Regulations enacted during the Obama administration tried to achieve a higher quality of care and improved safety for our seniors who live in nursing homes. The Centers for Medicare & Medicaid Services (CMS) are now back-pedaling on enforcing those policies. Many of the new rules were supposed to be in place by November 28, 2017. However, nursing homes will now have another 18 months to come into compliance. If you have relatives in nursing homes, you may wonder that for CMS to refrain from enforcing certain nursing home regulations – how might this affect your elderly loved ones?
The new regulations covered such patient-focused safeguards as:
- Having a sufficient number of staff present at the facility
- Employing staff who are qualified to deliver behavioral health services
- Correctly prescribing psychotropic medications
Violations of the new regulations (which were the first significant rules update for nursing homes since 1991) came with the threat of:
- Being kicked out of the Medicare provider program,
- Having to pay fines, and
- Medicare refusing to pay for the services provided.
The CMS has decided to ignore these compliance incentives during the 18-month stay they put on enforcement of the new regulations. They will issue formal citations for violations of the new regulations. However, with no actual punishments, the citations will be impotent. The CMS justifies the 18-month stay by claiming that they will educate Medicare providers about the new regulations during that time.
The nursing home industry had cried “Foul!” at having to comply by November 28, 2017 with regulations for which the CMS just gave guidance in June of 2017. The industry wanted the new rules to be completely ignored and rewritten, so the CMS considers the 18-month stay a compromise.
How the 18-month stay can affect your elderly loved ones
With the new regulations having no teeth for the next 18 months, your loved ones in nursing homes are unlikely to see improvements in some of the problems that led to the rules, such as:
- Inadequate staffing at nursing homes,
- Unqualified staff at nursing homes, and
- Psychotropic drugs prescribed incorrectly
Another aspect of the new regulations that is under attack by the nursing home industry, is the fine structure. The industry wants the CMS to be able to assess only one fine per violation, regardless of whether the violation lasts for one day or for years. If the CMS accepts this wish of the industry, nursing homes will have no incentive to fix problems. This is because once a violation is found and fined, the nursing home would not have to pay any more for the same violation continuing or going uncorrected.
Nursing home patient advocates warn that the CMS is taking away its own powers to enforce regulations when dealing with deficient and dangerous nursing homes. The Center for Medicare Advocacy cautions that the proposed revisions to the rules will increase the risk of harm, injury, or death for nursing home residents. The nursing home industry in the United States has a history of neglect and abuse of seniors. While we have made progress in protecting our vulnerable elders in nursing homes, the current developments are a step back toward a time when conditions in our nursing homes were unacceptable.
Modern Healthcare. “CMS halts enforcement of some Obama-era nursing home standards.” (accessed December 13, 2017) https://www.modernhealthcare.com/article/20171205/NEWS/171209950
Center for Medicare Advocacy. “CMA Alert – Comments on Comments; Nursing Home Enforcement Weakened; More.” (accessed December 13, 2017) https://www.medicareadvocacy.org/cma-alert-comments-on-comments-nursing-home-enforcement-weakened-more/