for residents through increased transparency and accountability of long-term care providers and promote policies that support the provision of person-centered care and empowers consumers.

This position can be based remotely from anywhere in the U.S. Applications should be submitted by January 25th for first consideration. Applications and questions can be sent to info@theconsumervoice.org.

Read the position description and apply.

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Visiting Residents in Long-Term Care Facilities During the Holidays

December 12, 2023

Visits from family members can be an important support for a long-term care resident’s emotional well-being and can help ensure that residents receive quality care. Visits are a valuable time to look for changes in residents’ health and mental status. There are many ways families and long-term care residents can enjoy the holidays together.  Read our newly updated fact sheet for what to look for when visiting, tips and activity ideas for visiting your loved one, ways to engage with residents, and examples of potential gifts for residents.

Read the fact sheet.

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Amplify Your Advocacy

November 22, 2023

Dear Friends,

For nearly 50 years, Consumer Voice has been working to engage and empower long-term care residents and their families in the pursuit of quality care and services, quality of life, and protection of rights. 

Bringing the voice of the residents and family members to the policy and advocacy tables is powerful! No one can relay an experience as well as the person who has lived it! And those making decisions about long-term care and services need to hear from the people most impacted by the policies they enact. 

This has been more apparent than ever over the past year as we have advocated for implementation of the Administration’s bold initiatives for nursing home reform, including minimum staffing standards and increased accountability for nursing home owners and operators.  

You and other advocates from around the country have done a tremendous job of raising your voices by commenting on proposed rules, calling and writing your legislators, and sharing your stories about the need for meaningful long-term care reform. We can’t stop now!

We have to AMPLIFY OUR ADVOCACY to counter the misinformation and misguided attempts by the industry to derail the process!

CAN WE COUNT ON YOU to join us? Support the Consumer Voice today!

Your donation will:

  • Enable us to strengthen our national network of resident/consumer leaders and increase collaborations with partner organizations and coalitions.

  • Expand our ability to bring the resident/consumer and family voice to the policy and advocacy table through education, empowerment and effective strategies to impact long-term care policies.

  • Enhance our advocacy with policy-makers to support, enact, implement, and enforce policies that lead to quality care.  

What have we done so far towards this goal?

  • Led a coalition of partners to advocate for minimum staffing standards in nursing homes and responded to attempts to derail progress; supported the ability of consumers and advocates to submit comments by providing education and analysis of the proposed rules, talking points, templates, and a sign-on letter.

  • Facilitated an in-person dialogue with long-term care consumers, family members, and officials from federal agencies, such as the Centers for Medicare & Medicaid Services (CMS), Administration for Community Living, and Department of Justice, so they can better understand resident experiences and perspectives.

  • Supported resident and family participation in briefings for Congressional offices and staff; webinars; meetings with the CMS Administrator; and the Consumer Voice annual conference.

  • Hosted webinars and podcasts featuring current and former residents talking about the impact of policies on their lives, and also how they advocate for themselves and others.

  • Developed tools and resources for consumers and advocates to use in advocating for quality care and telling their stories.

Your support is needed to help us:

  • Respond quickly to opportunities and challenges around long-term care policies and practices.

  • Expand participation in our Consumer Advisory Panel of current and former long-term care consumers; and coordinate Advisory Panel activities, including hosting a minimum of quarterly meetings per year designed to promote dialogue among consumers and ask for consumer input on specific issues, such as infection prevention and transition from a nursing home.

  • Identify and promote successful practices for providing quality care and services; and empowering residents and other consumers.

  • Counter the extreme pressure from the nursing home industry to derail, delay, and weaken the initiatives that have been proposed to improve quality care.

What can you do to help?

SUPPORT OUR EFFORTS TO AMPLIFY OUR ADVOCACY

And that of long-term care consumers everywhere!

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CMS Issues Final Rule on Disclosure of Nursing Home Ownership

November 16, 2023

The Centers for Medicare & Medicaid Services (CMS) released a final rule implementing increased ownership and managerial disclosure requirements in nursing homes. This past April, Consumer Voice offered extensive comments in response to the proposed rule. In our comments, we urged CMS to define critical terms and to use their broad regulatory powers to implement the law in an impactful way.  The final rule reveals that CMS has made few changes, leaving the proposed rule mostly intact.

Knowing who owns a nursing home can be a matter of life or death. It is well documented that certain types of owners are more likely to provide poor care. For instance, one study found that residing in a nursing home owned by private equity owners raised the mortality rate of Medicare residents by ten percent.  On average, we know that non-profit homes staff 23% higher than for-profit homes, however, some kinds of non-profits staff much worse than others. In order to make informed choices, consumers must have access to detailed nursing home ownership.

Ownership information is also necessary to help hold nursing home owners and operators accountable for how they use the tens of billions of Medicare and Medicaid dollars they receive each year. Nursing home owners have learned countless tricks to disguise ownership of homes through the use of shell companies, layered corporations, and other devices. These steps are taken to mask how taxpayer dollars are used. We, as a country, have a tangible interest in how our taxpayer dollars are used to provide care to our most vulnerable citizens.

Just recently, in a different proposed regulation, CMS stated that a “lack of transparency, regarding nursing home finances, operations, and ownership impedes the ability to fully understand how current resources are allocated.”  In the final rule, CMS has taken a step in the right direction to begin to address the problem of the lack of transparency in nursing home ownership, but much more work needs to be done.

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2023 Consumer Voice Leadership Award Winners

November 14, 2023

Congratulations to the 2023 Consumer Voice Leadership Award Winners! These individuals have demonstrated exceptional commitment to improving the lives of long-term care consumers.

 

Janet Tulloch Memorial Award

This award was established in 2000 after the death of Janet Tulloch, a nursing home resident, author, committed advocate and long-time member of the Consumer Voice’s Board of Directors. It honors a citizen advocate, family caregiver or long-term care consumer (e.g., resident of a nursing home or assisted living facility or an individual receiving home and community-based services) who has worked directly with and for consumers to improve the lives of long-term care consumers.


MAURICE MILLER, Advocate and Nursing Home Resident

Maurice Miller is approaching 13 years as a stroke survivor and quadriplegic and will soon mark 11 years as a resident of the same facility in suburban Washington, DC. 

Maurice is a dedicated nursing home advocate with Consumer Voice. He is a frequent participant in podcasts, webinars, and Consumer Advisory calls. Maurice works to educate residents on how to use federal regulators to address their complaints, and fights for top-down nursing home reform.

CINDY NAPOLITAN, Advocate and Nursing Home Resident

Cindy Napolitan is a nursing home resident living outside of Dallas, Texas. She has lived in two different nursing homes over six years and has advocated for herself and others during that time.

Cindy is an advocate at the local, state, and federal level and is an active participant in Consumer Voice’s Consumer Advisory Council.

MARGARITE GROOJTES, Advocate and Nursing Home Resident

Margarite Grootjes has been a resident of a nursing home in southeast Ohio for the past seven years. Margarite is involved in advocacy work at various levels. 

She is president of the Resident Council at her nursing home; a member of the Consumer Advisory Council with Consumer Voice; and she is on the Workforce committee of the Moving Forward Coalition.

 

Janet Wells Public Policy Leadership Award

The Janet Wells Public Policy Leadership Award recognizes an individual who has provided exemplary leadership in the public policy field in advancing quality of care and quality of life for residents receiving long-term care services.


CHARLENE HARRINGTON, Professor of Sociology and Nursing at the University of California, San Francisco

Charlene Harrington is a respected worldwide expert whose name is synonymous with appropriate staffing and quality nursing home care. Over the past four decades, she has worked tirelessly not only to advocate, but to publish evidence-based research on this incredibly important topic. 

Charlene has devoted endless service to local, state, national, and international organizations and government entities. She is selfless in her commitment to the needs of nursing home residents and the frontline staff who care for them. Her dedication to education has empowered countless healthcare professionals, shaping the future of long-term care medicine. Her advocacy efforts have championed the rights and well-being of long-term care residents, leaving an indelible mark on the industry. Charlene Harrington has been a professor of sociology and nursing at the University of California San Francisco since 1980. She has testified before the U.S. Congress on long term care research and policy, written many articles and books on nursing homes and long-term care, and lectured widely in the U.S. and internationally.

 

Cernoria Johnson Memorial Advocacy Award

Cernoria McGowan Johnson (1909-1990) set up the national program of Nursing Home Ombudsmen in 1974. The award in her honor is presented to someone whose work has had national impact or is a model for national excellence and who exemplifies accomplishment in his or her chosen field.


EDWIN WALKER, Deputy Assistant Secretary for Aging, Administration for Community Living

Edwin Walker has served for more than 30 years in the the federal agency responsible for advocating on behalf of older Americans. Currently Edwin serves as the Deputy Assistant Secretary for Aging, and he leads the Administration on Aging in advocating on behalf of older Americans. Edwin has guided and promoted the development of home and community-based long-term care programs, policies, and services designed to afford older people and their caregivers the ability to age with dignity and independence and to have a broad array of options available for an enhanced quality of life. Edwin has also championed the promotion and implementation of evidence-based prevention interventions proven effective in avoiding or delaying the onset of chronic disease and illness.

Prior to joining HHS in 1992, Edwin served as the Director of the Missouri Division of Aging, responsible for administering a comprehensive set of human service programs for older persons and adults with disabilities. He received a Juris Doctor degree in law from the University of Missouri-Columbia School of Law and a Bachelor of Arts degree in Mass Media Arts from Hampton University.

 

Congratulations to the award recipients, and thank you for your advocacy!

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New Podcast Episode: The Measure of Our Age

November 09, 2023

M.T. Connolly is a writer, lawyer, researcher, policy-shaper, and leading national expert on elder justice. In her new book, The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life, M.T. discusses the challenges of aging, how things go wrong, and presents powerful tools we can use to forge better long lives for ourselves, our families, and our communities. In this episode, join our discussion with M.T. Connolly as we talk about the challenges of aging well, ageism, and advocacy for a better long-term care system.

About the Author

Screenshot 2023-11-09 134604.pngM.T. Connolly is a leading national expert on elder justice, a MacArthur “genius” grant awardee, and author of the 2023 book, The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life. She was the architect of the federal Elder Justice Act, founder of the Department of Justice’s Elder Justice Initiative, and lead author of the Elder Justice Roadmap, shaping federal, state, and local research, policy, and practice. She is also co-designer of the community-based “RISE” model intended to introduce holistic, hopeful, and effective ways to empower older adults, reduce harms, and promote elder justice.

Listen on Spotify and Apple Podcasts!

Subscribe to the Pursuing Quality Long-Term Care podcast on Spotify and Apple Podcasts

You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Consumer Voice and Others Comment on CMS's Proposed Nursing Home Staffing Rule

November 07, 2023

On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released the long-anticipated Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard in nursing homes.  The rule was open for public comment through November 6, 2023. CMS received more than 46,000 comments on the rule.

Thank you to all those who made their voices heard by commenting! We appreciate your advocacy!

Consumer Voice's comments to CMS on the rule included:

  • Consumer Voice strongly supports the proposed requirement that a nursing home have at least one registered nurse (RN) on site 24 hours per day, seven days per week. The current requirement of eight hours per day is insufficient and places residents at risk of harm.
  • While Consumer Voice supports the implementation of a minimum staffing standard, the proposed standard is too low and must be increased.
    • Additionally, we oppose the proposal that will permit waivers/exemptions from requiring nursing homes to comply with a minimum staffing standard if they meet certain criteria.
    • We urge CMS to reduce the timeframes for implementation and use a phased-in approach; and to adopt a more stringent system for monitoring and enforcing compliance with staffing standards.
  • Consumer Voice supports increased Medicaid transparency regarding direct care wages but believes more can be done.
  • While we support the proposed additions to the facility assessment regulation, we note that these additions will only be effective with proper guidance and enforcement.

Read our full comments.

Additional Support for Strengthening the Staffing Rule

More than 80 national and state organizations, including Consumer Voice, signed onto a letter regarding the rule. Plus, U.S. Representatives Lloyd Doggett (D-TX), Jan Schakowsky (D-IL), and 101 lawmakers wrote a letter urging CMS to strengthen and finalize the proposed Minimum Staffing Standards for Long-Term Care Facilities rule.

While official comments on the proposed rules have been submitted, our advocacy is not over.  Continue to let your policymakers know that strong staffing standards must be implemented; and stay tuned to the Consumer Voice for next steps!

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New Podcast Episode: Residents Amplify Their Voices for Change

October 24, 2023

Listen to the new episode of the Pursuing Quality Long-Term Care podcast, Residents Amplify Their Voices for Change. For decades Consumer Voice has designated October as Residents’ Rights Month. This month is an opportunity to recognize the value of each resident and the importance of treating every resident with dignity and respect. This year’s theme, Amplify Our Voices, highlights residents coming together to make their voices heard.

In this episode, join us as we speak with two resident advocates. Floyd Hartley is a former nursing home resident who now lives in the community and works as an advocate for all residents including those transitioning out of facilities. We also spoke with Cindy Napolitan, a current nursing home resident who has lived in two different nursing homes for over six years and has advocated for herself and others at the local, state, and federal level during that time.

Floyd and Cindy discuss how they work to improve conditions for nursing home residents. Their constant effort and advocacy illustrate how residents can use their own voices to make systematic change for consumers in long-term care facilities.

Listen to the podcast on Spotify, Apple Podcasts, SoundCloud, Facebook, Youtube, or our website

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Fact Sheet: Advocating for Rights and Better Care in Nursing Homes

October 03, 2023

Consumer Voice's new fact sheet, Advocating for Rights and Better Care, provides tips for resident and families for advocating for change in their nursing facilities and advocacy strategies for impacting long-term care policy.  Nursing home residents have the right to quality, person-centered care.  But too often, residents find themselves in situations where their rights are being violated and their needs are not being met. It is important to know the steps to take to advocate for yourself or your loved one when this happens. If things go wrong, there are specific actions you can and should take to try and change the situation within the facility. There are also ways to advocate for change on a broader level outside of the facility.

Get the fact sheet.

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New Issue of the Resident Advocate Newsletter

October 02, 2023

The Fall 2023 issue of The Resident Advocate is now available. This newsletter provides information on residents' rights and care issues; news and updates on national policy; and self-advocacy tips for obtaining person-centered, quality care.

This issue includes information on:

  • Tips for living with a roommate in a long-term care facility,
  • Staffing issues in long-term care and how you can advocate for change,
  • Steps to take when there is a problem in your nursing home,
  • Reminders for visiting long-term care facilities during the holidays, and
  • Participating in this year’s Residents’ Rights Month.

The Resident Advocate is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies. Download this issue or past issues.

Read the Fall 2023 Resident Advocate »

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Better Staffing Is Achievable: A Look at For-Profit vs. Non-Profit Nursing Homes

September 29, 2023

Since President Biden announced the implementation of a minimum staffing standard in February 2022, the nursing home industry has voiced strong opposition, claiming that it would be unable to meet a staffing standard. Now that the proposed rule has been announced, the for-profit lobbying industry has intensified their rhetoric, stating the whole system might collapse. 

Yet, if you look closely at the current staffing data, you see that thousands of non-profit nursing homes across the country are providing staffing that far exceeds the proposed CMS standard. What separates them from the for-profit industry is that they are not profit driven.  The data demonstrate that for-profit nursing homes purposefully understaff their facilities, diverting funds to other purposes, including profits.  

Read our one-pager about how non-profit homes staff, on average, 23% higher than for-profit homes.  A staffing standard would be a major step towards stopping the for-profit industry from siphoning dollars away from resident care. You will see how in every state, but one, non-profit nursing homes staff higher than their for-profit counterparts. 

We must stand with nursing home residents and demand a strong staffing standard now! 

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New Podcast Episode on Amplifying the Voices of Long-Term Care Residents

September 28, 2023

Description

Residents' Rights Month is celebrated every October and this year’s theme, Amplify Our Voices, emphasizes a community of long-term care residents coming together to make their voices heard. 

As we lead into Residents’ Rights Month, Consumer Voice spoke with two State Ombudsmen, Kelly Richards (Illinois) and Mairead Painter (Connecticut), who shared their experiences of amplifying the voices of long-term care consumers in their advocacy work.

In this episode, Kelly and Mairead discuss a variety of ways that long-term care consumers in their states have advocated to make positive change, including using the media, working with legislators, and sharing their personal experiences and stories. Kelly and Mairead also talked about actions Ombudsman program representatives can take to incorporate the voices of residents in their own advocacy.

Residents' Rights Month Resources, Promotional Materials, and More!

RRM 2023 logoVisit the Consumer Voice website for resources and materials to promote Residents' Rights Month. Plus, there's still time to get Consumer Voice’s new Residents' Rights Month products: newly redesigned door hangers; the Staying Engaged Enrichment booklet for residents; and I love Residents' Rights pencil pouches. Find those products and more in the online store.

 

Listen on Spotify and Apple Podcasts!

Spotify Promo4.pngSubscribe to the Pursuing Quality Long-Term Care podcast on Spotify and Apple Podcasts

You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Comment on the Proposed Minimum Staffing Standard in Nursing Homes

September 27, 2023

On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited Notice of Proposed Rulemaking (NPRM) proposing a minimum staffing standard in nursing homes. Consumer Voice believes the proposed staffing standard does not go far enough to protect residents of nursing homes. Read Consumer Voice's statement on the proposed rule.

More information on  how to submit detailed comments is forthcoming.  If you would like to comment now we urge you to follow the steps below, to share your story and include our talking points. 

To comment: 

1.) Open the commenting webpage in a new tab:  https://www.regulations.gov/commenton/CMS-2023-0144-0001

2.) In the comment box, state that:

The proposed rule does not go far enough to protect nursing home residents from harm.

Share your personal story or experience about the impact of inadequate staffing on you or someone you love.   

3.) Copy and paste: 

In order to protect nursing home residents from harm and to ensure a high quality of life: 

  • Require nursing homes to meet a total staffing standard of 4.2 hours per resident day (HPRD) within the next two years. This total should be made up of at least:
    • 1.4 HPRD of total licensed nurse care, composed of at least .75 HPRD of registered nurse (RN) care; and
    • 2.80 HPRD of certified nurse aide care (CNA).

RNs, LPNs/LVNs, and CNAs each have important roles in the provision of quality care to residents. A staffing standard should address total direct care for residents. These staffing levels are supported by decades of research and by the 2023 Staffing Study commissioned by CMS last year.

These additional requirements are financially feasible because the costs would be less than five percent of the over $100 billion that nursing homes receive from Medicare and Medicaid annually.

  • No waivers to facilities that cannot provide a level of care that ensures resident safety.
  • Restrict admissions when minimum staffing standards are not met.
  • Reduce the timeframes for implementation, particularly in rural areas, and require phased-in compliance. The 2023 Staffing Study found that staffing in rural homes is almost identical to staffing in homes located in urban areas. Residents in rural homes should not suffer for years before the staffing standard is implemented.

4.) In the drop-down question, “What is Your Comment About?” choose Long Term Care 

5.) Complete the remaining questions on the form 

6.) Click, “Submit Comment.” 

All comments are due by November 6, 2023.

We strongly urge you to  encourage others to comment. It is vital that CMS hears from as many people as possible that this rule needs to be strengthened!

Thank you for making your voice heard!

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GAO Report Finds Transparency Gaps in Private Equity Nursing Home Ownership

September 27, 2023

House Ways and Means Committee Ranking Member Richard E. Neal (D-MA) released a report titled “Limitations of Using CMS Data to Identify Private Equity and Other Ownership” from the U.S. Government Accountability Office (GAO) that shows transparency gaps in the data collected by the Centers for Medicare and Medicaid Services (CMS) to identify private equity and other owners in nursing homes.  GAO was asked to review CMS’s nursing home ownership data for information about private equity owners. Their report 1) estimates the percentage of Medicare-enrolled nursing homes in 2022 that were private equity-owned and 2) describes the limitations of using CMS’s data to identify private equity and other owners of nursing homes.  The report found significant limitations in CMS' ability to identify a nursing homes' ownership, including those that are private equity-owned.

Transparency in nursing home ownership is critical - different types of nursing home ownership result in different care quality for residents. For instance, a recent study documented that Medicare residents in nursing homes, owned by private equity investment firms, had an increased mortality rate of 10%. Nursing home residents and their families must have access to reliable and thorough ownership information when making decisions about their care.  Consumer Voice has been continually advocating for increased transparency of nursing home ownership. Visit our website to learn more about the issue.

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CMS Must Make the Minimum Staffing Rule Stronger To Protect All Nursing Home Residents

September 22, 2023

Nursing home residents, their families, and advocates have advocated for a minimum staffing standard for decades. In February 2022, President Biden announced an historic set of nursing home reforms, intended to improve quality and safety, including a minimum staffing standard,

On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard. While Consumer Voice appreciates that a standard has been proposed, it must be made much stronger so that ALL nursing home residents are safe and living a high quality of life. Consumer Voice recommends:

  • Require nursing homes to meet a total staffing standard within the next two years. This total should be made up of at least:
    • 1.4 hours of total licensed nurse care, composed of at least .75 hprd of registered nurse (RN) care; and
    • o 2.80 hprd of certified nurse aide care.

RNs, LPNs/LVNs, and CNAs each have important roles in the provision of quality care to residents. A staffing standard should address total direct care for residents. These staffing levels are supported by decades of research and by the 2023 Staffing Study commissioned by CMS last year.

These additional requirements are financially feasible because the costs would be less than five percent of the over $100 billion that nursing homes receive from Medicare and Medicaid annually.

  • No waivers to facilities that cannot provide a level of care that ensures resident safety.
  • Restrict admissions when minimum staffing standards are not met.
  • Not delaying implementation of this standard for five years in rural areas. The 2023 Staffing Study found that staffing in rural homes is almost identical to staffing in homes located in urban areas. Residents in rural homes should not suffer for years before the staffing standard is implemented.

Consumer Voice strongly supports CMS’ proposal to require nursing homes to have an RN on staff 24 hours per day, seven days per week. RNs play a critical role in resident care. The current requirement of eight hours per day places all residents at risk of harm.

Consumer Voice also supports the proposed Medicaid transparency provisions, although we also request that Medicaid cost reports be made publicly available to disclose the total amount of spending on nursing, ancillary, and support services compared with spending on administration, property, and profits. Medicare costs reports also should be made more transparent regarding spending, related party transactions, and disallowances, along with greater accountability requirements for ensuring that funds are spent on resident care.

Consumer Voice supports the proposed enhancements to the facility assessment requirements. These new provisions would require facilities to develop and implement staffing plans that are based on residents’ needs and acuity. These plans would also include staff retention and hiring plans. For these provisions to be effective, however, it will be critical that they are enforced by state regulators. 

Consumer Voice will work with residents, families, and other advocacy organizations to submit comments that urge CMS to adopt a strong standard for all nursing home residents. Please stay tuned for more information.

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CMS Releases Proposed Rule on Nursing Homes Minimum Staffing Standard

September 01, 2023

Today, the Centers for Medicare & Medicaid Services (CMS) released the long-anticipated Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard in nursing homes. While Consumer Voice is continuing to review the NPRM, we are extremely disappointed with CMS’s proposal. The proposal flies in the face of decades of research demonstrating a need for a strong staffing standard that protects all nursing home residents from harm.

Key highlights from the rule include:

  • Nursing homes would be required to provide only 3 hours of direct care per resident per day. This requirement would include only .55 hours of Registered Nurse (RN) care and 2.45 hours of certified nurse aide (CNA) care. The NPRM failed to propose a minimum for licensed practical nurses (LPNs) who play a critical role in nursing home care.
  • Facilities would be eligible for waivers from complying with this minimum if they met certain criteria.
  • Implementation of the requirement would be phased in over a 3-year period.
  • Facilities would be required to have an RN on staff 24 hours a day, 7 days a week. This requirement would be an increase from the current requirement of eight hours per day.

Over twenty-years ago an in-depth, evidenced-based CMS study found that each nursing home resident required at least 4.1 hours of direct care each day to avoid compromised care that placed residents at risk of harm. Today, nursing home residents are sicker, as many more functional older individuals choose to remain at home and live independently. Rather than taking steps to ensure all residents receive high quality care, today’s proposed rule would implement a standard of care well below the 4.1 hours of care and result in an increased risk of harm to nursing home residents.

Despite this dismal proposal, it is critical that we all comment on this rule to make it better. There is ample evidence supporting staffing standards significantly higher than the rule proposed by CMS. CMS, Congress, and other policy makers  need to hear our voices to make this proposal better.

We are continuing to review the rule and will be holding a webinar in the coming weeks to discuss the rule and how to comment. Please stay tuned for more information.

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Consumer Voice Submits Comments to ACL on Older Americans Act Program Regulations

August 23, 2023

Consumer Voice submitted comments to the Administration for Community Living (ACL)'s Notice of Proposed Rulemaking: Older Americans Act.  This is the first major update to most Older Americans Act (OAA) program regulations in nearly 35 years.  Much has changed in the provision of services during that time, and the Older Americans Act has been amended by Congress seven times since 1988.  ACL is seeking to align the regulations to the current statute and reflect the needs of today's older adults.  In addition, the rule addresses new issues that have emerged since the last update, and clarifies a number of requirements.  To learn more about the NPRM, visit https://acl.gov/OAArule.

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New Podcast Episode on Nursing Home Arbitration Agreements

August 18, 2023

Description

When a person enters a nursing home, one of the first things they usually do is sign their admissions contract. Typically, these contracts contain pre-dispute arbitration agreements. These agreements take away your right to hold your nursing home accountable in court for any potential negligence or wrongdoing. “Pre-dispute” arbitration agreements require you to give up this right before the harm even occurs so you will never have the chance to decide if going to court is the right option for you. Nursing home residents have the right to refuse pre-dispute arbitration. 

In this episode, Consumer Voice's Jocelyn Bogdan speaks with Victoria Schall, a trial attorney experienced in filing civil lawsuits against facilities for abuse and neglect of residents, about why nursing home residents should not sign pre-dispute arbitration agreements, what rights residents have regarding these agreements, and what arbitration may look like for residents who have already signed their contracts.

Video on Arbitration in Long-Term Care Facilities 

Screenshot 2023-08-18 103912.png

Watch this 4 minute video for an overview of arbitration in long-term care facilities.

Listen on Spotify and Apple Podcasts!

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You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Sessions to Look Forward to at the Consumer Voice Conference

August 18, 2023

Can't-Miss Sessions at the Consumer Voice Conference

  • Strategies for Avoiding Unnecessary Guardianships
  • Using Federal Law to Protect Assisted Living Residents
  • Advocating for Residents During the Decertification of America's Largest Nursing Home
  • The Impact of Administrative Staff on Quality
    Reforms for System-Wide Transformation
  • Community Response to Improved Nursing Home Care
  • HCBS Transition Strategies for Nursing Home Residents
  • The Outliers: Some Nursing Homes Beat the Odds
  • Understaffing Litigation in Nursing Facilities
  • Balancing Infection Control and Residents' Rights in Nursing Home Communities
  • Transformational Change Within Organizations, Systems, and Communities to Support "Good Lives for All People"
  • How Individual Advocacy Can Impact the World
  • Brief Interventions for Implementation of Trauma-Informed Care
  • Food Equity Advocacy Strategies in Long-Term Care Services and Supports
  • Using Data in Systems Advocacy

The above sessions will be available in-person and for livestreaming. All attendees have access to session recordings for 90 days.

See the preliminary agenda.

 

Plus, individuals attending in-person will have exclusive access to -

Additional sessions:

  • Proving the Legal Elements of Negligence Against Long-Term Care Facilities
  • Advocating for Better Care Through Staffing Ratios
  • Local and State LTCOP Approaches to Addressing Involuntary Transfer/Discharge
  • How Fear of Retaliation Silences Residents in America's Nursing Homes
  • Revolutionizing Access to Government Quality Care Data
  • No Country for Old People: Advocacy Through Film

And other special sessions and networking opportunities.

If you are planning on attending in-person, book your hotel room as soon as possible; the block is filling fast.

Can't make it to Baltimore? Watch the livestreams.

  • Watch live all plenary sessions and most breakout sessions
    • Participate in the discussion in the chat and ask speakers questions live
  • Network with conference attendees in the app or online
  • Visit the virtual exhibit booths to gather resources
  • Access session recordings for 90 days

Learn more about the conference and register.

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New Podcast Episode on the U.S. Supreme Court Case on Nursing Home Residents' Rights

July 27, 2023

Few lawsuits make it all the way to the U.S. Supreme Court. However, one brought by the family of Gorgi Talevski did just that -- and they won! The Talevski case decision is important in that it addresses the rights of nursing home residents, their ability to sue a state run (publicly owned) nursing home, and addresses the importance of the Nursing Home Reform Act in establishing the standard of care.

Join our discussion with Suzana Talevski, attorney and daughter of Mr. Talevski; Maame Gyamfi, Senior Attorney at AARP Foundation Litigation; and Toby Edelman, Senior Policy Attorney with the Center for Medicare Advocacy.

Ms. Gyamfi authored an amicus curiae, or friend of the court, brief on behalf of AARP and several other groups, including Consumer Voice. Ms. Edelman authored an amicus brief addressing the background and history of the Nursing Home Reform Act.

In this episode, we discuss the lawsuit, the Supreme Court decision, and what this means for residents. To access the U.S. Supreme Court decision and briefs filed in this case, visit the U.S. Supreme Court website, Docket No. 21-806.

Listen on Spotify and Apple Podcasts!

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You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Tell Congress to Support a Strong Minimum Staffing Standard in Nursing Homes

July 27, 2023

On February 28, 2023, President Biden announced a historic set of nursing home reforms. The centerpiece of these reforms was the promise to create a minimum staffing standard in nursing homes. For the first time, nursing homes will be required to provide, at a minimum, a certain amount of direct care each day to each resident. Since this announcement, residents, families, nursing home workers, and their advocates have been working tirelessly to support the Biden proposal.

Over twenty years ago, the Centers for Medicare & Medicaid Services (CMS) commissioned a study that found that a nursing home resident needed, at a minimum, at least 4.1 hours of direct care per day (hpd). Since then, nursing home residents have become sicker and in need of more care, while more functional individuals choose to remain at home. Any minimum staffing standard below 4.1 hpd will be unacceptable.

The nursing home industry is spending millions of dollars to try and derail this historic reform by the Biden Administration. Nursing Home residents need your help!

Use our online form to send a message to your members of Congress urging them to support a strong staffing standard in nursing homes.

In August, Congress will be in recess and your Congressmembers will be returning home. Many members of Congress will be conducting town halls or attending events where you can make your voice heard. 

After taking the action above, call your members of Congress and tell them you support a strong minimum staffing standard that is equal to or above 4.1 hpd. Find contact information for your members of Congress.

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Consumer Product Safety Commission Issues Mandatory Rules for Adult Portable Bed Rails

July 12, 2023

The Consumer Product Safety Commission issued mandatory rules for Adult Portable Bed Rails (APBRs). The rule establishes a mandatory performance requirement and test procedure to reduce the risk of entrapment and other hazards associated with the use of adult portable bed rails and requires all APBRs sold in the United States and manufactured after the effective date to comply with the standard’s performance and testing requirements.

Consumer Voice submitted comments regarding this rule in January 2023.  In our letter, we noted that widespread and comprehensive education is need so that consumers can make better, more informed decisions about purchasing these devices.  Additionally, we point out that APBRs are frequently used because caregivers do not know what else to do. Individualized care - knowing a person’s needs, routines, and preferences - allows caregivers to anticipate when the person has to, or wants to, get out of bed. This permits the caregiver to assist the individual to do so safely. We recommend that an educational campaign include the development and dissemination of a resource on individualized care to reduce or avoid the use of APBRs. 

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Consumer Voice Submits Comments to CMS Supporting Increased Access to High-Quality HCBS

July 05, 2023

Consumer Voice submitted comments and suggestions to the Centers for Medicare & Medicaid Services (CMS) supporting the proposed “Medicaid Program; Ensuring Access to Medicaid Services” rule.  Consumer Voice strongly supports the goal of the Notice of Proposed Rulemaking (NPRM) to increase access to high-quality Medicaid-funded Home and Community Based Services (HCBS). We agree with CMS's multifaceted approach to achieve this goal, particularly the steps supporting the workforce, creating quality measures, increasing transparency and accountability in HCBS spending, and implementing a grievance program for recipients of Medicaid Fee for Service (FFS). Our comments focused mainly on the HCBS provisions within the NPRM. Consumer Voice strongly supports increasing access to high-quality HCBS services for older adults and people with disabilities, as well as the adoption of measures to improve job quality for direct care workers.

Read our full comments.

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New Podcast Episode on Progress and Challenges for LGBTQ+ Residents in Long-Term Care Facilities

June 27, 2023

LGBTQ+ individuals have the same rights as other long-term care consumers, but they often face specific difficulties, such as discrimination and stigma. Even before entering long-term care, LGBTQ+ individuals are often concerned about whether the facility will accept them as who they are, and whether they will feel comfortable having partners and friends visit. LGBTQ+ older adults are less likely to have children to care for them and are more likely to live alone without a caretaker. Many LGBTQ+ older adults are not “out” because they fear discrimination.

In this episode, we are joined by Sherrill Wayland, Director of Special Initiatives at SAGE (Services and Advocacy for LGBTQ Elders), the largest organization improving the lives of LGBTQ+ older adults, advocating for the community since the 1970s. Sherrill discusses some of the challenges these residents face, what questions LGBTQ+ older adults should ask when comparing facilities, and best practices for facilities to train staff and maintain an inclusive community. Despite the challenges that exist, Sherrill shares some encouraging indicators of progress among facilities in states across the country.

For resources for LGBTQ+ residents and support from the National Long-Term Care Ombudsman Resource Center, visit the NORC website. To access SAGE resources for LGBTQ+ older adults, including its National LGBTQ+ Elder Hotline, visit www.sageusa.org.

Listen on Spotify and Apple Podcasts!

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You can also listen on YouTube, SoundCloud, Facebook, or our website.

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New Fact Sheet - The Value of Being Heard: Loneliness and Isolation in Long-Term Care

June 27, 2023

Consumer Voice and the National Center on Elder Abuse (NCEA) have created a fact sheet outlining the consequences of loneliness and social isolation and providing tips to improve the social connectedness of long- term care residents.   Twenty-five percent of Americans over 65 are considered socially isolated and forty-three percent describe themselves as feeling lonely.  The problems are more severe for people in long-term care.  The consequences of loneliness can manifest both medically and emotionally and can increase the risk of developing dementia by 50%. There are ways that loved ones, facilities, and the entire community can help combat isolation and loneliness in long term care.  Learn more by visiting our fact sheet: The Value of Being Heard: Loneliness and Isolation in Long-Term Care.

Plus, listen to the recent podcast episode on the same topic.

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ACL Seeks Input on Updates to Older Americans Act Program Regulations

June 15, 2023

The Administration for Community Living (ACL) is seeking input on proposed updates to the regulations for its Older Americans Act (OAA) programs. The last substantial update to most OAA program regulations was in 1988; the OAA has been amended by Congress seven times since 1988.

ACL states that the proposed rule addresses issues that have emerged since the last update and clarifies a number of requirements. It aims to better support the national aging network that delivers OAA services and improve program implementation, with the ultimate goal of better serving older adults. This Notice of Proposed Rulemaking (NPRM) looks at all OAA programs including the Long-Term Care Ombudsman Program, Elder Abuse Prevention, Legal Services, and Family Caregivers. Refer to the overview document for more information.

ACL has solicited input from the field as it developed these proposed rules through a Request for Information (RFI) and series of listening sessions.  Consumer Voice submitted comments on the RFI last year and hosted a listening session on the topic at a past annual meeting.

Instructions for submitting comments can be found in the NPRM, which was posted on the Federal Register website today. Comments must be received by 11:59 pm ET on August 15, 2023.

For more information on the proposed rule, join ACL for an informational webinar Thursday, June 22 at 12:30pm ET.

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Major Supreme Court Victory for Nursing Home Residents' Rights

June 13, 2023

On Thursday, June 8, the United States Supreme Court delivered a victory to nursing home residents residing in state run (publicly owned) Medicaid-funded nursing facilities, by finding that these residents have a private right of action against a nursing home if it violates rights conferred upon residents by the Federal Nursing Home Reform Act of 1987 (FNHRA). The family of Gorgi Talevski brought the lawsuit in federal court after serious issues arose when Mr. Talevski was admitted to an Indiana nursing home, Valparaiso Care and Rehabilitation (VCR). The complaint alleged that the facility illegally sedated Mr. Talevski with a variety of psychotropic drugs and then illegally discharged him from the facility. The federal district court dismissed the complaint, holding that FNHRA did not provide nursing home residents with a private right of action. The Seventh Circuit reversed the district court, and the United States Supreme Court upheld the Seventh Circuit’s decision.

The facts of Mr. Talevski’s case were, unfortunately, all too familiar to nursing home resident advocates.  When Mr. Talevski was admitted to VCR, he could still talk, feed himself, walk, socialize, and recognize his family. However, his condition quickly deteriorated – he began to lose his ability to communicate and could no longer feed himself. Although VCR claimed this was the natural progression of his dementia, outside physicians discovered that VCR was illegally sedating (chemically restraining) Mr. Talevski with six different psychotropic drugs. His medication was then tapered down, and he regained the ability to eat on his own. Ultimately, VCR illegally discharged Mr. Talevski, and refused to readmit him when VCR was found to have violated his discharge rights under FNHRA.

The Supreme Court held that FNHRA explicitly confers certain rights on nursing home residents, including the right to be free from chemical restraints and not to be subject to illegal discharge. In turn, these rights were found enforceable under Section 1983 of the United States Code, which provides citizens with a private right of action when a state deprives them of rights secured by the “Constitutions and laws.”

Consumer Voice joined an amicus curiae, or “friend of the Court,” brief in favor of upholding the right of residents to sue in cases like Mr. Talevski’s. The brief highlighted the inadequate care, poor conditions, and abuse many nursing home residents endure. Too often the federal and state regulatory systems fail nursing home residents, as it did in Mr. Talevski’s case. Providing residents with a private cause of action in instances where the facility is operated by a state allows residents to address poor care directly in the courts.

While the Supreme Court decision is critical for reaffirming that all residents have been conferred explicit rights under the FNHRA, the decision is narrow, and will not apply to residents operating in privately-run facilities. These residents will not have recourse to the courts under Section 1983 of the United States code, because these facilities are not state actors.  

Unfortunately, Mr. Talevski passed away in October 2021. Consumer Voice is grateful for the willingness of Mr. Talevski’s family to stand up for resident rights and for obtaining this important victory in the Supreme Court.

Learn more about residents' rights.

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No Country for Old People: Getting Poor Care in Highly Rated Facilities

June 08, 2023

Consumer Voice has long been concerned with the use of antipsychotics and other drugs in long-term care, as they are too often used as chemical restraints in place of providing adequate care. In this episode, Consumer Voice Executive Director, Lori Smetanka, is joined by award-winning writer/director Susie Singer Carter and former federal prosecutor Rick Mountcastle to discuss their upcoming documentary, No Country for Old People. Susie and Rick are collaborating on the film to promote conversations about the improper treatment and poor conditions many individuals in long-term care endure and spur action to address these failures in care. The documentary was inspired by Susie’s mother and the ordeal she experienced in what was advertised as a five-star long-term care residence in Los Angeles.

Without Susie’s consent, her mother was given Depakote, a medication that was not approved for the treatment of dementia-related agitation. When she eventually came off the drug, which had a black-box warning, Susie noticed her mother’s personality return to a limited degree, but her quality of life significantly worsened, and she would never walk again. As was true for many with family members in long-term care, the COVID-19 pandemic drew the curtain on what was really going on, even in reputable facilities. Susie connected with Rick, who led the investigation and charges against Depakote’s manufacturer, Abbott Laboratories. Rick is also known for his prosecution of Purdue Pharma and its top executives for the false marketing of oxycontin and their contribution to the opioid crisis in America, as featured in the miniseries Dopesick. After they spoke, Susie realized that the use of chemical restraints in long-term care – as well as harmful neglect of residents – were systemic issues nationwide, not limited to her mother’s facility in California. The two teamed up to co-produce the documentary, united in their sense of urgency to make this story heard.

Consumer Voice agrees that a culture change is necessary to hold these facilities – many of which receive public funds – accountable for how they treat their residents. No Country for Old People is in development, and Susie and Rick intend to make the film available to as many people as possible. Learn more about the documentary and make a donation to its production.

Listen on Spotify and Apple Podcasts!

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You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Consumer Voice Submits Comments to CMS on its Notice of Proposed Rule Making

June 07, 2023

Consumer Voice has submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its April 10, 2023 Notice of Proposed Rule Making (NPRM). The rule proposes to increase Medicare rates for nursing home stays by 3.7% in 2024. In addition, the rule proposes new measures of quality and some changes to the Medicare Value Based Purchasing Program. Consumer Voice voiced strong opposition to CMS's proposal to adopt the CoreQ measure as part of its Skilled Nursing Facility Quality Reporting Program (QRP) to survey resident satisfaction. While Consumer Voice does support directly measuring resident satisfaction, we oppose the use of CoreQ, a measure developed by and for the nursing home industry. The measure is biased toward positive reviews, is too vague, and excludes too many residents. In the letter, we urge CMS to reconsider its decision to use this measure.

Read our full responses to the NPRM.

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Consumer Voice Conference Registration Open

June 01, 2023

Join us for the 2023 Consumer Voice Conference October 30-November 1, 2023 at the Hilton Baltimore Inner Harbor.

Consumer Voice's Annual Conference educates and empowers long-term care consumers and consumer advocates. The conference covers long-term care issues, including current trends, best practices, advocacy opportunities, and new research. Attendees have the opportunity to learn, network, and exchange ideas with advocates from all over the country.

Register now to join us in Baltimore. Livestreaming options are also available.


If you need to pay by check and/or are eligible for a group discount, please email csteier@theconsumervoice.org prior to registering.
 

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New Podcast Episode on Loneliness and Social Isolation in Long-Term Care

May 23, 2023

The US Surgeon General referred to the epidemic of loneliness and social isolation in the United States as a public health crisis with profound consequences, and emphasized the need to prioritize social connections. Throughout the COVID-19 pandemic, perhaps no community was more impacted by loneliness and isolation than people living in long-term care. This seclusion led to many emotional, physical, and psychosocial health consequences.

In this episode, we speak with Dr. Susan Wehry, a nationally recognized keynote speaker and workshop facilitator on depression, dementia, and healthy aging, about the impacts of severe isolation and extreme loneliness many residents have experienced, not just during the pandemic, but before and after. Dr. Wehry discusses the value of being heard and ways staff, family members, and friends can work to help combat loneliness in long-term care moving forward.

Listen on Spotify and Apple Podcasts!

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You can also listen on YouTube, SoundCloud, Facebook, or our website.

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Senate Special Committee on Aging Report: Nursing Home Survey Agencies are Severely Understaffed

May 18, 2023

Today, the Senate Special Committee on Aging, led by Chairman Bob Casey, released a new report, “Uninspected and Neglected: Nursing Home Agencies are Severely Understaffed, Putting Residents at Risk.”  The report details a nationwide staffing crisis at state survey agencies that is directly impacting the health and well-being of nursing home residents. In addition, the Senate Special Committee on Aging held a hearing on the issue today, at which State Long-Term Care Ombudsman Leah McMahon testified regarding how inadequate staffing at state survey agencies is impacting resident care in Colorado.

The importance of state survey agencies cannot be understated. They are charged with enforcing federal and state regulations to ensure the safety of nursing home residents. Inadequate state surveying activity allows facilities to continue to operate in a manner that harms residents or puts them at risk of harm.

Key findings from the report include:

  • One-third of the 15,000 nursing homes in the United States are behind on their annual surveys, with 11% of homes not having had a survey in over two years.
  • 31 of 52 state survey agencies are experiencing vacancy rates of 20% or higher, with nine survey agencies having vacancy rates over 50%.
  • Low salaries and burnout lead to high staff turnover in state agencies, which results in inexperienced surveyors.
  • Many states have turned to hiring third-party companies to conduct surveying activities and are paying exorbitant fees for their services. The report also calls for increased oversight of these third-party survey companies.

The Committee’s report made several recommendations, including:

  • Increased funding from Congress. Funding for state survey agencies has been flat for years, despite calls for increases from both Presidents Trump and Biden.
  • Congress and state governments should take action to support state surveyors, including providing educational opportunities and mental health support.
  • Congress should increase funding for State Long-Term Care Ombudsman programs. The report relies heavily on input from Ombudsman program representatives and notes their critical role in advocating on behalf of residents and calls for increased funding for these critical programs.

Consumer Voice has long been concerned about inadequate enforcement activities in nursing homes and delays attributable to staffing shortages and has repeatedly called for increased funding for state survey agencies. Consumer Voice is grateful to the Senate Special Committee on Aging and Chairman Casey for drawing attention to this important issue, and we urge Congress, the Centers for Medicare & Medicaid Services (CMS), and state governments to adopt the report’s recommendations. 

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80% of Voters Support Minimum Staffing Standards in Nursing Homes

May 10, 2023

According to a recent poll, 80% of U.S. registered voters supported candidates who support requiring minimum staffing standards in nursing homes.  Eighty-nine percent of Democrats and 74% of Republicans said they were more likely to vote for candidates who backed minimum staffing standards. The poll conducted by Fabrizio Ward and Impact Research and released by AARP also found wide support for candidates who back proposals that support family caregivers and help seniors live in their own homes.  Seventy-eight percent of voters are current, past, or future family caregivers, and over 70% of voters across the political spectrum said they would be more likely to support a candidate who backed proposals for family caregivers such as a tax credit or paid family leave.  Eighty-nine percent of Democrats and 72% of Republicans support expanding services to help seniors stay out of the nursing home by living at home

Read the Study

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Updated Nursing Home Visitation Guidance from CMS

May 10, 2023

On May 8, 2023, the Centers for Medicare & Medicaid Services (CMS) released updated nursing home visitation guidance. The guidance notes that while the Public Health Emergency (PHE) is ending on May 11, 2023, CMS still expects all nursing homes to adhere to infection control procedures.
 
Additional updates include:

  • Facilities should post visual alerts in the facility alerting the public to infection control procedures and practices.
  • Indoor visitation should occur in the residents room during a COVID-19 outbreak.
  • Facilities must continue to follow CDC recommendations regarding infection control procedures.

Importantly, the guidance continues to state there are no current COVID-19 scenarios that would permit a facility to prohibit a resident to have visitors at anytime.  
 
Additionally, on May 11, 2023, the COVID-19 outbreak testing requirement will no longer be in effect. Under that guidance, facilities were required to follow a certain testing protocol when a COVID-19 outbreak occurred. The updated guidance requires nursing homes to conduct COVID-19 testing in compliance with CDC recommendations.

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Resident Advocate Newsletter Spring 2023

May 08, 2023

The Spring 2023 issue of The Resident Advocate is now available. This newsletter provides information on residents' rights and care issues; news and updates on national policy; and self-advocacy tips for obtaining person-centered, quality care.

This issue includes:

  • Information on what the end of the federal Public Health Emergency (PHE) means for long-term care residents,
  • Tips to advocate for higher levels of staffing, and
  • Information about this year’s Residents’ Rights Month.

The Resident Advocate is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies. Download this issue or past issues from our website.

Read the Spring 2023 Resident Advocate »

NOTE: The newsletter is mailed free of charge to residents of nursing homes, assisted living facilities and board and care facilities, and individuals receiving long-term care in their home or community. If you are an individual receiving long-term care and would like to have the next issue of The Resident Advocate mailed to you, send your name and address to info@theconsumervoice.org.

If you are a nursing facility, long-term care Ombudsman program representative, or other advocate who would like copies, you are welcome to download and print the issues from our webpage.

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New Podcast Episode on Facilities that Weathered the Storm of COVID-19

May 05, 2023

As we are finding our way out of the COVID-19 pandemic and Public Health Emergency (PHE) that devastated so many lives – particularly in nursing homes – there is an opportunity to look back at what happened, both the good and the bad, and find the lessons we can learn from to perhaps do better in the future. This is particularly true in evaluating what was happening in long-term care facilities prior to and during the pandemic that affected their response to COVID-19, and the subsequent increase in staffing shortages that many facilities are experiencing.

In this episode of the Pursuing Quality Long-Term Care podcast, Consumer Voice Executive Director, Lori Smetanka, talks with David Farrell, a licensed nursing home administrator who has spent his entire career in the long-term care profession, about the long-term care facilities that had better outcomes than their peers, or as David notes, facilities that “weathered the storm of COVID-19 and staffing crises.”

David and his colleagues did a deep dive into those facilities that were outliers or stood out from their peers with regard to COVID-19 infections and staffing shortages, to try to determine what was happening that we could learn from, and hopefully replicate.

Resource: Sharing Lessons From Successes

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Consumer Voice Sends Letter to CMS Regarding Inaccuracies on Care Compare

May 04, 2023

Consumer Voice sent a letter to Chiquita Brooks-LaSure, Administrator for the Centers for Medicare & Medicaid Services (CMS), regarding the Department of Health and Human Services Office of Inspector General's (OIG) report which found widespread inaccuracies in the information reported to the public on Care Compare. Nearly 20 years ago, the Inspector General identified many of these same inaccuracies in a report on Nursing Home Compare, Care Compare’s predecessor website. Although CMS promised two decades ago to correct the problems that led to the inaccuracies (and to require state agencies to verify that the database includes the most recent inspections), the same problems remain today, based on the same underlying causes.

More troubling still, CMS now dismisses OIG’s detailed concerns about how Care Compare fails to identify health, life safety code, and emergency preparedness deficiencies for two-thirds of the nursing facilities in the country. CMS refuses to commit to correcting the problems that make Care Compare understate deficiencies so significantly and extensively. In our letter, we urge CMS to take the findings of the OIG report seriously, to adopt all of the report’s recommendations, and to undertake a system-wide review to determine how these serious errors were made.

Read our letter.

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Vaccination Requirement for Workers and Regulatory Waivers to End

May 02, 2023

On May 1, 2023, the Biden Administration announced it would be ending the federal requirement that nursing home workers be vaccinated against COVID-19 on May 11, 2023, the end of the Public Health Emergency (PHE). Additionally, the Centers for Medicare & Medicaid Services (CMS) issued new guidance addressing how the end of the PHE would affect certain regulatory waivers that had been issued to nursing homes at the beginning of the PHE.

Consumer Voice opposes lifting the requirement that nursing home workers be vaccinated against COVID-19. COVID-19 vaccinations have proven to be the most effective protection for nursing home residents. For the week ending December 13, 2020, there were 34,101 COVID-19 cases reported in nursing homes, along with 6,077 resident deaths. For workers, those numbers were 29,086 cases and 42 deaths. A month later, for the week ending February 21, 2021, the number of COVID-19 cases for residents had dropped to 2,316 resident cases and 879 resident deaths. For workers, the numbers were 3,018 cases and 25 deaths. These precipitous declines in cases and deaths correspond with the introduction of COVID-19 vaccinations for both residents and workers. Since then, COVID-19 vaccinations have likely saved the lives of tens of thousands of nursing home residents.

Nursing home residents suffered disproportionately during the COVID-19 pandemic. COVID-19 vaccines have been the most effective tool in protecting residents from contracting COVID-19 and dying. Despite the end of the PHE, COVID-19 is still present in nursing homes and in our communities. Fortunately, vaccinations have significantly reduced the likelihood of death from COVID-19. Consumer Voice is concerned that lifting the requirement that staff be vaccinated will put both residents and staff at increased risk for spreading and contracting the virus and experiencing severe illness or even death. Further, it sends the wrong message to both residents and workers that vaccination is not important and could reduce the rates of vaccination in both residents and staff.

Additionally, yesterday, CMS released new guidance regarding regulatory waivers due to expire on May 11, 2023. CMS had issued numerous waivers at the beginning of the COVID-19 pandemic, which were, according to CMS, designed to provide nursing homes “flexibilities” in treating residents during the pandemic. While many of these waivers have been rescinded, several remain in effect, but will now terminate at the end of the PHE. The terminating waivers include:

  • Nursing homes will no longer be able to employ untrained workers: CMS had issued a waiver allowing nursing homes to employ workers as CNAs, who had not met the regulatory training and certification requirements. While this waiver was due to end last year, CMS continued to allow many states to employ untrained workers. When the PHE ends, all workers will need to meet the training and certification requirements within four months. Consumer Voice has strongly opposed this waiver, as we heard from residents, workers, and CMS that these untrained workers were providing substandard care.
  • Three-day hospital stays prior to admission to a nursing home for Medicare residents: CMS had waived the requirement that a Medicare recipient have a three-day hospital stay prior to admission to a nursing home. The three-day requirement will be reinstated at the end of the PHE. Consumer Voice supported this waiver and thinks the three-day hospital stay requirement should be eliminated.
  • Resident Grouping, Cohorting, and Transfer and Discharge: CMS had waived certain resident protections to allow facilities to group residents based on COVID-19 status and to transfer/discharge residents without notice to cohort them with other residents with similar COVID-19 status. All of these waivers will be lifted, and facilities will no longer be able to group or transfer residents, without their consent, based on COVID-19 status. The notice requirement prior to discharge or transfer is reinstated, as well.

Importantly, the result of most of the waivers expiring will reinstate important protections for nursing home residents. We urge the Biden Administration and CMS to reconsider lifting the requirement that nursing home staff be vaccinated. The COVID-19 pandemic may seem over for some, but it is still very real for nursing home residents. We must continue to be vigilant and protect our most vulnerable citizens. 

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President Biden Issues Executive Order to Increase Access to High-Quality Long-Term Care Services, Support Family Caregivers, and Create Better Jobs for Long-Term Care Workers

April 20, 2023

On April 18, 2023, President Biden issued a wide-ranging executive order designed to increase access to high quality long-term care services and child care services, to support family caregivers, and to create better jobs for long-term care workers. Importantly, the executive order acknowledged that the country must do more to support workers who provide long-term care services by increasing pay and benefits, providing additional training and educational opportunities, and offering other supports to workers. The order also called for the U.S. Department of Health and Human Services (HHS) to explore innovative ways to support family members providing care to loved ones with dementia. Consumer Voice strongly supports the actions announced in the executive order, and thanks President Biden for taking decisive action to support long-term care workers and family caregivers.

As Consumer Voice has pointed out, there is a job quality crisis in the long-term care industry, particularly in nursing homes. Low wages and poor benefits, little opportunities for career advancement, and impossible workloads have led to a staffing turnover rate of nearly 54% annually. In a statement on April 18, 2023, the Biden administration acknowledged this high turnover rate, and recommended that HHS “condition a portion of Medicare payments on how well a nursing home retains workers.” The statement acknowledged the forthcoming minimum staffing standard as another important tool to enhance job quality for nursing home workers. Consumer Voice strongly supports these efforts by the Biden administration to address job quality by requiring nursing homes to spend Medicare and Medicaid dollars on staffing.

It has been over a year since President Biden announced the most significant nursing home reforms in decades. Tuesday’s announcement continues the Administration’s efforts to address the crisis in nursing homes by supporting long-term care workers. We must have better jobs and supports for long-term care workers in order for nursing home residents to be safe and receive high-quality care. We applaud the Administration’s continued efforts to help protect our country’s most vulnerable residents. 

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New Podcast Episode: Increase Scrutiny of Nursing Home Finances

April 18, 2023

In this episode of the Pursuing Quality Long-Term Care podcast, we are sharing audio from Consumer Voice’s webinar that was part of the Dignity for All: Staffing Standards Now! campaign. Through this campaign, Consumer Voice is advocating for a minimum staffing standard in nursing homes.

This discussion highlighted how there is little accountability for how nursing homes spend taxpayer dollars, despite receiving tens of billions of dollars each year in Medicare and Medicaid dollars. In this episode, you will hear Consumer Voice's Public Policy Director, Sam Brooks, and Attorney, Ernie Tosh discuss the new report, Where do the Billions of Dollars Go? A Look at Nursing Home Related Party Transactions.

The report takes an in-depth look at how nursing home owners and operators funnel billions of dollars through companies they own with little to no accountability for how that money is used each year. Sam and Ernie also offer examples and solutions to address this industry-wide problem to ensure public dollars are going toward resident care.

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Consumer Voice and Other Advocates Submit Comments on Proposed Nursing Home Ownership Regulations

April 14, 2023

Today, Consumer Voice, along with other advocates, submitted comments on nursing home ownership regulations recently proposed by the Centers for Medicare & Medicaid Services (CMS). The proposed regulations seek to implement ownership disclosure requirements passed as part of the Affordable Care Act in 2010 (ACA). Often referred to as Section 6101, the law was designed to increase transparency of who owns, controls, and operates nursing homes. Consumer Voice supports CMS’s efforts to implement regulations that help pull back the veil on nursing home ownership and control. However, we are concerned that the proposed regulations will not realize the transparency envisioned by the original law.  Our comments offer suggestions to strengthen the regulations so that they will achieve the transparency goals passed by Congress over thirteen years ago.

Transparency in nursing home ownership is critical. As our comments note, different types of nursing home ownership result in different care quality for residents. For instance, non-profit homes, generally, provide more staffing and perform better on quality ratings. However, different types of for-profit ownership can result in poorer care as well. For instance, a recent study documented that Medicare residents in nursing homes owned by private equity investment firms, had an increased mortality rate of 10%. In other words, it can be a matter of life and death knowing who owns the nursing you home live in.

Additionally, as Consumer Voice’s recent report “Where Do the Billions of Dollars Go? A Look at Nursing Home Related Party Transactions” documents, billions of dollars are funneled through a tangled web of related party companies, each year. Section 6101 of the ACA was designed to bring transparency to these various companies, so as to increase accountability for how Medicare and Medicaid dollars are spent. Our comments offer suggestions to CMS on how they may implement regulations to achieve this goal.

We are grateful to the Biden Administration for proposing new regulations regarding nursing home ownership. We urge them to consider our recommendations to ensure that nursing home residents, their families, and consumers have access to reliable and thorough ownership information, and that nursing homes are held accountable for how they spend taxpayer dollars.

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CMS Revises Guidance for Enforcement of Infection Control Deficiencies

April 12, 2023

On March 30, 2023, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance, QSO-23-10-NH, “Strengthened Enhanced Enforcement for Infection Control Deficiencies and Quality Improvement Activities in Nursing homes,” which strengthens enforcement efforts for noncompliance with infection control deficiencies (F880) and vaccine immunization requirements for staff and residents (F887).

Consumer Voice has long been advocating with CMS and the Administration for stronger enforcement measures. Prior to the COVID-19 pandemic, noncompliance with Infection Prevention and Control was the top deficiency cited. Despite the devastation nursing home residents faced throughout the pandemic, most violations inspectors found were labelled as causing “no actual harm,” which means facilities rarely faced any meaningful financial penalties.  The revised guidance directly responds to Consumer Voice’s concerns over lack of enforcement, targeting “facilities with, or at risk for, the most significant negative resident health outcomes.”  

Among other things, facilities that are now cited with Actual Harm for non-compliance for Infection Prevention and Control (F880) will face a 10% increase in Civil Money Penalties with a ten percent increase adjustment; and facilities cited with Immediate Jeopardy will face a 20% increase in Civil Money Penalties.

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Tell Congress to Support Standards for Nursing Home Staffing and Transparency

April 06, 2023

The Biden Administration is on the brink of implementing important reforms for nursing homes - requiring staffing standards and increasing transparency and accountability for owners and use of public money.  We need Members of Congress to show their support for these proposals that will promote meaningful improvements in care for residents.  Tell your Members to support nursing home staffing and transparency!

Use our simple online form to send a message to your Members of Congress now.

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Two New Podcast Episodes on How Inadequate Staffing Affects Quality of Life and Care

April 06, 2023

In these two episodes of the Pursuing Quality Long-Term Care podcast, we are sharing audio from two of Consumer Voice’s webinars that were part of the Dignity for All: Staffing Standards Now! campaign. Through this campaign, Consumer Voice is advocating for a minimum staffing standard in nursing homes.

Episode 30: Quality Jobs, Quality Care

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The implementation of a minimum staffing standard would not only protect nursing home residents it would address the long-standing job quality problems that plague nursing homes. On average, nursing home staff turnover is 52% each year, which is the result of low-wages, poor benefits, inadequate training, and little opportunity for job growth. The burden of providing essential and critical care falls largely on women, a majority of whom are women of color, while they are treated poorly by nursing home owners and operators.

In this episode, you will hear a conversation with Consumer Voice and several direct care workers, also members of the Service Employees International Union, who discuss what it is like to work in an understaffed facility and what a minimum staffing standard would mean to direct care staff in nursing homes. View the webinar slides.

Episode 31: Resident Voices on How Staffing Impacts Their Lives

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This discussion highlighted the experiences of long-term care residents as they shared, in their own words, how living in a facility with inadequate staffing affects their quality of life and the quality of care that they receive, and what it would mean for their lives to live in a facility with enough staff. View the webinar slides.

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New Report: How Nursing Homes Funnel Billions of Dollars Through Related Party Companies with Little Scrutiny from the Federal Government

March 28, 2023

Report coverToday, Consumer Voice is releasing its new report, “Where Do the Billions of Dollars Go? A Look At Nursing Home Related Party Transactions,” which documents how each year nursing homes funnel billions of dollars through related party companies (companies they own) with little to no oversight by the Centers for Medicare & Medicaid Services (CMS). The report provides a detailed look at related parties and how nursing homes potentially use them to hide how much money they are making and to give the illusion that their facilities are not profitable.

The report uses cost data submitted to the federal government by nursing homes to illustrate the industry-wide practice of related party transactions and how at the same time, residents face inadequate staffing and poor care.

Our report found:

  • Despite billions of dollars being funneled through related party companies each year, there appears to be little to no scrutiny by the federal government on how this money is spent.
  • Nursing home owners and operators routinely pay their related parties more than the reported costs, in some instances by nearly 1200%.
  • Related parties make nursing homes look less profitable, while a closer look at the parties involved reveals that profits may be hidden in these transactions.
  • Cost reports do not capture enough information on related party transactions to enable CMS to fulfill its regulatory obligation to ensure taxpayer dollars are going towards care and not profits to owners and operators.

The constant refrain from the nursing home industry is that they need more money. Yet, our report shows that billions of dollars go unaccounted for each year and are potentially being siphoned off to the profits of nursing home owners and operators.  In our report, we offer solutions to the lack of transparency and accountability for how nursing home dollars are spent. CMS must take action now to ensure that taxpayer dollars are spent on care and that the safety and well-being nursing home residents is assured.

Join us for a webinar Thursday, April 6th to hear more about the report in detail.

Register Now

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2022 Annual Report

March 27, 2023

Read Consumer Voice's Annual Report to learn about the year's priorities and accomplishments.

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Members of Congress Send Letter to CMS Urging Enactment of a Minimum Staffing Standard in Nursing Homes

March 21, 2023

In a March 13, 2023 letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, 113 members of Congress urged CMS to propose strong mandatory minimum staffing standards in the proposed Fiscal Year 2024 Medicare payment rule.  In the letter, the Representatives note that creating a minimum staffing standard was a part of President Biden's announcement of historic nursing home reforms a year ago. The letter describes why it's essential to enact nurse staffing ratios in nursing facilities and recounts widespread support for such ratios.  The letter also calls for further transparency in Medicare and Medicaid spending on nursing facilities.

Read the full letter.

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New Podcast Episode on Staffing Standards Benefitting Residents and Workers

March 15, 2023

In this episode of the Pursuing Quality Long-Term Care podcast, we are sharing the audio from Consumer Voice’s webinar earlier this month that launched our “Dignity for All: Staffing Standards Now!” campaign. Through this campaign, Consumer Voice is advocating for a minimum staffing standard in nursing homes.

In this episode, you will hear about the importance of adequate staffing for residents’ safety and health from Sam Brooks at Consumer Voice, and Toby Edelman, at the Center for Medicare Advocacy. You will also hear from Shelley Jackson, a CNA in Pennsylvania, and Margarite Grootjes, a resident in Ohio, as they share what it is like to live and work in a facility without adequate staffing.

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Dignity for All: Staffing Standards Now Camapaign

Dignity for AllFebruary marked the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan. Since his announcement, the Centers for Medicare & Medicaid Services (CMS) has embarked on a study to determine the minimum level of direct nursing care all residents need and has promised to propose a standard this spring.

The nursing home industry's opposition to a minimum staffing standard has been fierce. The voices of residents and workers have been lost in the discussion. Over the next several months, Consumer Voice and resident advocates will center the discussion of minimum staffing standards on residents and workers by holding a series of events to uplift their voices. We must ensure that the primary focus of adequate staffing is on the residents and workers!

Visit the Dignity for All campaign webpage for resources, stories, and to stay up-to-date on the schedule of upcoming events.

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Avoiding Drugs Used as Chemical Restraints: Residents' Rights and Facility Responsibilities

March 08, 2023

All nursing home residents have the right to quality, individualized, person-centered care that respects their needs, choices, preferences and routines. This includes when antipsychotic drugs are considered for use. Too often, individuals living with dementia are prescribed off-label antipsychotic medications instead of being provided quality care to meet their needs. These drugs have been found to increase the risk of harm or death for elderly patients with dementia.

Consumer Voice is releasing a new booklet, developed as result of our work on Avoiding Drugs as Chemical Restraints Consumer Education Campaign, which was in partnership with AARP Foundation.  The booklet provides information and tips on having clear communication with long-term care providers, ensuring that resident needs are met, how to provide nonpharmacological interventions, what to do if an antipsychotic drug has been prescribed, and residents' rights regarding antipsychotic drugs.

Get the Booklet.

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Senators Casey and Wyden Release Report on Failures of Long-Term Care Facilities to Protect Nursing Home Residents from Extreme Weather Events

February 24, 2023

On February 23, 2023, the United States Senate Finance Committee and Senate Special Aging Committee released a report Left in the Dark which focuses on a catastrophic weather event in February 2021 in Texas that revealed how unprepared nursing homes were to protect residents from extreme weather events. Led By Chairs Ron Wyden and Senator Casey, the report details how widespread power outages affected nursing homes and resulted in more than 1,400 nursing home residents being evacuated.

Key finding of the report include:

  • Increased extreme weather emergencies place all nursing home residents across the country at risk.
  • Despite increased power outages, federal regulations do not require nursing homes to have back up power sources. The report also found that most states do not require assisted living facilities to maintain backup power. 
  • Understaffing in nursing homes and regulatory agencies contribute to the lack of emergency preparedness in nursing homes.

In addition to these findings, the report made strong recommendations including:

  • Passing the Real Emergency Access for Aging and Disability Inclusion for Disasters Act (READDI), which would ensure older adults and people with disabilities that reside in long-term care facilities are included in emergency and disaster planning.
  • Calling on the Centers for Medicare & Medicaid Services (CMS) to issue a mandatory staffing minimum for nursing homes, which would address chronic understaffing in nursing homes.
  • Recommending Congress increase funding to state survey agencies responsible for licensing nursing home facilities and enforcing state and federal regulations.

Consumer Voice strongly supports the recommendations laid out in the Left in the Dark report. Not only does this report highlight how unprepared nursing homes are to protect residents from extreme weather events, it comes on the heels of the devastating and catastrophic events of COVID-19, which led to the deaths of nearly 200,000 nursing residents, which made clear that many nursing homes are grossly unprepared to protect residents from infections disease.

Consumer Voice thanks Senators Wyden and Casey for issuing this report and recommending strong steps to protect nursing home residents.

Read the full report.

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Dignity for All: Staffing Standards Now!

February 23, 2023

This month marks the one-year anniversary of President Biden's announcement of historic nursing home reforms. Creating a minimum staffing standard, which would be the most significant increase in protections for nursing home residents in decades, was central to his plan. Since his announcement, the Centers for Medicare & Medicaid Services (CMS) has embarked on a study to determine the minimum level of direct nursing care all residents need and has promised to propose a standard this spring. 

The nursing home industry's opposition to a minimum staffing standard has been fierce. The voices of residents and workers have been lost in the discussion. Over the next several months, Consumer Voice and resident advocates will center the discussion of minimum staffing standards on residents and workers by holding a series of events to uplift their voices. We must ensure that the primary focus of adequate staffing is on the residents and workers!

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GAO Report Calls for Increased Transparency in Nursing Home Ownership

February 03, 2023

On Thursday, February 3, 2023, the Government Accountability Office (GAO) released a new report, "Nursing Homes: CMS Should Make Ownership Information More Transparent for Consumers,” finding fault with how the Centers for Medicare & Medicaid Services (CMS) currently provides information to consumers regarding nursing home ownership. The report noted that ample evidence demonstrated that different ownership types often lead to disparate health outcomes for nursing home residents. For instance, non-profit homes generally perform better on measures of quality than for-profit nursing homes. The GAO report acknowledged these differences in care quality and emphasized the importance of accurate and accessible ownership interests to consumers.

The report’s primary focus was on how CMS provides ownership information on its Care Compare website. Echoing concerns of Consumer Voice and other advocates, the GAO report found that CMS:

  • Was not providing information in plain language with clear graphics. For instance, the GAO noted terms such as “5% owners or greater indirect ownership interest” and “operational/managerial control.” These terms are vague and undefined and not easily understandable to consumers.
  • Failed to organize information to highlight patterns. The GAO report found that “the presentation of ownership information on Care Compare does not allow consumers to easily identify relationships and patterns related to quality across nursing homes under common ownership.”
  • Did not explain the purpose and value of ownership information on Care Compare. Nowhere on Care Compare is there an explanation of how the type of ownership may result in worse care. This absence of an explanation may result in consumers overlooking its importance.
  • Did not disclose the key strengths and limitations of the data. This failure is significant because, as noted by the GAO, nursing home ownership data is often incomplete and inaccurate. CMS admitted in the report that the ownership structures for some nursing homes are so nebulous that they are sometimes unable to ascertain who owns a nursing home. Despite this fact, CMS does not disclose the unreliability of the data to the public on Care Compare.

The GAO report made two recommendations:

  • Use plain language to define key terms in the ownership section of Care Compare.
  • Organize ownership information by providing consumers easy access to a list of all facilities under common ownership, their respective star ratings, and a distribution of star ratings across nursing homes with common ownership to allow consumers to examine quality patterns across such facilities.

CMS concurred with both recommendations. Additionally, the Biden Administration announced last year that it would address the issue of inaccurate and incomplete ownership information and take steps to make ownership data available to consumers. The GAO report noted that CMS had taken some steps to release more ownership data, but CMS admitted this data was for researchers and not consumers. However, CMS has promised more action to ensure access to residents and their families.

Consumer Voice has long advocated for all consumers to have access to reliable and relevant ownership information for individual nursing homes with care quality information for all nursing homes under common ownership. When deciding on a nursing home, residents and their families must have access to ownership data that is reliable and accurate. It is currently impossible to easily access care quality information across nursing homes with common owners. Further, until CMS ensures that ownership information for all nursing homes is accurate, the system's utility, as a whole, will be undermined.

While the GAO report finds fault with CMS’ current system of providing nursing home ownership information, Consumer Voice has been encouraged by the steps the agency has taken over the past year. Nevertheless, CMS has significant work to do to realize the goals announced by President Biden and laid out in the GAO report.

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Biden Administration Announces End to Public Health Emergency

February 01, 2023

The Biden Administration has announced an end to the Public Health Emergency (PHE). This announcement means that all outstanding waivers granted to nursing homes from certain regulatory requirements will end on May 11, 2023. At the beginning of the pandemic, the Centers for Medicare & Medicaid Services (CMS) waived a variety of regulatory requirements that nursing homes had to comply with, including the reporting of important data and training requirements for certified nurse aides (CNAs). While most of those waivers have been rescinded, CMS has continued to allow some states to employ untrained nurses aides. CMS has allowed this practice despite admitting that "Poor quality of care, such as improper transfers, turning and positioning, poor incontinent/skin care, or weight loss related to poor assistive dining techniques could be related to inadequate training, as these skills are required components of NATCEP programs." (QSO-22-15-NH)

Consumer Voice and other advocates have been advocating for the recission of this waiver for roughly two years.  The policy has allowed for tens of thousands of nursing home residents to receive care from some staff who are not fully trained or certified as required by federal rules. Allowing untrained workers to provide medical care is a significant threat to residents' health.

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Advocates Send Letter to CMS in Support of Staffing Study and Their Plan to Propose Minimum Staffing Standard

February 02, 2023

Consumer Voice along with more than a dozen other advocacy organizations sent a letter to Chiquita Brooks-LaSure, the Administrator of the Centers for Medicare & Medicaid Services (CMS), expressing strong support for the agency’s efforts to address the staffing crisis in nursing homes across the country.

Almost one year ago, President Biden announced a historic set of nursing home reforms, one of which was a promise to implement a minimum staffing standard. Since that announcement, CMS has embarked upon a rigorous and fact-based approach to making this promise happen, including soliciting input from the public and conducting a study on the direct care needs of nursing home residents.

Implementing a minimum staffing standard would be the most significant increase in protections for nursing home residents in decades. Overwhelming evidence connects better health outcomes with higher staffing levels. Just recently, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) called into question the adequacy of current staffing standards when analyzing the devastating effect of COVID-19 on nursing home residents.  Another OIG report in November 2022 found that inadequate staffing levels increase the likelihood that nursing home residents are illegally drugged, raising their risk of harm and even death. Poorly-staffed nursing homes are more likely to be cited for abuse, have worse health inspection results, and have lower overall ratings on CMS’s Compare Care website.

While it is unclear when a minimum staffing standard will be proposed, we need to ensure the voices of residents, families, and workers are heard.  Too often the voices of residents and their advocates are drowned out by the special interests of those in the nursing home industry. We must stand united to protect residents and be a voice of hope. We thank CMS for prioritizing the well-being of nursing home residents, our most vulnerable citizens, and look forward to working towards a staffing standard that protects all residents. 

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New OIG Report on First Year of COVID-19 Pandemic Dispels Myth of Inevitability of Infection, Finds Fault with Infection Surveys, and Recommends Exploring Increased Staffing to Protect Residents from Infections

January 19, 2023

The Office of Inspector General for the U.S. Department of Health and Human Services (OIG) released a data brief that examined how COVID-19 affected nursing homes during the first year of the pandemic. Using a variety of data sources, the report focused on the two initial COVID-19 surges that devastated nursing home residents in 2020, first in the spring and then in the fall. During this period of time, hundreds of thousands of nursing home residents were infected with COVID-19, with tens of thousands dying.

The report made several findings:

  • High COVID-19 transmission in a county did not always lead to nursing homes in that county reaching extremely high infection rates.
  • For-profit nursing homes made up a disproportionate percentage of nursing homes with extremely high infection rates.
  • Surveyors failed to identify infection control deficiencies in the majority of nursing homes with extremely high infection rates.
  • Current staffing requirements may not be sufficient to protect nursing home residents from deadly infections.

The report identified more than 1,300 homes with “extremely high infection rates” of 75% or more residents. Importantly, the report contradicts the assertion by many in the nursing home industry that nursing homes in high transmission areas could not prevent COVID-19 transmission to residents. The report found that 63% of counties with high transmission rates during the first surge did not have any nursing homes with “extremely high infection rates.” During the second surge, that number increased to 78%. According to the report, “Being located in a high-transmission county did not make it inevitable that a nursing home would have an extremely high infection rate.”

The report made several recommendations, including:

  • CMS re-examine current staffing requirements and revise them as necessary. The report stated, “Our findings also provide evidence of the need to propose new minimum staffing standards” to make sure residents receive good care.
  • CMS must improve how surveys identify infection control risks to nursing home residents and strengthen guidance on assessing the scope and severity of those risks.
  • Target nursing homes in most need of infection control intervention and provide enhanced oversight and technical assistance to these facilities as appropriate.

The OIG report identifies significant failures both of nursing homes and regulators to protect residents from COVID-19. Understaffing and poor enforcement of regulations led to the catastrophic events that resulted in the deaths of tens of thousands of nursing home residents and caused incalculable harm to others.

CMS has promised a minimum staffing standard, which according to the OIG report, will lead to better protections for nursing home residents. But CMS must also increase its enforcement actions regarding infection control. The OIG report makes clear: CMS must do something different in order to prevent a repeat of the first year of the COVID-19 pandemic. 

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CMS Announces Actions to Combat the Illegal Drugging of Nursing Home Residents

January 18, 2023

The Centers for Medicare & Medicaid Services (CMS) announced new steps to protect nursing home residents from inappropriate diagnosing of schizophrenia which often results in the improper use of antipsychotic medications to sedate and chemically restrain residents. In addition, CMS announced that it would now post on Care Compare citations that are under dispute by nursing homes.

Inappropriate Diagnoses of Schizophrenia

In 2008, CMS introduced a quality measure in its Care Compare rating system that calculated the percentage of long-stay residents (over 100 days) that were receiving antipsychotic medications. This measure was introduced to combat the practice of some nursing homes illegally using antipsychotic medications to sedate residents with dementia or other increased care needs, rather than providing appropriate hands-on care interventions. The measure, however, excluded residents with certain diagnoses, including schizophrenia, Huntington’s disease, and Tourette syndrome. As a result, some nursing homes began to improperly diagnose residents with schizophrenia, to disguise the use of antipsychotics to sedate residents rather than provide appropriate hands-on care interventions. The improper use of antipsychotic medications is extremely dangerous and can lead to a variety of poor health outcomes for residents, even death.

In the new guidance, CMS acknowledges that there has been a steady rise in schizophrenia diagnoses since the quality measure was introduced. This announcement comes on the heels of a report from the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) which found that from 2015-2019 there was a 194% increase in the number of residents diagnosed with schizophrenia who did not have that diagnosis prior to admission to the nursing home. It is important to note that it is extremely rare for schizophrenia to suddenly occur in older people. The onset of schizophrenia generally occurs in someone’s late teens through their twenties. Importantly, the OIG report directly connected illegal drugging of nursing home residents with inadequate staffing in nursing homes.

CMS announced that it will begin to conduct audits of nursing homes with high rates of schizophrenia diagnoses and “examine the facility’s evidence for appropriately documenting, assessing, and coding a diagnosis of schizophrenia.” Facilities that have “inaccuracies” will have their Quality Measure Rating adjusted in the following ways:

  • The Overall QM and long-stay QM ratings will be downgraded to one star for six months(this drops the facility’s overall star rating by one star).
  • The short-stay QM (under one hundred days) rating will be suppressed for six months.
  • The long-stay antipsychotic QM will be suppressed for 12 months.

While Consumer Voice has expressed significant concern with the accuracy of CMS’s Quality Measure, we support these actions. The Quality Measure rating often inflates a facility’s overall 5-Star rating on Care Compare. This action will help incentivize compliance and make sure the public is aware of these illegal practices in nursing homes.

More Must Be Done

Despite today’s announcement more must be done to protect residents. Importantly, CMS announced no other enforcement action against facilities who are found to be using this illegal practice. Additional penalties, including civil monetary penalties, should be assessed. Additionally, CMS should take steps to penalize medical professionals that inappropriately diagnose residents with schizophrenia to illegally prescribe antipsychotics.

Further, CMS must take steps to address problems identified by the recent OIG report. The report looked at the use of antipsychotic medications over the past ten years. While a reduction in antipsychotics was identified, the report found that this reduction was offset by facilities using other mind-altering drugs (psychotropic drugs) to sedate residents. CMS must take action to monitor the increased use of other drugs to chemically restrain residents.

Most importantly, CMS must implement a minimum staffing standard, as promised last year. As noted, the OIG report directly connected the use of drugging with inadequate staffing. Understaffed facilities often drug and sedate residents because they have inadequate staff to provide proper direct care interventions. Requiring facilities to have enough staff will directly address the problem of illegal drugging of residents.

CMS Will Now Post Citations Under Dispute

Also included in today’s announcement was a change in policy regarding the posting of violations on the Care Compare website. CMS’s policy has been that it does not post violations or citations that are in the dispute process. This process can take six months, but sometimes years, and results in consumers not being aware of deficient practice in nursing homes. CMS will now post these citations on Care Compare. Consumer Voice applauds this step as it increases transparency for consumers.

Both of these announcements were part of President Biden’s list of historic reforms announced last February. While today’s announcement regarding schizophrenia diagnoses is a promising first step, much more needs must be done to protect nursing home residents. Stay tuned for more on this issue from Consumer Voice.

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Why Nursing Homes Need a Minimum Staffing Standard

January 12, 2023

In April 2022, the Centers for Medicare & Medicaid Services (CMS) announced it was beginning the process of implementing a minimum staffing standard for nursing facilities.   This standard would require nursing homes to have enough staff to provide each resident with a minimum amount of direct care each day. Since the announcement, CMS has undertaken a study to determine the standard and intends to publish proposed rules in early 2023. When implemented, this standard will be the most significant increase in protections for nursing homes in decades.

Staffing nursing homes adequately has multiple benefits to residents. Numerous studies have found that there is a correlation between higher staffing levels and improved care quality. A 2001 CMS study found that nursing home residents require 4.1 hours per resident day (hprd) of direct nursing care to avoid being at an increased risk of harm.  The study found that every day residents need, at a minimum, .75 hours of care performed by an Registered Nurse, .55 hours of care performed by a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), and the remaining 2.8 hours of care to be performed by a Certified Nursing Assistant (CNA). Any new federal staffing standard should separately mandate staffing hours for each nursing staff category, i.e., RN, LPN/LVN, CNA. A 2020 paper recommended a guide for determining adequate staffing that resulted in a proposal for six different minimum staffing standards based on PDPM resident acuity levels. 

Consumer Voice strongly supports the creation of a staffing standard that creates different minimum staffing baselines based on the acuity of nursing home residents. It is essential that this standard provide minimum staffing levels based on resident acuity and be broken down into nursing staff to resident ratios. A minimum staffing standard will save countless lives and result in better health outcomes for nursing home residents across the country.

Read our new issue brief for more information.

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MACPAC Report Calls for Increased Transparency in How Nursing Homes Spend Medicaid Dollars

January 06, 2023

On January 3, 2023, MACPAC, a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress on Medicaid programs, issued a report finding that without increased transparency in how nursing homes spend Medicaid dollars, it could not properly calculate the actual costs of providing care to Medicaid residents in nursing homes. As a result, MACPAC was not able to determine the adequacy of Medicaid payments to nursing homes. “This report mirrors President Biden’s call for increased scrutiny of nursing home finances, which were part of his historic nursing home reforms announced in February 2022,” said Toby Edelman, Senior Policy Attorney with Center for Medicare Advocacy.   

The MACPAC report noted the difficulty of ascertaining costs by looking at data from nursing homes. The report stated, "it is difficult to use stated cost reports to compare payment rates and costs across states,” because states have varying definitions of what services a nursing home can be compensated for providing.

Additionally, the report noted it was unable to ascertain the effect of related party transactions on costs, finding that these transactions "may artificially inflate the costs reported on Medicare cost reports." Because of the lack of transparency in nursing home cost reporting, the report concluded by calling for "additional payment and financing data at the facility level. Such data are needed to provide a complete understanding of all types of Medicaid payments to nursing facilities." Richard Mollot, Executive Director for Long Term Care Community Coalition commented “For years we have known that nursing homes use related party transactions to not only hide how they take profits, but also to make their facilities seem less profitable.”

Importantly, the report looked only at base payment rates for nursing homes and did not account for supplemental payments that many states make to nursing homes. According to the report, these payments, “can substantially affect measures of Medicaid nursing facility payments relative to costs, but unfortunately, complete data on supplemental payments to nursing facilities are not yet available at the facility level.” The lack of access to supplemental payments added to MACPAC’s inability to accurately determine Medicaid costs and payments.  

For years, independent researchers and nursing home resident advocacy organizations, including Consumer Voice, Center for Medicare Advocacy, and Long Term Care Community Coalition have challenged the nursing home industry's assertion that Medicaid payments are inadequate. Despite the lack of supporting evidence, the industry’s claim has been accepted as fact by many federal and state policy makers. Advocates have repeatedly called for increased transparency in how current Medicare and Medicaid dollars are spent before more public money is given to nursing homes. The federal and state governments must require increased disclosure of related party transactions and other accounting hijinks nursing homes use to hide how they spend taxpayer dollars.

Consumer Voice Executive Director, Lori Smetanka said, “The MACPAC report confirms that until there is more transparency and accountability for current payments to nursing homes, facilities should not be given more public funds to fulfill their contractual obligations to residents, families, and taxpayers.”

For more information you may contact Sam Brooks at sbrooks@theconsumervoice.org.

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New Podcast Episodes: Visiting Nursing Homes During the Holidays and What Residents and Families Need to Know About COVID-19 Boosters

December 20, 2022

Two new episodes of the Pursing Quality Long-Term Care podcast are now available:

Visiting Nursing Homes This Holiday Season
As the result of changing CMS and CDC nursing home guidance since the start of the pandemic, residents and families have had a great deal of uncertainty during the holidays surrounding visitation and the requirements for residents who leave their facilities. Jerry Rothkoff of Rothkoff Law Group joins us to talk about the state of visitation now, almost three years into the pandemic, and how to spend time safely together this holiday season.


What Nursing Home Residents and Their Families Need to Know about COVID-19 Vaccinations and Boosters
COVID-19 cases and deaths are rising across the country, while at the same time seasonal influenza and RSV cases are also causing hospital beds to be full. In this episode of the podcast, Dr. Celine Gounder, Senior Fellow and Editor-at-Large for Public Health at the Kaiser Family Foundation and Kaiser Health News, discusses the importance of nursing home residents and staff being up to date with their COVID-19 vaccinations. Dr. Gounder addresses questions about the efficacy of boosters and also how frequently nursing home residents and staff should be receiving them.

Listen to the episodes on Apple PodcastsSoundCloudFacebook, or our website.

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CPSC Issues Notice of Proposed Rulemaking on Use of Adult Portable Bed Rails

November 29, 2022

The Consumer Product Safety Commission (CPSC) has issued a notice of proposed rulemaking about the use of adult portable bed rails [CPSC-2013-0022].  Comments are requested to be submitted at www.regulations.gov, Docket No. CPSC-2013-0022, by January 9th 2023.

The CPSC has determined preliminarily that there is an unreasonable risk of injury and death associated with entrapment hazards from adult portable bed rails (APBRs).  It is proposing a rule to require that adult portable bed rails meet the requirements of applicable voluntary standards created in 2017.  Among CPSC's findings leading to this action is that manufacturers of these devices failed to comply fully (or even at all) with the voluntary standards established in 2017, and the number of injuries skyrocketed to over 5,000 for the years 2020 and 2021 - the last years for which statistics have been completed.

CPSC seeks comments on the following:

  • Information regarding any analysis and/or tests done on APBRs in relation to the risks of injury or death they present;
  • Information regarding any potential costs or benefits of the proposed rule that were not included in the foregoing preliminary regulatory analysis;
  • Information regarding the number of small businesses impacted by the proposed rule and the magnitude of the impacts of the proposed rule;
  • The testing procedures and methods of the proposed rule and whether they sufficiently reduce the risk associated with APBRs, or whether other measures are necessary and information demonstrating how these measures address the identified risks;
  • Potential alternatives to APBRs if they are banned, and the impact that a ban on APBRs would have on consumers;
  • Any qualitative or quantitative evidence concerning the utility that APBRs have for consumers relative to alternative products that might be used as substitutes in the event APBRs are banned; and 
  • The appropriateness of the 30-day effective date, and a quantification of how a 30-day effective date would affect the benefits and costs of the proposed rule.

For more information and Consumer Voice materials and statements on this issue, view our issue page.

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Urge Your Members of Congress to Include Provisions that Support and Protect Nursing Home Residents in End of Year Appropriations Bill

December 06, 2022

Nursing home residents need your help! Currently, Congress is discussing important end of the year legislation.  On December 6th, Consumer Voice and other advocates sent a letter to Congress asking them to include critical nursing home provisions in an end of year appropriations bill. Contact your members of Congress today and tell them to stand with nursing home residents and include these important provisions.

These provisions would further the ambitious and historic nursing home reforms announced by President Biden in February 2022. President Biden’s reforms focused on care quality, particularly staffing, enforcement and accountability, and transparency in how nursing homes spend tax dollars.

Just last week, the USA Today published an article detailing the failures of federal and state government to enforce staffing regulations. The article details the devastating effect poor staffing and poor enforcement has on nursing home residents.

The USA Today article found:

  • 76% of nursing homes were not staffed to levels that the federal government pays them to be and of those, only 5% were cited for inadequate staffing.
  • There has not been an increase in funding for the state agencies that enforce nursing home laws and regulations since 2014.
  • Roughly 1/3 of the over 15,000 nursing homes in the United States are overdue for an annual inspection. 
  • 1 in 4 states miss critical federal deadlines when investigating complaints regarding nursing homes.

The connection between poor staffing and poor health outcomes for nursing home residents has been documented for decades.  Yet, the USA Today study shows that a large majority of nursing homes fail to provide enough staffing, and federal and state governments are doing little to hold them accountable for their failures.

In 2021, the House of Representatives passed a bill that included provisions that would directly address the problems detailed in the USA Today article.

These important provisions would:  

  • Provide funding to support state regulatory agencies in their survey and certification activities. There has not been an increase in funding for oversight agencies since 2014. Funding would go towards hiring and training of survey and certification agency staff.
  • Provide funding to CMS to audit Medicare cost reports. In 2020, nursing homes received $66.9 billion in Medicare and Medicaid dollars. Additionally, they received tens of billions of dollars in COVID-19 provider relief funds. Yet little to no scrutiny is placed on how this money is spent. We must have accountability for how our tax dollars are used. 
  • Provide funding to ensure accurate data on nursing home resident health conditions and treatment. Nursing homes submit data to the federal government on each nursing home resident in their care, yet these data are not audited for accuracy. Accurate and complete information is essential to ensuring the well-being of nursing home residents.

In addition, the bill reauthorized and updated the Elder Justice Act which provided crucial funding for long-term care staff, ombudsman and adult protective services programs, and to other critical programs that serve Older Americans.

Send a message to your members of Congress telling them to include these provisions in an end of the year appropriations bill. Together we can help protect residents!

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DOH Report Identifies Residents at Increased Risk of Discharge from Nursing Homes

December 01, 2022

A recent report by the U.S. Department of Health and Human Services used Medicare data to identify certain characteristics or risk factors that placed nursing home residents at an increased risk of discharge. 

These characteristics included:

  • Residents with severe behavioral symptoms.
  • Residents with psychiatric and mood disorders. 
  • Residents with impairments that required more staff time. 
  • Residents transitioning to Medicaid.

Residents with these risk factors were more likely to be discharged from for-profit nursing homes. 

This report confirms what residents and advocates have learned from experience: residents with medical conditions that require increased care are often at greater risk of being discharged from nursing homes. Importantly, the report notes that all of the health conditions that place residents at an increased risk of discharge are conditions nursing homes are required to treat. 

Read Consumer Voice's summary of the DOH report and also access information and resources on nursing home discharge. 

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New Guidance from CDC to Reduce Spread of COVID-19 in Assisted Living Facilities

November 29, 2022

On November 29th, the Centers for Disease Control and Prevention (CDC) released new guidance to help reduce the spread of COVID-19 within congregate settings, including assisted living facilities.  Importantly, this guidance does not apply to skilled nursing facilities and does not apply to healthcare services being provided in congregate settings, both of which are governed by: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html.  The CDC is encouraging facilities to balance COVID-19 prevention with the impact of reducing access to daily services and programing. 

To assess COVID-19 risk in assisted livings and group homes, facilities should monitor COVID-19 community levels and consider: the vulnerability of their residents, facility characteristics that could accelerate COVID-19 spread such as poor ventilation and high volumes of visitation, and whether COVID-19 is actively spreading in the facility.

To mitigate risks, facilities can consider several strategies including: increasing and improving ventilation, expanding the use of masks, implementing screening testing, moving activities outdoors, creating physical distance, and enhancing cleaning and disinfecting protocols.

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Spending Time with Loved Ones During the Holidays

November 23, 2022

The holiday season is quickly approaching and nursing home residents will soon be welcoming an increased number of loved ones visiting their facilities. With a little planning and preparation, residents can visit with their loved ones and stay safe during their holiday visits!

Remember: Residents have the right to see visitors of their choosing when they choose, and residents can leave their facilities to visit with family, participate in community activities, or for any other reason.


Visit Safely

  • Protect yourself and those around you by ensuring you and your family member are fully vaccinated. Get the latest COVID-19 boosters, and talk with the facility's administration about resident access.
  • The holidays are a busy time in nursing homes and many nursing homes facilitate large holiday events for their residents. During times of peak visitation and large gatherings, be aware that facilities may encourage physical distancing between families and groups to reduce the risk of spreading COVID-19 and other viruses. Read more in the the Centers for Medicare & Medicaid Services (CMS) nursing home visitation guidance.
  • Unvaccinated visitors, or visitors who refuse to disclose their vaccination status, should be masked at all times. Whether fully vaccinated visitors will be required to mask in a facility will depend on the COVID-19 community transmission level. See our guidance for when visitors should mask in nursing homes.
  • Residents may choose to leave their facilities and visit their loved ones in their homes or go out to dinner or to an event. Residents who leave should follow all recommended infection prevention control measures. For those who leave for more than 24 hours the CDC recommends residents be tested for COVID-19 upon returning and advises residents to wear a face mask for 10 days.

Scheduling Your Visit

Even though the holidays are a special time, there are situations where it may make sense to delay your visit and celebrate later.

  • If the resident has COVID-19 or is in quarantine, CMS recommends that visitors delay their visit. If a visitor still chooses to visit, the facility will explain the risks of visiting the resident, and the visitor will be required to wear a facemask and stay in the resident’s room.
  • Visitors who have tested positive for COVID-19 or who are experiencing symptoms similar to COVID-19 symptoms should wait to visit a nursing home until at least 10 days have passed since their first symptoms or positive test. Instead, facilities can help coordinate phone calls or video calls between the resident and their loved ones.
  • If a facility is currently experiencing a COVID-19 outbreak, visitation is discouraged. If residents choose to have visitors during this time, visitors will be asked to stay in a resident’s room or a designated visiting area and should wear face masks and social distance.

If you have questions about visitation or residents’ rights, contact your Long-Term Care Ombudsman Program.

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Help Us Carry the Voices of Residents to Policymakers

November 28, 2022

Our work continues to push for critical reforms in the long-term care system. And we know that we’re on the right track! The newly released study from the prestigious National Academies of Science, Engineering & Medicine, and the proposed reforms unveiled by the Administration earlier this year both recognize and validate what Consumer Voice has been advocating for over many years:

  • The need for more staff

  • Increased staff training

  • Greater transparency and accountability of owners and resources

  • A more effective oversight system

  • Increased support for direct care staff

  • Greater emphasis on providing person-centered care

… among other things.

Your support has helped us carry the voices of residents and families to policymakers showing the impact of a failed system. Momentum is on our side to achieve critical reforms. With your continued help we will be at the table as decisions are being made to ensure the well-being of residents is at the center of any policy development and resident voices, like Maurice's, are heard.

Together we can make sure the recommendations and proposals put forward this year become reality for nursing home residents across the country!

We cannot do this important work without you!

Make a contribution to support residents.

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OIG Report Shows Failures to Stop Illegal Drugging

November 18, 2022

On November 17, 2022, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) released a report documenting the failure of an over ten-year effort by the Centers for Medicare & Medicaid Services (CMS) to reduce the inappropriate use of psychotropic medications in nursing homes. CMS defines a psychotropic drug as any drug that affects brain activities associated with mental processes and behavior. The OIG report found that despite reducing the use of some inappropriate medications, nursing homes began to use other drugs to improperly sedate and restrain residents.

In 2011, CMS announced a “national partnership” to reduce the inappropriate use of antipsychotic medications in nursing homes. The partnership was created in response to the widespread practice of nursing homes illegally using medications to sedate residents rather than providing other direct care-based interventions. This practice is often referred to as using “chemical restraints.” The partnership sought to work with federal and state agencies, providers, stakeholders, and others to reduce the use of these medications.

Over the years, CMS has touted the success of the partnership, noting a steady decline in the use of antipsychotics. However, the OIG report found that this reduction was smoke and mirrors. While antipsychotic use may have declined, the use of other psychotropic drugs, such as anticonvulsants and antidepressants, both of which carry an increased risk of death for older individuals and other severe side effects, increased.

From the report:

"While the use of one category of psychotropic drug-antipsychotics-decreased from 31 percent in 2011 to 22 percent in 2019 the use of another category of psychotropic drug -anticonvulsants- increased. Anticonvulsants showed an increase in use among nursing home residents from 28 percent to 40 percent during the same period."

Importantly, the reduction in antipsychotic use is questionable. As explained below, as CMS turned its focus on antipsychotic use many nursing homes began inappropriately diagnosing residents with schizophrenia to mask antipsychotic use. As a result, it is unclear how much the inappropriate use of antipsychotics actually decreased.

In addition, the OIG report found that:

  • Between 2011 and 2019, 80% of Medicare long-stay residents (individuals residing in nursing homes for over 100 days) were prescribed a psychotropic drug.
  • Nursing homes with lower RN staffing numbers were associated with higher use of antipsychotic drugs.
  • Nursing homes with higher percentages of residents with low-income subsidies had higher use of psychotropic drugs in 2019.
  • From 2015-2019, there was a 194% increase in the number of residents diagnosed with schizophrenia without a corresponding diagnosis before their admission to the nursing home.
  • By not collecting data on Medicare Part D claims, CMS is limited in its ability to effectively conduct oversight of psychotropic drugs.

These findings confirm what Consumer Voice and other advocates have known for years, nursing homes with insufficient staffing often rely on inappropriate medications to sedate residents rather than providing care. This practice often has a disproportionate impact on low-income residents.

Additionally, the rise in schizophrenia diagnoses is mainly attributable to CMS’s creation of a quality measure based on antipsychotic use. CMS uses a quality measure that excludes residents with schizophrenia diagnoses when calculating antipsychotic use. The OIG report confirms that this exclusion has resulted in nursing homes inappropriately diagnosing residents with schizophrenia in order to prescribe antipsychotic medications and avoid repercussions from regulators.

The OIG report made several recommendations, including an increased effort by CMS to use data to identify the inappropriate use of medications to chemically restrain residents and to require Medicare Part D prescribers to provide diagnosis codes when prescribing psychotropic medications. Currently, CMS does not require a diagnosis, and as a result, CMS must inspect the resident’s medical records, in order to determine the reason a psychotropic medication is being prescribed. This inefficiency, having to inspect medical records physically, severely inhibits oversight and enforcement.

Consumer Voice has long been concerned about the illegal use of medications to chemically restrain nursing home residents. Recently, Lori Smetanka, Executive Director of Consumer Voice, authored an article decrying the practice and noting the increase of antipsychotic use during the pandemic. The OIG report reveals that the current approach by CMS is not working. Despite claiming for years that it was partnering with stakeholders to decrease the use of antipsychotics and other psychotropic medications, nothing has changed.

The OIG report directly connects the illegal drugging of nursing home residents with inadequate staffing. It confirms the need for a minimum staffing standard, promised by the Biden Administration earlier this year. Until a minimum staffing standard is implemented, nursing homes will continue to find ways, such as illegal drugging, to avoid investing in staff. In addition to a minimum staffing standard, CMS must increase penalties for nursing homes that illegally drug residents. CMS must fulfill its regulatory role and protect nursing home residents.

Access more information and resources on the illegal use of medications to chemically restrain nursing home residents.

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CMS Relaxes Enforcement of Nursing Home Staff Vaccination Mandate

November 01, 2022

Despite noting its success, the Centers for Medicare & Medicaid Services (CMS) announced on October 26, 2022 that it was relaxing enforcement practices regarding its mandate that all nursing home staff be vaccinated against COVID-19.  The updated guidance noted that because COVID-19 hospitalizations and deaths were down across the country, it was relaxing the enforcement penalties when nursing homes do not meet the vaccination requirements. Facilities that do not comply with the mandate will be cited at Level 1 noncompliance, essentially the lowest level of violation. Additionally, facilities that do not meet the mandate could be able to avoid any citation by showing they are attempting to meet the mandate requirements.
 
Consumer Voice strongly supported the implementation of the vaccine mandate for staff. Due to industry wide failures in infection control, vaccines have proven to be the most effective protection from COVID-19 for nursing home residents. The decrease in deaths from COVID-19 was evidence of the efficacy of the vaccine mandate in nursing homes, not a signal to CMS to decrease resident protections. Consumer Voice strongly opposes the revisions to the guidance and believes the guidance is a step in the wrong direction.

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New Fact Sheet on Community Engagement within Long-Term Care Facilities

October 26, 2022

Communities are essential to the physical and mental health of everyone, including long-term care residents. During the COVID-19 pandemic, residents were isolated from their communities both inside and outside of their facility. Many residents who were separated from their friends, loved ones, and neighbors, during the pandemic showed signs of mental health conditions such as depression and anxiety. Now that restrictions have been lifted, residents are re-establishing their roles in their communities.

A new fact sheet, Inspiring Community Engagement with Long-Term Care Facilities, provides ideas for building community within a long-term care facility and becoming a part of the larger community outside of the facility.

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Biden-Harris Administration Announces Actions to Increase Accountability and Improve Quality in Nursing Homes

October 26, 2022

On Friday, October 21, 2022, the Biden-Harris Administration announced new actions to increase accountability and improve quality in nursing homes.  
Central to Friday’s announcement were changes to the Special Focus Facilities (SFF) Program.  Administered by the Centers for Medicare & Medicaid Services (CMS), the SFF program places special scrutiny on select nursing homes with a documented pattern of providing poor care. (See the most recent list of SFF.)  The changes to the SFF program include:

  • Escalating penalties for violations in nursing homes that fail to improve, including considering terminating facilities from the Medicare and Medicaid programs that continue to be cited for dangerous violations;
  • Stricter requirements that a nursing home must meet in order to graduate from the program;
  • Continued close scrutiny of the facility for at least 3 years after a facility leaves; and
  • Increased engagement by CMS with the poor-performing nursing homes in the program to help them understand how to improve.

Additionally, the Department of Health and Human Services (HHS) and the Department of Labor (DOL) announced newly available funds to support good-quality nursing home jobs.  HHS and DOL have made funds available to increase the number of nursing educators, expand nursing education and training, and support the nursing workforce pipeline.

For more information about the new actions from the Biden-Harris Administration, read the fact sheet.

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Guidance for Masking During Visitation in Nursing Homes

October 24, 2022

On September 23, 2022, the Centers for Medicare and Medicaid Services (CMS) updated their guidance for masking during visitation in nursing homes. Read our new one-page fact sheet for simple information on when masking is recommended in a long-term care facility.

Recommendations for masking in nursing homes are based on community transmission levels which are the number of new COVID-19 cases in a particular area in the previous seven days. When community transmissions levels are high, masking is recommended in all health care settings, including long-term care facilities. When community transmission levels are not high, and the facility is not experiencing an outbreak, a facility could choose to not require visitors to wear a mask or face covering.

REMEMBER! Regardless of the COVID-19 community transmission level, when visiting a resident, you should follow their preference about masking in their presence. The nursing home is their home, and the choice should be theirs.

Get the fact sheet.

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New Podcast Episode on Residents' Rights

October 20, 2022

For decades the Consumer Voice has designated October as Residents’ Rights Month as a way to honor residents living in long-term care. This month is an opportunity to focus on the commitment to recognize the value of each resident and the importance of treating every resident with dignity and respect.

In this episode, join us as we speak about this year’s Residents’ Rights Month theme, Inspiring Unity within Our Community. Lori Smetanka, Executive Director at Consumer Voice, and Jocelyn Bogdan, Senior Policy Specialist at Consumer Voice discuss why having a community is important, how residents can exercise their rights around their community, and examples of ways residents, families, and staff can help build a community for residents living in long-term care.

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Listen to Previous Episodes 

View a full list of past episodes and listen to them on Apple PodcastsSoundCloudFacebook, or our website.

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Nursing Home Abuse: How to Spot It and How to Get Help

October 14, 2022

All older people have the right to live free from abuse and neglect. Yet, thousands of nursing home residents experience mistreatment every year.  A new fact sheet from Consumer Voice and the National Center on Elder Abuse (NCEA) provides information on what families can do to identify abuse and what to do if you suspect abuse is occurring.

Get the Fact Sheet

For more information on the topics raised in the fact sheet, listen to the Pursuing Quality Long-Term Care podcast episode, "Addressing Abuse in Long-Term Care Facilities."  In this episode, Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics, and Beverley Laubert, the National Ombudsman Program Coordinator at the Administration for Community Living discuss abuse of those living in long-term care facilities.

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Consumer Voice Joins Amicus Brief Emphasizing Residents' Rights

October 12, 2022

Consumer Voice joined an amicus brief, filed with partner organizations, to the U.S. Supreme Court in Health and Hospital Corp. v. Talevski on behalf of residents of nursing facilities to maintain their ability to enforce their rights under the Federal Nursing Home Reform Act and Section 1983. Consumer Voice filed the brief with AARP Foundation, California Advocates for Nursing Home Reform, Center for Medicare Advocacy, Justice in Aging, and the Long Term Care Community Coalition.  The amicus emphasizes that the federal nursing facility law establishes rights for residents, and that government enforcement is inadequate to protect those rights. The case is scheduled for oral argument in November. 

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CMS Waives Training and Certification Requirements for 15 States

October 11, 2022

On August 29, 2022, CMS issued formal guidance to nursing homes, counties, and states on how they may continue to operate without properly certified staff. This guidance came only two months after CMS rescinded the March 2020 waiver that allowed nursing homes to employ aides who are not fully trained and certified in accordance with federal requirements. This waiver was issued at the beginning of the pandemic and resulted in tens of thousands of insufficiently trained workers to provide direct care to nursing home residents. The August 29, 2022 guidance effectively continued the waiver for states, counties, or facilities that could meet certain criteria. Consumer Voice strongly opposed the August 29, 2022 guidance, noting that CMS itself had acknowledged this policy had resulted in poor health outcomes for nursing residents.  

Now, less than two months later, CMS has waived the full training and certification requirements for fifteen states.  These states were granted an extension to their waiver because they demonstrated testing backlogs or other delays that providers said prevented them from converting a large number of temporary nurse aides into permanent fully certified nurse assistants.  These states are Rhode Island, Massachusetts, Washington, Indiana, Louisiana, Maryland, Minnesota, Oklahoma, Pennsylvania, Texas, Vermont, New York, Georgia, New Jersey and Tennessee. Those waivers expire on various dates.
 
As a result of this policy, tens of thousands of nursing home residents will receive care from some staff who are not fully trained or certified as required by federal rules. Nursing facilities and states had over two years to create plans to have aides trained and certified. Instead, it appears that many facilities and states waited until the waiver ended and now are scrambling to meet the regulatory requirements.  

Residents, families, and other consumers concerned as to whether a nursing home is employing uncertified aides can:

  • Ask the nursing home administrator if the facility is currently operating with a nurse aide certification waiver. If so, how many nurse aides are uncertified? What is the facility's plan and timeline to get all aides fully trained and certified?
  • Contact your local state survey agency to determine whether a facility, county, or state has received a waiver of the nurse aide certification requirements.  
  • If a state or county has been granted a waiver, ask the state survey agency what their plan is to get all nurse aides fully trained and certified.

Report all instances or concerns regarding poor care to the local long-term care ombudsman and the state survey agency. 

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New Issue of The Resident Advocate Newsletter

October 10, 2022

The Fall 2022 issue of The Resident Advocate is now available. This newsletter provides information on residents' rights and care issues; news and updates on national policy; and self-advocacy tips for obtaining person-centered, quality care.
This issue includes:

  • Ways to build community within and outside of the long-term care facility in order to increase residents' well-being,
  • Resources for residents as they prepare to vote in elections,
  • Tips for staying hydrated as well as common signs and symptoms of dehydration,
  • Flu season and COVID-19 booster resources, and
  • Information about this year’s Residents’ Rights Month.

The Resident Advocate is a great resource to share with long-term care residents. Nursing home staff, long-term care Ombudsman programs, family members, and other advocates are encouraged to forward this newsletter to residents or print and share copies. Download this issue or past issues from our website.

Read the Fall 2022 Resident Advocate.

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Consumer Voice Submits Comments on Rule Prohibiting Discrimination in Healthcare

October 04, 2022

Yesterday, Consumer Voice sent a letter to the Office for Civil Rights at the Department of Health and Human Services commenting on the notice of proposed rulemaking on Section 1557 of the Patient Protection and Affordable Care Act (ACA).  The Health Care Rights Law (Section 1557 of the ACA) prohibits discrimination in health care on the basis of race, color, national origin, sex, age, and disability.  These prohibitions on discrimination are essential for residents of long-term care to receive high quality care in an environment free from discriminatory practices.

Consumer Voice supports:

  • Section 1557 applying broadly to health programs and activities.
  • Medicare Part B treated as federal financial assistance (FFA), and Part B providers as recipients under Section 1557.
  • Ensuring that the more than 6.5 million seniors over age 60 and four million people with Medicare who are limited English proficient (LEP) can access care and services, receive important healthcare information in a language they understand, and be informed of their rights and how to enforce them.
  • Requiring that individuals be notified of their rights of nondiscrimination and of availability of language assistance services and auxiliary aids and services.
  • Designating a Section 1557 Coordinator, establishing policies and procedures, and training employees.
  • Clear, accessible procedures for filing, investigating, and remediating discrimination complaints, including intersectional claims.
  • Strong prohibitions on sex discrimination in order to address health disparities for LGBTQ+ older adults.
  • Preserving prior existing requirements for structural accessibility and the reasonable modifications and incorporating the U.S. Access Board’s accessible medical and diagnostic equipment standards in the final rule.
  • Prohibiting discriminatory plan benefit design and marketing practices.
  • Prohibiting discrimination through the use of clinical algorithms in decision-making and broadening the prohibition to include any form of automated decision-making system.
  • Prohibiting discrimination in telehealth services.
  • Adopting a demographic data collection requirement and establishing demographic data collection as a function of civil rights monitoring.

For more information, read the full letter.

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It's Residents' Rights Month!

October 01, 2022

October 1st marks the beginning of a month-long celebration of residents' rights. Spend time this month honoring residents living in all long-term care facilities, including nursing homes, sub-acute units, assisted living, board and care, and retirement communities. Plus, take time to focus on individuals receiving care in their homes or communities.

Being a part of a community is essential to our well-being. Throughout the pandemic, residents of long-term care facilities were disconnected from the resident and staff communities within their facilities when activities and group dining were limited. Residents were disconnected from the broader local community when visitation was restricted, and many residents were unable to leave their facilities to participate in outside activities.

This year's Residents’ Rights Month theme - Inspiring Unity within Our Community - emphasizes the importance of fostering meaningful community within the facility and encouraging residents’ connection to their local community.


Resident's Voice Poster Contest Selections

Thank you to the artists whose pieces were chosen:

Carrington Place art

"(Community) means to feel and stay connected to others through different experiences together. The project we picked gave everyone an opportunity to participate, be involved and be able to work at their own pace to create something special together. Even the residents that don’t actively participate can enjoy the finished artwork on display."

By Velma, Doris, Jere Robert, Catherine, Marybell, Lori, Caroline, Valice, Barbara, Betty F., WenMei, Barbara, Roe, Jane, Bill, Donna, Marina, Shirley, Jeanette, Thelma, Harvey, Thomas, Martha, Charlie, Nina, Betty S., Marty, Dylon, Warren, Harry, and Ann, residents of long-term care at Carrington Place in Matthews, NC

 Robertson artwork

"The petals are made of residents' handprints, the center is made of staff fingerprints, and the center represents the love we have for each other at our facility." 

By Alice, Alma, Barbara, Bernita, Betty, Brenda, Clare, Connie, Conrad, Daphne, Deetta, Dewey, Doris, Dorothy, Edna, Estill, Faye, Geneva, Harold, Hazel, Herbert, Ida, Ina, Jacob, Jane, Jimmy, Joanne, Joyce, Letha, Linda, Marian, Marjorie, Mary P., Mary R., Melvin, Minnie, Missouri, Nerita, Opal, Paul, Peggy, Sally, Shannon, Sharon, Sue, Todd, William and Willie, residents of long-term care at Robertson County Healthcare Facility in Mount Olivet, KY

Thank you to all of the long-term care consumers who submitted entries for this year's Resident's Voice Challenge. We received many fantastic submissions! 
View all submissions. 

 

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New CDC/CMS Guidance Ends Some Indoor Masking Requirements in Long-Term Care Facilities

September 27, 2022

The Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) have released updated guidance regarding masking in long-term care facilities.  Under the new guidance, nursing homes in counties where COVID-19 community transmission is not high can choose not to require visitors to wear face coverings or masks while in the facility, except during an outbreak.  The guidance states that in nursing homes in counties where COVID-19 community transmission is high, "everyone in a healthare setting should wear face coverings or masks."  In its guidance, the CDC notes that "updates were made to reflect the high levels of vaccine-and infection-induced immunity and the availability of effective treatments and prevention tools."

See the CMS and CDC guidance

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Additional Medicare Nursing Home Ownership Data Publicly Available

September 27, 2022

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has made additional data publicly available on the ownership of all Medicare-certified nursing homes.  For the first time, state licensing officials, state and federal law enforcement, researchers, advocates and the public will be able to identify common owners of nursing homes across nursing home locations. This information can be used with other data sources to assess the performance of facilities under common ownership, such as owners affiliated with multiple nursing homes with a record of poor performance.  The release of the data is in support of the Biden-Harris Administration's effort to improve nursing home transparency.

Learn more in the press release from CMS.

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GAO Report Details Infection Control Failures During Pandemic and Makes Recommendations for Reform

September 21, 2022

On September 14, 2022, the U.S. Government Accountability Office (GAO) released a report detailing the catastrophic failure of nursing homes to protect residents from COVID-19. The report focused on infection control practices and how years of poor practices, by nursing homes and government agencies, in the years preceding the pandemic resulted in the devastating impact on nursing home residents.

Importantly, the GAO report addressed not only the harm caused by the COVID-19 virus itself, but how many residents suffered as a result of policies implemented by the federal government and nursing homes, including bans on visitation and allowing nursing homes to use untrained nursing staff.

The report made several findings and recommendations to the Center for Medicare & Medicaid Services (CMS) to help protect residents from infections in the future.

What the Report Found:

  • CMS’s current infection control preventionist (ICP) standards are too vague.
  • CMS is not collecting staffing data on infection control preventionists.
  • CMS’s ICP guidance to state survey agencies is inadequate.
  • 2020 data from nursing homes showed a worsening in seven of eight key indicators of nursing home resident mental and physical health.
  • Stakeholders reported bans on visitation during the first year of the pandemic contributed to declines in resident health.
  • Only 1% of infection control violations were classified at the highest severity in 2018 and 2019.
  • CMS’s policy of allowing untrained workers to provide care in nursing homes contributed to poor infection control practices.

What the Report Recommended:

  • CMS establish minimum infection preventionist training standards.
  • Collect and use infection preventionist staffing data.
  • Strengthen ICP enforcement guidance to states.

Consumer Voice recommends that CMS:

  • Require all infection preventionists to be an RN, advanced RN, or physician.
  • Establish clear national training standards that all infection preventionists must meet.
  • Increase penalties for infection control deficiencies.

Read our full summary and analysis of the report.

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High Staff Turnover: A Job Quality Crisis in Nursing Homes

September 08, 2022

Data from the Centers for Medicare & Medicaid Services (CMS) show that, on average, nursing homes experience 52% turnover of direct care staff each year, with roughly 30% of homes experiencing over 60% staff turnover.

A new Consumer Voice report shows that nursing homes with higher staff turnover:

  • Provide poorer care
  • Have higher instances of resident abuse
  • Have higher numbers of substantiated resident complaints

What the nursing home industry describes as a staffing crisis is a job-quality crisis. The average annual income for a certified nursing assistant (CNA) is $25,200. 34% of nursing home direct care nursing staff rely on public assistance. Nursing home direct care staff work in highly-stressful environments, where they provide skilled care to our most vulnerable citizens, but are paid inadequate wages and are provided poor benefits. These and other factors contribute to nursing homes having to replace every other nursing staff worker each year.

In the new report, we look at nursing staff turnover across the country and its negative effect on quality of care and quality of life for residents. The report examines the causes of high staff turnover and offers solutions to the various causes.

Read the full report.

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CMS Continues to Allow Nursing Homes to Employ Uncertified Staff

August 31, 2022

At the beginning of the COVID-19 pandemic in 2020, the Centers for Medicare & Medicaid Services (CMS) issued a variety of waivers of federal regulations, claiming these waivers were necessary to address the Public Health Emergency (PHE). One of these waivers was the prohibition against nursing homes employing Certified Nursing Assistants (CNAs) for longer than four months unless they met the training and certification requirements. CMS justified allowing untrained aides to provide care during the PHE by citing staffing shortages. Despite acknowledging that they were concerned about poor health outcomes resulting from untrained staff working in nursing homes, CMS allowed this waiver to continue until June 2022. Consumer Voice had grave concerns about the waiver, repeatedly calling for its recission, as we frequently heard from residents who were receiving poor care from untrained staff.

Despite ending the waiver in June, CMS continues to allow nursing homes to employ uncertified staff for longer than four months. On August 29, 2022, CMS issued formal guidance to nursing homes, counties, and states on how they may continue to operate without properly certified staff. Federal regulations require CNAs to meet training and testing requirements, in order for CNAs to continue to work in a nursing home after four months. These requirements include 75 hours of training in a variety of areas, including providing care to residents with cognitively impaired residents, residents’ rights, and mental health and social services needs. 42 C.F.R. § 483.35.152(b). CNAs must also pass a written or oral exam demonstrating their competency in these skills. 42 C.F.R. 483.154(b)(i) and (ii). To ensure these requirements are being met, each state must have a Nurse Aide Competency Evaluation Program (NATCEP).

In its August 29, 2022 guidance, CMS states it is aware that “there may be instances where the volumes of aides that must complete a state approved NATCEP exceed the available capacity for enrollees in a training program or taking the exam.” If a facility, county, or state documents these instances, CMS will waive the requirements that aides be fully trained and certified (passed a certification test) within the 4-month period. CMS is waiving all of the requirements in these instances, regardless of whether it caused by a delay in training or testing. To obtain a waiver a facility need only document a phone call to a NATCEP in which they were told there was a delay, the date the contact occurred, that they told state officials, and an estimate when the aides will be certified. For counties and/or states to obtain waivers they must show what is causing the delay, how many aides are affected, and a plan to address the certification of aides.

Consumer Voice opposes this blanket waiver of certification requirements. Nursing facilities and states had over two years to create plans to have aides trained and certified. Instead, it appears that many facilities and states waited until the waiver ended in June and now are scrambling to meet the regulatory requirements. Additionally, the CMS waiver applies to all the certification requirements, regardless of whether it is caused by an inability to get aides trained or tested. If delays are due to a backlog in testing, CMS should still require the aides to meet the training requirements in the required timeframe. Further, CMS has not taken any steps to make residents, long-term care ombudsmen or the public aware when a facility, county, or state has obtained a waiver. Residents and their families must be made aware when they are receiving care from uncertified staff, and as mandated advocates for residents, long-term care ombudsmen should be similarly informed.

Resident, families, and other consumers concerned as to whether a nursing home is employing uncertified aides can:

  • Ask the nursing home administrator if the facility is currently operating with a CNA certification waiver. If so, how many CNAs are uncertified? What is the facility's plan and timeline to get all CNAs fully trained and certified? 
  • Contact your local state survey agency to determine whether a facility, county, or state has received a waiver of the CNA certification requirements. 
  • If a state or county has been granted a waiver, ask the state survey agency what their plan is to get all CNAs fully trained and certified.
  • Report all instances or concerns regarding poor care to the local long-term care ombudsman and the state survey agency.

It has been over two years since this waiver was issued. It is inexcusable that nursing home residents continue to be placed at risk of harm due to receiving care from uncertified staff.

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CMS Provides Details on Staffing Study

August 24, 2022

Earlier this year, President Biden announced a comprehensive set of reforms to improve safety and quality of nursing home care.  One initiative of these reforms is to establish new minimum staffing requirements, ensuring that every nursing home has sufficient staff who are adequately trained.   In April of this year, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) asking for input on a variety of issues related to a minimum staffing standard.  Read Consumer Voice’s responses to the RFI.

In its August 22, 2022 blog post, CMS noted it received "divergent views on the establishment of minimum staffing levels" from industry associations and nursing home resident advocates. Advocacy groups and family members of residents generally supported establishing a minimum staffing standard, but industry and provider groups expressed concern.  CMS stated that it is its goal to "consider all perspectives" when crafting the minimum staffing requirements.

Central to CMS’ goal of establishing a minimum staffing standard is a multi-faceted staffing study to be conducted by CMS. In its blog post, CMS laid out its plan for the staffing study which includes:

  1. Literature review: a review of existing studies and information to summarize the relationship between care quality and safety and staffing levels.

  2. Site visits to nursing homes and related analyses: CMS will visit 50 to 75 nursing homes to interview staff and residents regarding staffing levels and care.  In addition, CMS will be collecting observational data on care provisions to develop a simulation model to document the impact of different staffing levels on care quality. The goal, as stated by CMS, is to document not just what staffing levels currently exist, but what levels are needed to meet all residents needs.

  3. Quantitative analyses: CMS will study payroll data from nursing homes from 2018-2021 to identify staffing levels associated with better care.

  4. Cost analyses: CMS will use the data collected in the previous steps to attempt to ascertain the additional costs, if any, of a minimum staffing standard.

Learn more about CMS’ staffing study in their blog post.

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Legislation that Would Improve Nursing Home Conditions Introduced in House

August 17, 2022

This month, Congresswoman Jan Schakowsky (D-IL) has introduced two bills that would improve conditions in nursing homes.  Consumer Voice supports both pieces of legislation.  The Linking Investors and Nursing Home Quality (LINHQ) Act would bring transparency into nursing home ownership and financial activity by requiring nursing homes and parties with ownership interests to disclose ownership and financial information each year.  The Infrastructure Modernization Project Related to the Overall Enhancement of Nursing Homes Act (IMPROVE Nursing Homes Act) would provide funding for resident-centered nursing homes by creating a grant program to convert traditional nursing homes into small-house nursing homes with person-centered cultures.

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CMS Updates Nursing Home Regulations

August 10, 2022

On August 3, 2022, the Center for Medicare & Medicaid Services (CMS) published updated nursing homes regulations, which included changes to the requirements for the Director of Food and Nutrition Services and updates to the Life Safety Code.  CMS also announced changes to the Skilled Nursing Home Quality Reporting Program (QRP) and the Value Based Purchasing Program (VBP).

In 2019, CMS proposed changing the regulations regarding the qualifications for directors of food and nutrition services to allow a director of food and nutrition services to either have two years of experience working in that position or have completed a minimum course of study in food safety. Prior to the proposed change, a director of food and nutrition services was required to be a certified dietary manager, a certified food manager, have a similar certification in food service management and safety, or have an associate’s degree or higher in food service management or hospitality. 

In response to the 2019 proposed regulation, Consumer Voice submitted comments strongly opposing this change, noting that “two years or more years of experience as a director of food and nutrition services does not mean a person is adequately equipped for this position,” and “the proposed alternative qualification, a ‘course of study’ is extremely vague.” Consumer Voice argued that CMS’s justification for watering down the qualification requirements - there being a burden on nursing homes - was far outweighed by the safety and health of residents.

After reviewing public comments, CMS acknowledged that the proposed qualification requirements were insufficient.  They revised the regulation to state that the director must have “two or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023.” Unlike the 2019 proposed regulation, the new qualification requirements cannot be met by having taken a course of study alone but must be accompanied by two years of experience as the director of food and nutrition services.  

Additionally, CMS finalized 2019 proposed changes to 42 C.F.R. §483.90(a), the Life Safety Code.  The new regulations allow long term care facilities, certified before July 5, 2016, to use an alternative scoring system to meet fire safety requirements.  CMS noted that allowing this system does not lower facility safety standards. 

CMS also announced the adoption of several previously proposed measures for the Skilled Nursing Home Quality Reporting Program (QRP) measures and the Value Based Purchasing Program (VBP).

The QRP measure, Influenza Vaccination Coverage Among Healthcare Personnel measure, requires nursing homes to annually report data on the rate of influenza vaccination of healthcare staff in the facility.  This measure will be publicly available on Care Compare. After public comment, CMS adopted the use of this measure beginning in fiscal year 2024.

CMS adopted several additional measures for the Value Based Purchasing program. The program seeks to incentivize good care through a variety of measures that financially reward nursing homes for good performance.

The new measures adopted include:

  • Skilled Nursing Facility Health-Care Association Infections Requiring Hospitalizations: This measure identifies nursing homes with higher rates of infections acquired during the resident’s stay at a facility. It will go into effect in fiscal year 2026.
  • Total Nursing Hours per Resident Day Staffing Measure: This measure uses payroll data from nursing homes to calculate total direct care nursing hours per resident each day and is already used on the Care Compare website. It goes into effect in fiscal year 2026.
  • DTC-PAC Measure: This measure looks at a facility's successful discharge of residents to the community using two years of discharge data.

These measures were included in CMS’ wide-ranging Notice of Proposed Rulemaking issued on April 15, 2022, which also included several requests for information, including on a proposed minimum staffing standard.  Read Consumer Voice’s response to these requests. In the August 3, 2022 notice, CMS offered broad summaries of the public responses to its request for information, but offered no insight into any forthcoming actions it may be taking.

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Reference Guide and Summary of CMS's Updated Nursing Home Guidance

July 12, 2022

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released much awaited Phase 3 guidance along with updated Phase 2 guidance. The guidance was issued as the result of 2016 revisions to the Medicare Requirements for Participation for Nursing Homes. Due to delays caused by the COVID-19 pandemic, CMS is only now releasing the last set of guidance, which was originally scheduled to be released in 2019.

The Phase 3 Guidance offers significant updates to the requirements state oversight agencies must follow when surveying and assessing a nursing home’s compliance with the federal regulations. These areas include:

  • Visitation
  • Staffing
  • Abuse and Neglect of Residents
  • Transfer and Discharge Rights
  • Infection Control
  • Resident Assessments

The guidance to state oversight agencies is 847 pages. CMS has highlighted the updated text in red. Consumer Voice has created a Reference Guide and summary to help consumers understand and access this updated guidance.

Overall, Consumer Voice believes the updated guidance will increase protections for nursing home residents in a variety of areas. 

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Action Update

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Tell Your Member of Congress to Hold Nursing Homes Accountable

July 12, 2022

Urge your member of Congress to support the implementation of staffing standards and to hold long-term care facilities accountable for the care they provide and the money they receive.

Thank you to all those who have scheduled a visit with your member of Congress. 

Let us know about your visit by emailing info@theconsumervoice.org and posting a photo on social media at your member of Congress' office using #HearingConsumerVoices and tag us @ConsumerVoices on Twitter and @theconsumervoice on Facebook.

If you haven't had a chance to schedule a visit yet, visit our webpage to learn how.

Next, use our easy online tool and pre-written letter to send a message - it takes just two minutes!

Plus, Make a Quick Phone Call

While phone calls can sound intimidating, they can be very simple.  Find your member of Congress' phone number and follow this script:

"Hi.  I'm calling because I'm a constituent, and I want (Name of Member of Congress) to support minimum staffing standards for nursing homes and increased transparency and accountability for taxpayer money that nursing homes receive."  

You can also call off hours and leave a message.

Have you completed all three of our actions?

  1. Schedule a Visit

  2. Send a Message

  3. Make a Phone Call

Let us know on social media using #HearingConsumerVoices and remember to tag us @ConsumerVoices on Twitter and @theconsumervoice on Facebook.

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CMS Issues New Guidance and Training for Nursing Home Surveyors

June 30, 2022

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited guidance to state survey agencies. In 2016, CMS revised the Requirements for Participation for Long-Term Care Facilities. These revisions were to be implemented in three phases. Due to delays caused by the COVID-19 pandemic, CMS is just now releasing revisions to the Phase 2 guidance along with the new Phase 3 guidance.
 
The newly released guidance (QSO-22-19-NH) provides direction to surveyors in a variety of areas, including:

  • Abuse and neglect investigations;
  • Admission, transfer, and discharge rights;
  • Mental health and substance abuse disorders;
  • The inappropriate diagnosis of schizophrenia;
  • The use of certain medications;
  • Infection control;
  • Arbitration agreements;
  • Revisions to the complaint investigation process; and
  • Revisions to the Psychosocial Outcome Severity Guide.

In addition to the new guidance, CMS issued new training resources for state surveyor agencies.

The new guidance will go into effect on October 24, 2022.

In the coming days, Consumer Voice will be releasing more detailed information on the new guidance, including a summary and analysis. 

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Registration Open for 2022 Consumer Voice Conference

June 22, 2022

Join us in Baltimore, Maryland November 14-16, 2022 at the Lord Baltimore Hotel to reconnect in person.  Over the pandemic, we've learned how important it is to connect face-to-face, build relationships, learn from each other, and create connections.  With COVID-19 safety measures in mind, we are ready to come together again as a community of advocates.

For those unable to join us in person, virtual conference programming will be December 8-9, 2022.  New live sessions, as well as select recorded programs from the in-person conference will be available. (Note: Registration to the in-person conference also gives you access to the virtual programming). 

Learn more and register.

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Consumer Voice Executive Director Speaks at Elder Justice Coordinating Council Meeting

June 21, 2022

Consumer Voice Executive Director Lori Smetanka spoke at the recent Elder Justice Coordinating Council (EJCC) meeting.  She participated in a discussion on nursing home reform, enforcement and residents' rights.  The EJCC coordinates activities related to elder abuse, neglect, and exploitation across the federal government.

Read her remarks.
 

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Take Action

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Use Our Advocacy Toolkit to Set Up a Visit to Urge Your Member of Congress to Support Policies that Hold Nursing Homes Accountable

June 21, 2022

Nursing homes have been telling Members of Congress why they can't provide quality care and hire staff.   Your Members need to hear from YOU to say "Yes, they can" and to support policies that will hold the nursing homes accountable.

Face-to-face visits with your elected officials (or their staff) are a very influential form of advocacy. Members of Congress are about to return to their home districts for a summer recess, so it’s a great time to schedule a visit to make your voice heard! Some offices may also be holding virtual visits.

Tell you member of Congress to support the implementation of staffing standards and hold long-term care facilities accountable for the care they provide and money they receive.

We’ve made preparing for these visits easy! Check out our Advocacy Toolkit for tips on:

How to Schedule a Visit with Your Members of Congress

How to Conduct a Visit & Tips for What to Expect

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New Podcast Episode on Addressing Abuse in Long-Term Care Facilities

June 15, 2022

Abuse is defined in the federal nursing home regulations as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. It can take many forms including physical abuse, verbal, sexual, mental, emotional, and financial. Even though federal law states that residents of long-term care facilities have the right to be free from abuse, it still does occur and is largely under-reported and inadequately investigated and addressed.

In this episode we are talking with Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics, and Beverley Laubert, the National Ombudsman Program Coordinator at the Administration for Community Living about abuse of those living in long-term care facilities – an issue that affects thousands of residents of nursing homes, assisted living facilities, and other long-term care settings.

Recent data indicates increased concern about incidences of abuse in long-term care facilities. That, along with the fact that June 15 is designated as World Elder Abuse Awareness Day (WEAAD), made us think it was important and timely to talk about this issue.

Listen on Apple Podcasts!

Subscribe to the Pursuing Quality Long-Term Care podcast in Apple Podcasts

Don't have an iPhone? Listen on SoundCloudFacebook, or our website

Listen to Previous Episodes 

View a full list of past episodes and listen to them on Apple PodcastsSoundCloudFacebook, or our website.

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World Elder Abuse Awareness Day is June 15

June 15, 2022

World Elder Abuse Awareness Day (WEAAD), observed each year on June 15th, serves as a call-to-action for our communities to raise awareness about abuse, neglect, and exploitation of elders, and reaffirm our commitment to the principle of justice for all.

Elder abuse is widespread. Every year an estimated 1 in 10 older Americans are victims of elder abuse, neglect, or exploitation. And that’s only part of the picture: Experts believe that elder abuse is significantly under-reported, in part because so many of our communities lack the social supports that would make it easier for those who experience abuse to report it. Research suggests that as few as 1 in 14 cases of elder abuse come to the attention of authorities.

We can prevent elder abuse from happening. We can strengthen the social support structure, we can reduce social isolation, protect communities and families against elder abuse, and build a nation where no individual is subject to abuse.

WEAAD Fact Sheet: Frequently Asked Questions about Elder Abuse

More information about WEAAD.

Consumer Voice has several resources available for preventing, identifying, and reporting abuse, neglect and exploitation:

Find even more resources on Consumer Voice's Elder Abuse Issue Page.

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