CMS New Regulations Focus on Nursing Facilities Improving Resident Care

Mya Strauss

Associate Editor

Beazley Institute for Health Law & Policy, Loyola University Chicago, Masters of Law 2019

The Centers for Medicare and Medicaid Services (CMS) efforts to strengthen the nation’s health care through its oversight of health care programs, including Medicare, has continuously made strides to ensure its beneficiaries receive the quality and affordable health care needed. The U.S. has struggled with the quality of care provided in nursing homes to the most vulnerable citizens for years. Nursing homes have continued to remain highly regulated, but the U.S. government has failed to hold the nursing homes industry accountable for the poor quality of care provided. America’s shortage of nurses has contributed to the poor quality of care that leads to life threatening problems of Medicare beneficiaries living in nursing homes. Furthermore, despite the nursing home industry’s large profitability, and the level of hands on care that the nurses provide, the pay for staff nurses in nursing homes is less than other major employers. Thus, CMS has implemented regulations to guarantee nursing homes are properly staffed in order to improve resident care and safety by monitoring payroll-based data and holding nursing homes accountable for poor care by minimizing reimbursement for conditions that could be averted with better oversight.

Nursing Shortage

The nursing shortage we are experiencing is not an overall shortage nor is it happening in the traditional hospital setting. Where the shortage hits hard is in the nursing home and assisted living areas.  There are a number of issues contributing to the shortage. First, nursing programs have struggled to graduate nurses according to the rate of the growing need for health care services due to the lack of nursing professors needed to educate incoming students. Second, the current nursing workforce is aging and ultimately retiring. Lastly, turnover is high due to nurses feeling overworked due to shortages. These are just a few factors contributing the shortage of nurses. Reportedly, 90% of long-term care facilities lack adequate staffing to care for nursing home resident basic needs. The shortage not only affects the nurses but also affects the patients and ultimately the nursing home organizations where patients reside. Research showed that nursing facilities with higher staffing levels tend to have fewer resident hospitalizations. Understaffed nursing homes place its residents at serious risk of injury due to the provision of poor quality of care.

Staffing Level Data

In order for nursing homes to receive payment under federal programs such as Medicare and Medicaid, CMS provides a number of regulations for facilities to follow.  CMS has recently requested nursing facilities provide payroll data to assess issues with understaffing and to protect the safety of nursing home residents. Federal law requires Medicare and Medicaid nursing homes to have a registered nurse on duty at least eight hours a day seven days out of the week. Despite this fact, some nursing homes reported days where no registered nurse was on their premises.

Nursing home management will need to update their procedures to ensure the management team properly schedules and documents staffing levels. Providing a lead registered nurse to ensure proper nurse staffing levels are accurately documented on either a daily and/or weekly basis will prevent the facility from receiving citations for insufficient staffing. Facilities monitoring scheduling on a daily and weekly basis will allow management to promptly detect insufficient staffing hours and correct them by requesting an on call nurse to come in or by having a nurse extend his/her hours for the day. Nursing homes must reiterate the importance of proper staffing and timely reporting to guarantee that its residents have proper oversight of their medical care. Failure to report and failure to have adequate staffing could affect the facilities’ Medicare ratings.

Nursing Home Accountability

CMS has financial incentives in place encouraging nursing homes to staff properly and to deliver a level of care that will reduce hospital readmissions of nursing home patients. The financial incentives are determined by readmission rates based on if their residents reenter the hospital within 30 days of being released. Having adequate and properly trained staff in place can prevent avoidable events from occurring. CMS posts Medicare ratings based on a number of quality measures online. Falling short of quality measures provided can potentially affect the organization if the ratings are low. This follows suit with the current administration efforts to increase transparency to ensure Americans receive high quality care and improve the safety and health outcomes of the patients.

Nursing facilities will need to provide continuous internal training and utilize the Civil Money Reinvestment Program provided by CMS. The CMRP equips nursing home management and staff with tools and assistance to enhance resident care. The support provided will reduce adverse events, strengthen staffing quality and performance, and reduce staff turnover among many other efforts.