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Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care … Read more

                      GAO Findings. Federal law requires state survey agencies to investigate allegations of resident abuse and neglect stemming from complaints and facility-reported incidents. About three-quarters of all abuse violations nationwide stem from these investigations. Unfortunately, a recently published management report by the U.S. Government Accountability … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more

The Trump Administration solicited ideas for cutting nursing home standards of care[1] and has announced plans to publish new Requirements of Participation in order to reduce the burden on nursing facilities.[2] In October 2016, the Obama Administration revised these Requirements, which establish the standards of care for nursing facilities that receive public reimbursement from the … Read more

The facts are in: The ever-increasing use of observation status deprives many Medicare beneficiaries of care and coverage in skilled nursing facilities (SNFs).  In 2018, research by Avalere Health confirmed that the use of SNFs by beneficiaries in the traditional Medicare program declined each year between 2009 and 2016. Avalere identified the cause as “fewer … Read more

Many nursing homes have closed in recent months throughout the country.  The nursing home industry instinctively claims that the cause is Medicaid rates that are low,[1] too low even to cover nursing home costs (See our joint letter, below). The New York Times’ recent article about the closure of a rural South Dakota nursing facility … Read more

On November 28, 2019 – three years after the revised federal nursing home rules were issued – “Phase 3” requirements will go into effect. These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. This presentation will examine the Compliance and … Read more

The U.S. Senate Committee on Finance held a hearing on nursing home resident abuse and neglect on March 6, 2019. The Senate Finance Committee did not invite a single consumer advocate to testify before the Committee, although a nursing home industry representative did participate in the hearing. As a result, the Center for Medicare Advocacy … Read more

The Long Term Care Community Coalition (LTCCC), a non-profit consumer advocacy organization headquartered in New York, has published a report examining the federal requirements and key practices for addressing nursing home resident abuse, neglect, and crime. The report, Addressing Abuse, Neglect, and Suspicion of a Crime Against Nursing Home Residents, is free and available on … Read more

Nursing homes can be penalized through the imposition of a civil money penalty (CMP) for either the number of days that the facility has not been in compliance with a federal requirement (per-day) or for each instance of noncompliance (per-instance). Responding to requests from the nursing home industry, the Trump Administration rolled back previous guidelines … Read more

NOT FORGOTTEN: PROTECTING AMERICANS FROM ABUSE AND NEGLECT IN NURSING HOMES Hearing held March 6, 2019 Statement for the record submitted by:  Tony Chicotel, Staff Attorney; Michael Connors, Long Term Care Advocate; Janet Wells, Public Policy Consultant California Advocates for Nursing Home Reform 650 Harrison Street, #2 San Francisco, CA  94107 www.canhr.org Toby Edelman, Senior … Read more

Medicare requires a three-day inpatient hospital stay in order to qualify for care at a skilled nursing facility. Sadly, and all too often however, beneficiaries are classified as hospital outpatients on observation status. While outpatients on observation status and inpatients may receive the same care and services, for the same number of days or weeks, … Read more

On March 6, 2019, the U.S. Senate Committee on Finance held a hearing entitled “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes.” The hearing consisted of two panels of witnesses. The first panel included Patricia Blank (daughter of a nursing home neglect victim), Maya Fischer (daughter of a nursing home rape victim), … Read more

United States Senate Committee on Finance “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019 Statement submitted by: Long Term Care Community Coalition, Center for Medicare Advocacy, National Consumer Voice for Quality Long-Term Care, Justice in Aging, California Advocates for Nursing Home Reform, and National Academy of Elder Law Attorneys … Read more

In cooperation with states, the Centers for Medicare & Medicaid Services (CMS) regularly identifies a subset of nursing facilities, generally one to two facilities per state, that are among the most poorly performing facilities in the country. These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious … Read more

In cooperation with states, the Centers for Medicare & Medicaid Services (CMS) identifies a subset of nursing facilities, generally one to two facilities per state, that are among the most poorly performing facilities in the country.  These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious problems” … Read more

States Whose Nursing Facilities Employ Few Registered Nurses Are More Likely To Be Penalized for Readmissions of Their Residents to Hospitals In 2014, as part of the Protecting Access to Medicare Act, Congress created the Skilled Nursing Facility Value-Based Purchasing Program, whose financial incentives are intended to reduce rehospitaliations of nursing home residents.  In December … Read more

The Center for Medicare Advocacy, the Long Term Care Community Coalition, the National Consumer Voice for Quality Long-Term Care, Justice in Aging, and California Advocates for Nursing Home Reform recently submitted a briefing to members of Congress addressing ongoing concerns regarding the health and safety of nursing home residents. The Nursing Home Reform Law requires … Read more

Most nursing facilities do not have sufficient numbers of nurses to provide the care that residents need.  The result is poor care outcomes for residents – avoidable pressure ulcers, medication errors, inappropriate use of psychotropic medications, failure to assist residents with activities of daily living, avoidable weight loss, falls, and more.   The problem of insufficient … Read more

January 2019 – The nursing home industry is facing tremendous turmoil because some operators are undertaking risky financial deals in an attempt to squeeze out larger profits from their nursing homes, even when these deals could potentially harm residents. The recent collapse of several nursing home chains around the country also raises serious concerns about … Read more

Elder Justice: What "No Harm" Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a "no harm” deficiency is and what it means to nursing home … Read more

State Attorneys General are successfully litigating issues of key importance to nursing home residents, including insufficient nurse staffing levels and inappropriate transfers or discharges of residents. This Alert discusses two cases: the Pennsylvania Attorney General’s challenge to inadequate staffing levels by a national chain and the Maryland Attorney General’s challenge to a state chain’s transfer … Read more

Under the Trump Administration, the Centers for Medicare & Medicaid Services (CMS) has been advancing “burden” reduction measures in nursing homes. The focus of these measures is to reduce both minimum safety standards for resident care and financial penalties when those minimum standards are violated. This rollback builds on the long and, too often, significant … Read more

On September 20, 2018, CMS issued a notice of proposed rulemaking (NPRM) to revise the emergency preparedness program requirements. Most notably, the proposed rule would allow nursing homes to review their emergency preparedness programs and to train staff to carry out those plans every two years rather than annually. The HHS Office of the Inspector … Read more

November 15, 2018 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends … Read more

Legislation to Reduce Rehospitalizations Fails to Answer Questions About Resident Protections The Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2018 (H.R. 6502) would allow certain medical groups to provide telehealth and on-site first responder services to nursing home residents in an attempt to reduce rehospitalizations. Although the goal of reducing unnecessary and inappropriate rehospitalizations is … Read more

On October 11, 2018, the Department of Health and Human Services published final rules updating civil money penalty (CMP) amounts for civil penalties assessed on or after October 11, 2018 for violations of various HHS programs occurring on or after November 2, 2015.  83 Fed. Reg. 51369 (Oct. 11, 2018) (“Annual Civil Monetary Penalties Inflation … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for SNF care and emphasizes language from the Jimmo Settlement … Read more

In September 2007, The New York Times published a lengthy investigative article about private equity’s purchase of nursing facilities – “At Many Nursing Homes, More Profits, Less Nursing.”[1]  The Times reported that private equity firms purchased facilities and divided ownership into multiple companies, insulating themselves from private litigation and meaningful regulatory enforcement.  Meanwhile, the firms … Read more

The involuntary transfer and discharge of nursing home residents is the top complaint received by nursing home ombudsman programs nationwide.  In December 2017, the Centers for Medicare & Medicaid Services (CMS) announced an initiative “to examine and mitigate facility-initiated discharges that violate federal regulations.”[1]  While recognizing the seriousness of involuntary transfer and discharge for residents … Read more

Effective October 1, 2019, CMS will replace the prospective payment system for skilled nursing facilities, Resource Utilization Group (RUG-IV), with a new prospective payment system called the Patient-Driven Payment Model (PDPM).[1] In all significant respects, the final rules are unchanged from proposed rules published in May.[2] The new system, which is budget-neutral, bases payment on … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies some of the most poorly performing nursing facilities in the country as Special Focus Facilities (SFFs).  In this Second Report on SFFs, the Center for Medicare Advocacy looks at one of four categories of SFFs – those that “have not improved” – and how they game … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies some of the worst performing nursing facilities in the country as Special Focus Facilities (SFFs).  This Report looks at one of the four categories of SFFs – those that “have not improved” – and how they game and manipulate CMS’s Five-Star Quality Rating System.[1] As discussed … Read more

A joint Statement from the Center for Medicare Advocacy and the Long Term Care Community Coalition Background. Substandard care and insufficient staffing are longstanding problems in too many nursing homes across the United States. The nursing home industry often blames lack of funds for the failure to ensure appropriate staffing. However, the nonpartisan Medicare Payment Advisory … Read more

The Center for Medicare Advocacy wanted to determine whether nursing facilities that had one-star in their health survey ratings on Nursing Home Compare were able to boost their overall ratings from one star to two stars through the designation of five stars in the self-reported quality measure domain.  The finding – that many facilities in … Read more

Charlene Harrington, professor emerita at the University of California San Francisco, and Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman have written an analysis of the class action lawsuit against twelve Golden Living nursing facilities in Arkansas for insufficient nurse staffing. The case was settled for $72 million in 2017.[1]  In “Failure to … Read more

The Center for Medicare Advocacy issues this Special Report to shine a light on nursing homes throughout the country that have been identified as providing the poorest quality care to residents – while facing limited, if any, enforcement action as a consequence. Known as Special Focus Facilities, (SFFs), these facilities are identified by the Centers … Read more

Nursing facilities that are identified as among those providing the poorest quality care to their residents face limited, if any, enforcement actions.  This Report looks at these nursing facilities. Background In cooperation with states, the Centers for Medicare & Medicaid Services (CMS), identifies nursing facilities that have a history of serious noncompliance.  These facilities – … Read more

An emerging issue of concern for advocates is nursing facilities’ increased marketing of “in-house” managed care plans – specifically, Institutional Special Needs Plans, or I-SNPs – to their residents.[1]  These Medicare Advantage plans are limited to beneficiaries who require, or are expected to need, institutional long-term care for 90 days or more. A recent article … Read more

______________ The front page of The New York Times last Sunday—July 8, 2018—featured an article on nursing home staffing. “’It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years,” by Jordan Rau, reveals that a new reporting system based on payroll-based data indicates facilities have less staffing, especially on weekends, than previously … Read more

The Centers for Medicare & Medicaid Services (CMS) has ended its campaign to reduce the inappropriate use of antipsychotic drugs for long-stay residents in nursing facilities (formally called the National Partnership to Improve Dementia Care in Nursing Homes) for facilities that reduced their antipsychotic drug usage by 34% by the end of 2016 (from 23.9% … Read more

Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services (CMS), invited the Center for Medicare Advocacy and other advocacy organizations to meet with her on June 25, 2018. The Administrator asked our organizations to provide one to two recommendations for the Requirements of Participation that would reduce burdens on nursing facilities. However, … Read more

June 11, 2018 Seema Verma Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard, Baltimore, MD  21244 Via Electronic Mail Dear Administrator Verma:  Thank you for the opportunity to meet with you on June 25, 2018 to discuss the Requirements of Participation (RoPs).  In response to your … Read more

The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017, which outlined proposed changes to Chapter 7 of the State Operations Manual (SOM), and invited public comment. As the Center for Medicare Advocacy noted in a previous alert, the proposed changes sought to reverse surveyor guidance issued … Read more

Since January 2017 the health and safety of nursing home residents has become increasingly imperiled. Nursing home lobbyists have urged the Centers for Medicare & Medicaid Services (CMS) to eliminate or delay regulations and dramatically reduce enforcement of violations. Unfortunately, CMS has shown a disturbing willingness to follow these lobbyists’ recommendations. For example, under regulations … Read more

On May 8, 2018, the Centers for Medicare & Medicaid Services (CMS) proposed a new Medicare Part A reimbursement system for skilled nursing facilities, called Patient-Driven Payment Model (PDPM).[1]  The Center for Medicare Advocacy issued an Alert on the proposed rules (“CMS Tries Again: Another New Skilled Nursing Facility Medicare Reimbursement System Proposed – If … Read more

June , 2018 Mr. Alex M. Azar. II Secretary, Department of Health and Human Services Seema Verma Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1696-P.  Notice of Proposed Rulemaking with Comment.  Medicare Program; Prospective Payment … Read more

On June 4, 2018, the House of Representatives Democratic Caucus Seniors Task Force held a briefing on “Protecting Seniors by Improving – Not Eroding – Nursing Home Quality Standards.” The Center for Medicare Advocacy, led by Senior Policy Attorney Toby Edelman, presented on the enforcement of the nursing home standards, as well as the current … Read more

In recent months, the buying and selling of nursing facilities and the transfers of licenses to new managers have raised questions about who the new owners/managers/lessees are and whether there are sufficient state and federal laws, regulations, and practices in place, meaningfully implemented and enforced, to protect residents. The issue came vividly into public consciousness … Read more

In their April 2, 2018 letter to CMS Administrator Seema, Republican leaders of the House Energy and Commerce Committee express serious concern about “recent media reports describing horrific instances of abuse, neglect, and patient harm allegedly occurring at SNFs and NFs across the country.”[1]  They focus particular attention on Dr. Jack Michel, an owner of … Read more