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December 4, 2018

The 2 ways CMS is aiming to bolster nursing home safety

Daily Briefing

    CMS is launching new efforts intended to increase safety at U.S. nursing homes.

    The new initiatives follow reports of patient safety issues at nursing homes throughout the United States. For instance, a Chicago Tribune/Kaiser Health News investigation published in September found that nursing homes across the country often failed to prevent bedsores and other infections that can lead to sepsis. That investigation also found instances in which nursing homes had inadequate staffing levels, particularly on weekends.

    CMS looks to bolster training of nursing home staff

    CMS last month announced a new, three-year initiative under the Civil Money Penalty Reinvestment Program that will focus on bolstering training of nursing home staff. CMS said under the initiative it will develop new training products, such as instructional guidelines, staff competency assessment tools, technical assistance seminars, and webinars. The agency said the training materials will focus on decreasing adverse events, improving dementia care, and bolstering staffing quality by improving performance and retention.

    CMS said the initiative will be funded by federal civil penalties the agency collects from nursing homes that do not comply with certain federal regulations. It is not clear how much money CMS collects in such penalties annually, Modern Healthcare reports.

    CMS says it will increase oversight of nursing home staffing levels

    In addition, CMS on Friday announced that it will increase its oversight of nursing home staffing levels, McKinight's Long-Term Care News reports.

    CMS said it will use payroll-based data to notify states of potential nursing home staffing shortages. In addition, CMS said it will require states to perform more nursing home inspections on weekends and cite nursing homes that do not have adequate staffing levels.

    CMS also said it will clarify how nursing homes must report staffing information, such as employee hours and meal breaks, and will offer nursing home administrators tools to verify their resident census counts.

    CMS Administrator Seema Verma said the agency is making the changes because of "potential risks revealed by new payroll-based staffing data" released by the agency. She said, "We're deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels or times when registered nurses are not onsite, and the impact that this can have on patient care. The actions announced today strengthen our oversight of resident health and safety, and help ensure accurate public reporting."

    Providers react

    Provider groups welcomed CMS' efforts to bolster training among nursing home staff.

    David Gifford—SVP of quality and regulatory affairs for the American Health Care Association, which represents nursing homes—said, "Workforce is one of the largest challenges facing long-term care providers, and continuing to develop resources to help our members maintain high quality care is top of mind for us."

    However, providers raised concerns about CMS' efforts to increase its oversight of nursing home staffing levels.

    Gifford said the actions "will enforce policies that make it even more difficult to meet regulatory requirements and hire staff." He added, "Rather than taking proactive steps to address the national workforce shortage long-term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing."

    Katie Smith—CEO of LeadingAge, which also represents nursing homes—expressed similar concerns. "We believe any discussion of nursing home staffing must be considered in the broader context of the labor force," she said, adding, "Our nonprofit members across the care continuum—including nursing homes—face a significant workforce crisis. Nursing homes go to extreme measures to staff sufficiently" (Stempniak, McKnight's Long-Term Care News, 12/3; Rau, Kaiser Health News, 11/30; Flynn, Skilled Nursing News, 11/30; Dickson, Modern Healthcare, 11/20; Stempniak, McKnight's Long-Term Care News, 11/21; Spanko, Skilled Nursing News, 11/20; CMS release, 11/30).

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