I’ve written a lot in the past few years about increased enforcement against nursing homes when it comes to health surveys by state departments of public health and the Centers for Medicare & Medicaid Services. 

Certainly, we have seen the onslaught of increased surveys, and increased fines and penalties for both licensure violations and certification deficiencies, coupled with the focus on infection control during the pandemic, as well. 

I’ve also written about the staffing crisis, and by now folks are, no doubt, tired of hearing about it.  There is a staffing shortage, and finding quality staff is a real problem for nursing homes … still.  

Everyone experiences and knows of the staffing crisis. Finding and maintaining staff continues to be a challenge for nursing homes. In fact, we have seen firsthand that staffing shortages have caused facilities to shut their doors, sometimes after decades of dedication to providing senior care in their communities.  

Amid this crisis, many of our facilities continue to receive remedies from surveys that impose not only severe penalties in the form of denial of payments for new admissions (DPNA) or civil money penalties (CMPs), but also the prohibition of offering Nurse Aide Training and/or Competency Evaluation Programs (“NATCEP”), usually for two years.  

Whether there is a NATCEP prohibition depends on the occurrence of one of three things during a survey or survey cycle:

  1. The imposition of a DPNA;
  2. The imposition of a CMP exceeding $11,995; or
  3. An extended or partial extended survey as a result of an alleged finding of substandard quality of care.

First, the DPNA or CMP can be enormous in and of themselves — but then to tag on a NATCEP prohibition to facilities that are short on staff is a real kick in the back for nursing homes. 

Second, NATCEP programs are sometimes a key lifeblood for facility operations, providing needed advertising of the profession to potential CNAs that may be recruited to the very facility in which they train for clinical education through the facility’s participation in the program. What better way to establish, recruit and maintain CNAs than having a robust NATCEP program in the facility?  

Taking that crucial program away from nursing homes is especially onerous for facilities trying to improve their staffing numbers in the midst of the very real shortage of CNAs today. 

Third, CNA programs may have a difficult time in locating clinical settings in which to place their students.

In other words, this penalty is excessive now more than ever before. Shouldn’t CMS consider eliminating the NATCEP prohibition? How about putting the imposition of a NATCEP remedy on a hiatus until staffing levels get back to normal, or at least become reasonable? There are plenty of statistics out there to show when the staffing shortage would be overcome, and when the remedy could be reinstituted by CMS. (Check out “Staffing shortages ease for SNFs, but they’re not out of the woods yet.”)

If CMS and state departments of public health are serious about their purpose and function, they should put NATCEP remedies on hold. After all, isn’t the purpose and function of CMS and departments to protect residents, and foster the delivery of healthcare in our facilities? 

CMS should put the onerous NATCEP remedy on hold for the sake of improving the staffing crises for facilities nationwide. 

Neville M. Bilimoria is a partner in the Chicago office of the Health Law Practice Group and member of the Post-Acute Care And Senior Services Subgroup at Duane Morris LLP; [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.