Nursing home surveyor conducting a site visit

The federal government is planning to add new penalties against nursing homes that fail to improve a record of providing poor care.

The Centers for Medicare & Medicaid Services will more aggressively enforce accountability in its Special Focus Facilities (SFF) program, the Biden administration announced in a fact sheet released Friday, Oct. 21. These first-time reforms build on the administration’s nursing home reform action plan, unveiled in early 2022, it said.

Will penalties work?

SFFs are nursing facilities that chronically underperform, with those in the program accounting for 0.5%, or 88 of the nation’s facilities. They receive twice the inspections of other facilities, at least once every six months. They must pass two consecutive inspections to successfully complete the program. Under the new changes, they will be monitored longer-term and penalized for backsliding.

“The SFF Program already provides more frequent inspections of these nursing homes, but more action is needed to ensure these nursing homes improve,” the administration stated. The new reforms will escalate penalties for failure to improve standards after violations, increase safety standards with scrutiny of SFFs for at least three years and provide technical assistance to help nursing homes implement quality improvements.

Industry advocates, meanwhile, pushed back at the plan for escalated enforcement. Increased citations and penalties have historically not made a dent in changing poor performers, the American Health Care Association and National Center for Assisted Living said in a Friday response to the Biden administration’s announcement.

The long-term care industry had previously criticized the Biden team’s plans on the grounds that it failed to provide funding assistance needed for facility operators to make mandated improvements. This time, AHCA/NCAL encouraged federal officials to support the Care for Our Seniors Act, which includes a five-point plan for addressing under-performing nursing homes, and is also endorsed by fellow long-term care advocate LeadingAge.

The AHCA/NCAL also disagreed with the rhetoric used in the Biden administration’s announcement, which referred to nursing home residents as “victims of an industry with little accountability to keep American seniors safe and protected.”

Mark Parkinson, president and CEO of AHCA/NCAL said, “Residents are not victims of the nursing home industry. Too many were victims of a vicious virus that targets the elderly as well as terrible public policy decisions — made by both parties — that failed to support and prioritize our most vulnerable.”

A drop in the bucket

LeadingAge, meanwhile, reiterated its support of federal initiatives to improve care at poorly performing nursing homes, supporting closures of those that do not improve. It also called for an “all-of-government approach to finding solutions that will address the chronic staffing challenge.”

In fact, the administration paired its Friday news of increased oversight and penalties with that of grants aimed at correcting the industry’s nurse staffing shortfall. Currently, a wide variety of healthcare stakeholders are eligible to apply for some of the $80 million earmarked for the purpose of helping to alleviate bottlenecks in training for the nursing workforce, the administration stated. In addition, the Department of Health and Human Services has awarded $13 million in grants to expand the number of supervisors of nursing students during clinical rotations, it stated.

But the grants are not nearly enough to bring facility operators back up to the staffing levels they’ll need to reform the industry and recover from pandemic losses, Parkinson said. Analysts have estimated that the nursing home industry will need billions of dollars to recover, he noted.

More coverage of Friday’s new reforms and announcements can be found at McKnight’s Long-Term Care News and McKnight’s Business.