CMS Issues Updates to Improve the Safety and Quality of Care for Long-Term Care Residents; Calls for Reducing Room Crowding

CMS recently issued updates to guidance on minimum health and safety standards that long-term care (LTC) facilities must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect LTC residents. The surveyors who use these resources to perform nursing home inspections are responsible for determining whether facilities are complying with CMS’ requirements.

These updates are in accordance with President Joe Biden’s vision to protect seniors by improving the safety and quality of our nation’s nursing homes, as outlined in this fact sheet. A key element of reaching this goal is addressing nursing home staffing levels.

To begin helping with staffing issues while the rulemaking process is underway, CMS added new requirements for surveyors to incorporate the use of Payroll-Based Journal staffing data into their inspections. This will help better identify potential noncompliance with CMS’ 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. This guidance will help uncover instances of insufficient staffing and yield improved care for patients/residents. 

With emerging infectious diseases such as COVID-19, CMS believes that the role of the infection preventionist (IP) is critical to a facility’s efforts to mitigate the onset and spread of infections. Using lessons learned from the pandemic, CMS provides further guidance requiring each facility to have an IP with specialized training to effectively oversee the facility’s infection prevention and control program—in accordance with the president’s campaign commitment to ensure that facilities have sufficient on-site IPs.

The updates also contain improvements to CMS guidance for mental health and substance use disorders and build upon the agency’s Behavioral Health Strategy to better meet the unique needs of LTC facility residents with these types of challenges. CMS also clarified the minimum levels of knowledge and skills necessary for facility staff to ensure that these policies and practices do not conflict with resident rights or other participation requirements.

As part of the Biden-Harris Administration call to reduce resident room overcrowding, CMS has highlighted the benefits of reducing the number of residents in each room for preventing infections and the importance of residents’ rights to privacy and a home-like environment. The pandemic has further proven the risk of contracting infectious diseases in rooms with too many residents. CMS urges providers to consider making changes to their settings to allow for a maximum of double occupancy in each room and encourages facilities to explore ways to allow for more single-occupancy rooms.

The online SOM will be updated on or after October 24, 2022, when these changes go into effect. Surveyors will begin using the guidance and changes, which will be incorporated into the survey process, on that same date.