Nursing Homes: Is Federal Regulation Tough Enough?

Posted on September 11, 2018 by Jodi Boyne

A hearing last week in the U.S. House Energy and Commerce Subcommittee on Oversight explored whether federal regulations for nursing homes were tough enough. 

In announcing the hearing, Subcommittee Chair Rep. Gregg Harper (R-MS) cited press reports of abuse and neglect occurring in nursing homes and said the hearing was the latest step in the committee’s ongoing investigation into the treatment of patients at nursing homes. The hearing comes at the same time as an Office of Inspector General (OIG) investigation into the accuracy of nursing home staffing levels reported under the Payroll-Based Journal (PBJ) system that have also been the subject of recent press reports. 

Instilling public trust in all that we do is a core part of our mission to transform and enhance the experience of aging. We do this by focusing on that which matters most to our residents and their families – safe, quality care. Our members have developed and implemented initiatives that are moving the field forward in quality of care and quality of life for all we serve. Our members are committed to bringing forward innovation and improvements that will help Minnesotans age well and live fully in all the places they call home. 

LeadingAge national examined some of the concerns being expressed by the Oversight Subcommittee and pointed to solutions that were already in place. They also shared support for the current PBJ system and encouraged CMS to fix some of the reporting problems members have cited to improve accuracy of the data.    

The underlying issue with nursing home staffing remains the most significant challenge our field faces.

LeadingAge recently shared this thought-provoking blog posting by David Stevenson in Health Affairs on the future of nursing home regulation and the role of government oversight. 

Stevenson noted that providers and consumers generally agree on the need for regulation to assure at least minimum standards of quality in nursing home care. He noted that, “nursing home quality assurance is better equipped to assure a minimal floor than it is able to incentivize excellent care.” He described the current impasse over modernization of nursing home regulation, “with providers and advocates staking out opposing sides and engaging in little discussion about the trade-offs of different approaches. Providers chafe under a system they find inflexible, ineffective, and overly prescriptive, while advocates point to widespread and continuing quality problems and resist efforts to scale back regulatory protections.” 

Given the dissatisfaction among both providers and consumers over the present state of nursing home quality oversight, Stevenson argues that progress ultimately will depend on the willingness of each side to engage with the other to work out solutions. He points out that providers would have to accept that the present regulatory framework is based on a legacy of unsatisfactory quality and the frailty of residents; consumers would have to recognize that most nursing homes aim to provide good quality care and that regulations can hamper innovation and person-centered practices. He urges all sides to establish common ground and work together to achieve high quality nursing home care. 

This sort collaborative process is already underway in Minnesota. For more information, see our Aug. 29 article: MDH Convenes Stakeholders to Discuss Next Steps in Addressing Elder Abuse.