FACT SHEET: Biden-Harris Administration Announces New Steps to Improve Quality of Nursing Homes

For far too long, nursing home residents have been the victims of an industry with little responsibility to ensure the safety and security of American seniors. COVID-19 has exposed the challenges in America’s nursing homes, with over 200,000 residents and staff dying from COVID-19. That’s why President Biden launched an action plan to improve the safety and quality of care in the nation’s nursing homes in his State of the Union address. Today, the Biden-Harris administration announced new measures to increase the accountability of bad actors in the nursing home industry, improve the quality of nursing homes, and make them safer. These efforts complement the administration’s investment in home and community-based services to prevent unnecessary nursing home admissions and to help nursing home residents return home when possible.

More aggressive enforcement for the worst performing nursing homes
Today, the Centers for Medicare and Medicaid Services (CMS) announced new actions to significantly strengthen nursing home accountability under the Special Focus Facilities (SFF) program, an oversight program for the nation’s lowest-performing nursing homes. The SFF program already provides for more frequent inspections of these nursing homes, but further action is needed to ensure these nursing homes improve.

SFF program reforms announced for the first time today:

  • Increasing penalties for nursing homes in the program that don’t improveEffective immediately, CMS will begin applying escalating penalties for violations, including considering facilities with evidence of dangerous violations in two consecutive inspections for the termination of Medicare and/or Medicaid funding.
  • Raising safety standards to improve: Due to today’s changes, CMS is increasing the requirements that nursing homes in the SFF program must meet in order to be successful and complete the program. Even after a facility has completed the program, CMS will now closely inspect the facility for at least 3 years and help ensure these care homes are consistently adhering to safety requirements.
  • Increase technical support: CMS is also increasing its engagement with these underperforming nursing homes through direct and immediate contact by CMS officials after their selection as SFF to help them understand how they can improve and access support resources such as CMS quality improvement organizations.
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More resources to support well paying union jobs in home care
Sufficient and high-quality staffing is the measure that is most closely linked to the quality of care given to residents. Creating high-paying, unionized jobs in the nursing home industry — and career paths into those jobs — promotes the “dual dignity” of patients and staff. That’s why today the Department of Health and Human Services (“HHS”) and Department of Labor (“DOL”) are highlighting new funds that are available to support the pathway into quality nursing jobs – including for the workforce in nursing homes:

  • A variety of employee representatives are currently eligible for $80 million in grants: Beginning now through January 6, nonprofit healthcare organizations, industry or trade groups, labor unions, labor administration organizations, education and training providers, workforce development organizations, and Native American tribal governments are eligible to apply for DOL’s Nursing Expansion Grant program, which will provide $80 million Dollars in grants to address US nursing staff training shortages and expand and diversify the pipeline of skilled nursing professionals. In particular, these funds will help: 1) increase the number of clinical and professional nursing instructors and educators, and 2) train frontline health professionals and paraprofessionals, including line-time nurses, to advance on a career path and obtain recognized post-secondary qualifications, including licensed ones , to obtain Resident Nursing and Registered Nursing. This program will place an emphasis on educating people from historically marginalized and underrepresented populations, which will help close the growing health equity gap in medically underserved communities.
  • HHS announces $13 million in grants to expand nursing education and training: These funds, made available by the Health Resources and Services Administration, will help increase the number of nursing instructors — experienced licensed clinicians who mentor nursing students during their clinical rotations. The expansion of faculty will help support the goal of nursing schools enrolling more students by providing more opportunities for well-supported clinical rotations and ultimately career paths.
  • HHS and DOL will provide opportunities to apply for additional federal funding to support the nursing pipeline: HHS and DOL have identified hundreds of millions of dollars of funds that will come online over the next year to improve caregiver staffing and workforce sustainability. The Biden-Harris administration encourages qualifying entities to braid these programs to attract and retain high-quality health care workers such as nursing assistants, home caregivers, and registered nurses:
    • By the end of this year, the Employment and Training Administration (ETA) of DOL YouthBuild will provide approximately $90 million in grant funding to qualifying nonprofits or consortia eligible to provide education or professional training under a federal program to provide professional training and educational opportunities to at-risk youth, with over one-third of recent grantees providing health-related education .
    • On an ongoing basis, ETAs National Dislocated Worker Grants Program provides tens of millions of dollars or more in grants to eligible states, governor-designated outlying areas, and organizations eligible for funding through the Indian programs to develop training in entry-level nursing professions such as certified nursing assistant, medical assistant, and physical therapy. These funds help develop training following major economic upheavals such as plant closures, mass layoffs, or higher-than-average demand for employment and training activities for uprooted military personnel and their spouses – with about three-quarters of grantees connecting participants to careers in healthcare .
    • In the first half of 2023, ETA’s Grants to the WORC initiative will provide up to $35 million in grants to eligible state, county, city or local governments, special district governments, regional organizations, independent school districts, public/state-controlled higher education institutions, private higher education institutions, historically Black colleges and universities, and Native American/Native American tribal governments. These grant funds enable affected communities to develop local and regional workforce development solutions that align with existing economic development strategies and community partnerships to foster new, sustainable employment opportunities and long-term economic vitality, all to support uprooted workers, new entrants to the labor market and incumbent workers for good jobs in high-demand professions including behavioral health, dental health and health IT.
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Building on other advances in nursing home reform
Today’s effort builds on the many other actions the Biden-Harris administration has taken to improve the quality and accountability of nursing homes since President Biden announced the State of the Union Nursing Home Reform Action Plan:

  • Determination of the minimum staff requirement: CMS has initiated a public submission process and research study that will inform future minimum staffing rulemaking, and the proposed rule is expected to be published by Spring 2023.
  • Crackdown on illegal debt collection: CMS works with the Consumer Financial Protection Bureau to crack down on nursing homes that illegally blame families for the debts of their loved ones.
  • Increasing transparency and accountability: CMS provided more data on who owns Medicare-certified nursing homes, helping families seeking comparisons understand if a nursing home is part of a bad chain. CMS also released – for the first time – publicly data on mergers, acquisitions, consolidations and ownership changes for nursing homes and hospitals enrolled in Medicare.
  • Incentives for quality performance through Medicare and Medicaid funding: CMS issued a final rule updating Medicare payment policies and rates for fiscal year (FY) 2023, including a nearly $1 billion payment increase and updates to the Skilled Nursing Facility (“SNF”) quality reporting program and the SNF Value Based Purchasing Program. CMS also issued a bulletin urging states to use their Medicaid agencies to achieve better health outcomes for nursing home residents and improve staff pay, training, and retention efforts — that is, Medicaid payments to measures to ensure safety and to bind quality of care.
  • Improving the comparability of families: CMS introduced its enhanced five-star nursing home quality rating system, which integrates data on weekend occupancy rates for nursing home nurses and information on annual turnover from nurses and administrators. The updated star ratings increase transparency to make it easier for families to compare to find the reliable, quality care their loved ones deserve.
  • Preventing Scammers from Getting Medicare Funds: CMS has issued a proposed rule requiring nursing home owners to provide fingerprints for state background checks in order to be eligible for Medicare funds to prevent abuse and Medicare fraud by nursing home owners.
  • Ensure pandemic preparedness: CMS has updated its guidance for care home inspectors to include requiring infection control specialists to be on site – not just outside consultants as the previous administration allowed.
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