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On July 23, 2019, the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,”[1] following its March 6 hearing “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes.”[2]  The Center for Medicare Advocacy is pleased that the July 23 hearing included a national advocate for residents as a witness.

The first panel featured Megan H. Tucker of the HHS Office of Inspector General (OIG) and John E. Dicken of the Government Accountability Office (GAO), who discussed their agencies’ recent reports.   Describing a series of recent reports, Tucker testified that the Centers for Medicare & Medicaid Services (CMS) should use data more effectively to ensure that abuse and neglect are identified and the deficiencies corrected.  Dicken discussed a new GAO report, released at the hearing, that focused on abuse and neglect of residents.  The GAO found that abuse deficiencies more than doubled between 2013 and 2017, with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported.  The GAO also found significant gaps in CMS’s oversight.  The Senators were engaged with the witnesses’ testimony and reports, asking many questions about criminal background checks.

The second panel included Robert Blancato, National Coordinator of the Elder Justice Coalition; Mark Parkinson (a late addition to the witness list), President and CEO of the nursing home trade association American Health Care Association (AHCA); and Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care.

Blancato called for a new Elder Justice Reform Act, focused on dedicated funding for Adult Protective Services; strengthening the long-term care ombudsman program; continuing the Elder Justice Coordinating Council; authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation; and funding for elder abuse forensic centers.

Parkinson described AHCA’s 2012 quality initiative, which currently focuses on lowering hospitalizations, customer satisfaction surveys, and continued decreases in use of antipsychotic drugs.  He noted facilities’ improvement in 18 of 24 quality measures.  The Center for Medicare Advocacy does not view “quality measures” as reflecting actual quality of care provided by nursing facilities.[3]

Smetanka made five recommendations to reduce abuse and neglect and, more broadly, improve care for residents, calling on Congress and CMS to:

  • Require standards for a sufficient, well-trained, well-supervised workforce;
  • Establish standards and oversight for facility ownership and operations, and expanding accountability to the corporate level;
  • Implement, enforce, and prevent the rollback of standards;
  • Increase transparency of information;
  • Strengthen and fund elder justice provisions

Toby S. Edelman of the Center for Medicare Advocacy did not testify but submitted a Statement for the record.[4]

An issue raised by both Smetanka and Edelman was the collapse of Skyline Healthcare, a New Jersey-based nursing home chain that rapidly began to manage nursing facilities across the country in 2016-2017, but then abandoned the facilities in the Spring 2018, leaving states with the responsibility of caring for thousands of residents.

An investigative report on NBC Nightly News on July 19, 2019 told the story of Skyline’s collapse in Massachusetts in May 2019 and abandonment of five facilities in the southeastern part of the state.[5]

Various Senators are considering legislative proposals to address the issues raised in the hearing.

July 25, 2019 – T. Edelman


[1] The Senator’s opening statements and witnesses’ prepared statements are available at
[2] See “Senate Finance Committee Holds Hollow Hearing for the Nursing Home Industry” (CMA Alert, Mar. 7, 2019),
[3] CMA, “Nursing Home ‘Quality Measures’ Do Not Reflect Quality of Nursing Home Care” (CMA Alert, Jul. 3, 2019),
[5] “NBC News Investigation: Nursing home chain collapses amid allegations of unpaid bills, poor care” (Jul. 19, 2019),;  Laura Strickler, Stephanie Gosk and Shelby Hanssen, “A nursing home chain grows too fast and collapses, and elderly and disabled residents pay the price,” NBC Nightly News (May 19, 2019),

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