Understand how we got here — and how to move forward.


March 1, 2022

Inside the Biden administration's plan to improve nursing homes

Daily Briefing

    The Biden administration on Monday announced plans to improve the quality of nursing homes in the United States, claiming that nursing homes are currently failing to follow federal guidelines.

    The post-acute leader's HR guide

    'Failure … is widespread'

    In a fact sheet, the White House noted that, "[d]espite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm. In fact, failure to comply with [f]ederal guidelines at nursing homes is widespread."

    The White House cited a report from the Government Accountability Office which found that 82% of all nursing homes inspected from 2013 to 2017 through Medicare and Medicaid surveys had a deficiency in infection prevention and control, "including a lack of regular handwashing."

    "Without decisive action now, these unacceptable conditions may get worse," the White House said.

    The administration also noted that "[p]rivate equity firms have been buying up struggling nursing homes, and research shows that private equity-owned nursing homes tend to have significantly worse outcomes for residents."

    According to the fact sheet, investment in nursing homes by private equity firms has increased from $5 billion in 2000 to over $100 billion in 2018. The fact sheet also cited a study that found private equity-owned nursing homes were 11.1% more likely to have a preventable ED visit and 8.7% more likely to experience a preventable hospitalization than for-profit nursing homes not owned by private equity firms.

    How the Biden administration plans to improve nursing homes

    In the fact sheet, the Biden administration outlined four main reforms it plans to implement to improve nursing homes.

    1. Establish a minimum nursing home staffing requirement.

    CMS will "propose minimum standards for staffing adequacy that nursing homes must meet." The fact sheet cited a study that found every 20-minute increase in nurse staffing was associated with a 22% drop in confirmed Covid-19 cases and a 26% drop in Covid-19 deaths. 

    CMS will also "conduct a new research study to determine the level and type of staffing needed to ensure safe and quality care and will issue proposed rules within one year," according to the fact sheet, and the facilities "will be held accountable if they fail to meet this standard."

    2. Reduce resident room crowding.

    The administration plans to reduce resident room crowding, noting that multi-occupancy rooms "increase residents' risk of contracting infectious diseases, including Covid-19." To do this, CMS "will explore ways to accelerate phasing out rooms with three or more residents, and to promote single-occupancy rooms."

    3. Adjust the Skilled Nursing Facility Value-Based Purchasing Program.

    The program provides financial incentives to nursing homes to meet certain quality standards, and, according to the fact sheet, CMS will "propose new payment changes based on staffing adequacy [and] the resident experience, as well as how well facilities retain staff."

    4. Prevent unnecessary treatment and medication.

    According to the fact sheet, the use of antipsychotic drugs in nursing homes has dropped significantly in recent years, however "inappropriate diagnoses and prescribing still occur at too many nursing homes."

    To combat this, CMS "will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications."

    The fact sheet also included other actions CMS will take, including the creation of a database of nursing home owners and operators, the collection and reporting of "more robust" corporate ownership and operations data, improvements to the Nursing Home Care Compare website, and a closer examination at the role private equity firms play in nursing homes.

    President Biden also intends to call on Congress to take more action to improve nursing homes in his State of the Union address, including the allocation of $500 million to CMS "to support health and safety inspections at nursing homes." (Frieden, MedPage Today, 2/28; Brown, McKnights, 2/28)

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.