A nursing home room
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The Centers for Medicare & Medicaid Services appears to be weighing changes to its nursing home room capacity standards, based on recommendations included in updated guidance released Wednesday. 

The issue was among several key topics addressed in a memo issued Wednesday for nursing home surveyors that updates guidance related to Phase 2 and Phase 3 of the Requirements of Participation. 

The updates had been due since 2019, but were delayed by the agency for additional review prior to the pandemic. Many of the items now being addressed have been informed by nursing homes’ COVID-19 experiences and lessons learned, CMS said.

Infection control and prevention requirements; staffing expectations; dementia care; appropriate diagnoses and medication use; and details on how to better care for residents with mental health and substance abuse disorders were all included in the guidance. All told, the new details bring the requirements to an astounding 847 pages, and providers will continue to parse the details in coming days and weeks.

The updated guidance will go into effect on Oct. 24, 2022, giving “ample time for surveyors and facilities to be trained on this new information,” CMS said. 

The extended deadline was welcomed by the American Health Care Association/National Center for Assisted Living. The association plans to “continue to advocate for resources to help providers make meaningful changes that benefit the safety and wellbeing of our residents,” David Gifford, chief medical officer for AHCA/NCAL, said in a statement to McKnight’s Long-Term Care News on Wednesday.

Resident rooms 

The memo includes recommendations related to resident room capacity, though there are no updated regulations at this time.

“CMS is highlighting the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment,” the agency said in a fact sheet.

Currently, CMS allows up to four residents in one room that allows for a minimum of 80 square feet per resident. Bedrooms in newly constructed or renovated facilities must accommodate no more than two residents, according to 2016 CMS guidance.

In response to President Joe Biden’s nursing home reform proposals, the agency plans to align its resident room requirements more inline with the 2016 guidance, CMS wrote. It’s also urging providers to consider making changes to their physical environment to allow for a maximum of double occupancy in each room, and explore more ways to add more single occupancy rooms for residents.

“This also builds on the lessons learned through the COVID19 pandemic, where having more residents in a room can make it more challenging to prevent the transmission of infectious diseases,” the agency wrote.


CMS added new requirements for surveyors to incorporate the use of Payroll Based Journal staffing data for more thorough investigations into provider compliance with staffing requirements. The update comes just months after PBL reporting expanded and as the agency works to establish new minimum staffing requirements for nursing homes.

“This will help better identify potential noncompliance with CMS’s nurse staffing requirements, such as lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day,” the agency said in a statement. “This guidance will help to uncover instances of insufficient staffing and yield higher quality care.” 

Katie Smith Sloan, president and CEO of LeadingAge, criticized the agency for “continuing the additional pile-on of regulations [that] will strain already-stretched providers.” 

“We all know that staffing goes hand-in-hand with quality care, and our mission-driven members are working valiantly to stay compliant,” Sloan said in a statement Wednesday. “But we continue to urge the administration to back its words of commitment to ensuring older adults’ access to care with meaningful action and funding.”