Policy & Advocacy

Consumer Voice continues to advocate for a minimum staffing standard and increased transparency in nursing homes, among other advocacy efforts. See below for a sampling of our recent advocacy priorities:

Transparency and Accountability

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 reference guide, Related Party Transactions and CMS's Role in Regulation, provides an overview of how nursing home owners use related party transactions for their own benefits and suggestions for how CMS can use its regulatory power to hold nursing homes accountable.

The report, Where Do the Billions of Dollars Go?: A Look at Nursing Home Related Party Transactions, 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.

In April 2023, Consumer Voice submitted detailed comments regarding a rule proposed by CMS to increase transparency of nursing home ownership.

CMS Releases Proposed Rule on Nursing Home Staffing Standard

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.

Consumer Voice submitted comments on the rule.

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.

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.

Biden Administration Proposed Nursing Home Reforms

On February 28, 2022, the Biden-Harris Administration announced a set of wide-ranging reforms aimed at improving the quality of nursing home care for residents. These reforms take aim at long-standing issues that have plagued nursing home care for decades, including poor staffing, inadequate enforcement, and lack of transparency in nursing home ownership and how taxpayer dollars are spent. If implemented, these reforms would be the most significant increase in protections for nursing home residents in decades. Read Consumer Voice's summary of the reforms.

In June 2022, Consumer Voice submitted comments to the Center for Medicare & Medicaid Services (CMS) in response to their Notice of Proposed Rule Making (NPRM) that included requests for information regarding the implementation of a minimum staffing standard in nursing homes and input on measuring health disparities in resident outcomes. Consumer Voice's comments strongly supported CMS's proposal to implement a minimum staffing standard.

Consumer Voice Policy Framework

In June 2021, Consumer Voice, along with other advocacy organizations, created a framework for nursing home reform post COVID-19. To address the longstanding problems in the long-term care system, as well as those exposed by the COVID-19 pandemic, we provide a baseline framework with recommendations in six critical areas that need reform:

1.)  Staffing and workforce;
2.)  Regulation and enforcement;
3.)  Ownership and management standards, transparency, and accountability for quality;
4.)  Government payment systems, financial transparency, and accountability;
5.)  Structural changes in the long-term care delivery system; and
6.)  Nursing home redesign and rebuilding.

Long-Term Care Issues & Resources