Hours after federal regulators announced they would be getting tougher on the worst of the nation’s worst skilled nursing facilities, the key Senate leader who instigated the crackdown said he wanted even more oversight — as well as more funding — for providers.

Meanwhile, the head of the country’s largest nursing home association took strong exception to the Centers for Medicare & Medicaid Services’s decision to increase demands on members of the Special Focus Facilities list targeted.

Sen. Bob Casey (D-PA), chairman of the Special Committee on Aging, who helped spark the SFF changes with a letter to CMS in May, was pleased with Friday’s action, but not satisfied.

“This is a strong step forward, but Congress needs to step up and build on this progress to make change in all nursing homes,” he said in a statement to McKnight’s Long-Term Care News

“This means increasing Medicaid funding and oversight funding so nursing homes have the resources they need to provide quality care and state surveyors are equipped to carry out consistent oversight and enforcement.”

AHCA/NCAL and other advocates agree with Casey, saying much of the answer lies in financial resources to fill staffing gaps that has had a domino effect of staff burnout, higher nurse agency rates (which also inflate staff employee salaries) and lower quality of care. 

“We remain concerned that the rhetoric surrounding these reforms is degrading to the millions of nursing home caregivers who are committed to caring for their residents like their own family and have risked their lives serving on the frontlines during this pandemic,” said Mark Parkinson, the president and CEO of the American Health Care Association/National Center for Assisted Living, in a statement.

In revising the SFF Program, CMS said it will toughen requirements for completion of the program, increase enforcement actions and lengthening the monitoring period for facilities that enter the program. In a nod to the sector’s staffing challenges, CMS also called on states to consider a facility’s staffing level in determining which facilities enter the SFF Program.

Parkinson echoed the view that many providers have: that state surveyors act as police rather than partners, as punishers and not helpers. 

“The Special Focus Facilities program is supposed to identify facilities in need of improvement and assistance; escalating citations and penalties have neither helped turn these facilities around nor prevented other facilities from becoming chronic poor performers,” he said.

CMS described the SFF changes as a way to “increase accountability of bad actors in the nursing home industry.” A particular complaint of regulators and others in the past has been poor facilities’ tendency to “yo-yo” on and off the list. Parkinson turned that narrative around in his statement.

“Residents are not victims of the nursing home industry,” he said. “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.”

Money has to follow

Katie Smith Sloan, CEO of nonprofit aging services advocate LeadingAge, said a comprehensive approach centered around employees and proper funding is needed.

“We continue to emphasize the need for CMS and all stakeholders to prioritize workforce. Staffing goes hand in hand with quality care. As we wrote to President Biden on March 11, 2022, we believe that it is time to take an all-of-government approach to finding solutions that will address the chronic staffing challenges nursing homes and other providers of care to older adults and families continue to navigate.

“Identifying, funding and implementing programs that bring more qualified staff to nursing homes, provide training and career ladders and lattices, are critical to ensuring that older adults and their families can access quality care.”

Parkinson said that analysts have projected that billions of dollars would be required to hire more than 100,000 more nurses and nurse aides if an expected federal staffing minimum moves forward next spring. 

“Long-term care needs a concerted and considerable investment to recruit and retain more frontline caregivers and address access to care issues for millions of seniors,” Parkinson said. “We hope to work with the administration to fully appreciate the role of nursing homes in our nation’s healthcare system, the dedication that our caregivers have to their residents, and the need for policy that pushes improvement, not punishment.”

Senior editor Kimberly Marselas contributed to this article.