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

The Centers for Medicare & Medicaid Services (CMS) 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 residents of LTC facilities. The surveyors who use these resources to perform both routine and complaint-based inspections of nursing homes are responsible for determining whether facilities are complying with CMS’ requirements.

“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is proud to be leading President Biden’s initiative to improve the safety and quality of care in the nation’s nursing homes, and this set of improvements is our next step toward that goal.”

The updates to the guidance make progress on President Joe Biden’s vision to protect seniors by improving the safety and quality of our nation’s nursing homes, as outlined in a fact sheet released before his first State of the Union Address in March 2022. A key part of reaching this goal is addressing nursing home staffing levels, which substantially impact the quality of care and outcomes for the resident experience. Today’s guidance furthers this goal but is just one piece of the implementation of the action plan announced in the State of the Union, which includes, among other things, new rulemaking to require minimum staffing levels in nursing homes.

To begin helping address the staffing issue while the rulemaking process is underway, CMS added new requirements for surveyors to incorporate the use of Payroll-Based Journal staffing data for 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 higher quality care. 

With emerging infectious diseases such as COVID-19, CMS believes that the role of the Infection Preventionist (IP) is critical in the 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 accord with President Biden’s campaign commitment to ensure facilities have sufficient on-site IPs.

The updated guidance clarifies CMS’s expectations for ensuring timely investigations. This will help address findings from the Government Accountability Office, which noted variation among states in reporting, tracking, and processing reports of abuse and neglect.

The updates also contain improvements to CMS guidance for mental health and substance use disorder and build upon the agency’s Behavioral Health Strategy to better meet the unique needs of LTC facility residents with mental health and substance use challenges. CMS also clarified the minimum level of knowledge and skills of facility staff to ensure that the 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 crowding, 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 several 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 for nursing home residents.

CMS believes all people deserve access to quality health care and will continue working to improve the safety and quality of nursing home care. CMS will hold nursing homes accountable and make the quality of care and facility ownership more transparent so potential residents and their loved ones can make informed decisions about care.

LTC facilities and state survey agencies can review each change in the advance copies attached to the CMS QSO-22-19-NH memorandum. 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 October 24, 2022.

Reference this fact sheet on the new and updated guidance for nursing home resident health and safety.

The Society submitted comments on the proposed rule issued before the COVID-19 pandemic. We will review the rule and provide updates at a future date.