New Report from Senators Warren, Sanders, Blumenthal: CMS Proposal to Increase Nursing Home Staffing Would Result in Improved Quality of Care
“The data indicates that implementing such a standard would result in higher quality ratings and fewer serious quality issues, fewer deficiencies in care, and less patient abuse”
Washington, D.C. – U.S. Senators Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), and Richard Blumenthal (D-Conn.) released a new report: Residents at Risk: Quality of Care Problems in Understaffed Nursing Homes and the Need for a New Federal Nursing Home Staffing Standard. The report reveals that, across a broad range of health outcomes, nursing homes with higher staffing levels that meet the requirements in the Centers for Medicare and Medicaid Services’ (CMS) proposed rule provide higher quality care than homes with lower staffing levels.
In February of last year, President Biden announced a set of reforms aimed at improving the quality of care and safety at nursing homes across the country, and this September, CMS released a proposed rule that would create new minimum staffing standards for nursing homes. The agency is currently evaluating the comments submitted by stakeholders on the rule. The proposed rule would require a minimum staffing ratio for registered nurses, nurse aides, and patients and implement a requirement of at least one registered nurse on-site 24 hours per day, 7 days a week.
Based on a Congressional Research Service (CRS) analysis of publicly available staffing and patient outcome data from CMS, the report reveals that the proposed minimum staffing standards for nursing homes would have significant benefits for resident care and safety.
“The analysis reveals that compared to nursing homes with higher staffing levels, nursing homes with low staffing levels have lower overall quality ratings, are more likely to have a history of serious quality issues, are more likely to have serious deficiencies in care, and are more likely to have residents that suffer from abuse,” said the report. “The analysis shows that, if CMS finalizes a strong new rule to impose higher minimum staffing ratios for nursing homes, it will have significant benefits by improving the quality of care for millions of residents in thousands of nursing homes across the country.”
The report findings show that:
- Nursing Homes with Lower Staffing Have Lower CMS Star Ratings. CMS’s Five-Star Quality Rating System has been developed by the agency to give a broad indicator of quality to consumers. The CRS analysis reveals that the nursing homes that currently meet the proposed minimum staffing standards have an overall average quality rating of 3.8; the nursing homes that do not meet the proposed standards have an overall average quality rating of 2.7.
- Nursing Homes with Lower Staffing Are More Likely to be “Special Focus Facilities” Because of Problems Providing High Quality Care. Nursing homes without adequate staffing are more likely to have this indicator of poor quality care compared to nursing homes that meet the proposed staffing levels.
- Nursing Homes with Lower Staffing Levels are More Likely to Have Serious Care Deficiencies. All nursing homes are subject to annual inspection by state regulators to determine if they are meeting basic federal health and safety standards. The analysis by CRS reveals that nursing homes that do not meet the proposed minimum staffing standard are much more likely to have serious deficiencies that cause harm to residents.
- Nursing Homes with Lower Staffing Levels are More Likely to Have Residents that Suffer from Abuse. Because patient abuse is such a serious matter, CMS carefully tracks nursing homes that have or might have a history of abuse. The analysis reveals that nursing homes with lower staffing levels are much more likely to have this abuse indicator. Specifically, 4.5 percent of the nursing homes that already have adequate staffing to meet the CMS proposal have the abuse indicator in Nursing Home Compare. In contrast, 8.5 percent of homes that do not meet the proposed CMS standard have the abuse indicator in Nursing Home Compare.
The report concludes that CMS should finalize this proposed rule to improve safety and quality of care for nursing home residents across the country.
Senator Warren has led the fight for stricter oversight of nursing homes and increased transparency:
- In May 2023, at a hearing of the Senate Special Committee on Aging, Senator Warren called out corporate owners of nursing homes, including private equity firms and Real Estate Investment Trusts (REITs), for their failures to protect patient safety and use of complex legal arrangements to avoid regulatory scrutiny.
- In May 2023, Senators Warren, Chuck Grassley (R-Iowa), and Bob Casey (D-Pa.) and Representatives Lloyd Doggett (D-Texas) and Katie Porter (D-Calif.) sent a bipartisan letter to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, calling on CMS to strengthen and finalize its proposed rule to make nursing home ownership more transparent.
- In December 2022, a Government Accountability Office (GAO) report requested by Senators Warren and Ed Markey (D-Mass.) found increases in both the number and the severity of care deficiencies cited at State Veterans Homes (SVHs) across the nation, citing an increase “from 424 in 2019 to 766 in 2021.”
- In May 2022, Senator Warren and lawmakers sent a letter to private equity giant KKR for the grossly substandard care and unsafe living conditions in group homes it owned for people with intellectual and developmental disabilities.
- In February 2022, testifying before the Senate Budget Committee, Senator Warren called out private equity firms’ predatory practices of buying up distressed companies; stripping workers of benefits, fair pay, and safe working conditions, and reaping billions in profits. She noted that research shows that private equity ownership of nursing homes led to a 10% jump in short-term mortality rates.
- In October 2021, Senator Warren and lawmakers reintroduced the Stop Wall Street Looting Act, a comprehensive bill to fundamentally reform the private equity industry and level the playing field by forcing private investment firms to take responsibility for the outcomes of companies they take over, empowering workers, and protecting investors.
- In October 2021, chairing a hearing of the Senate Banking, Housing, and Urban Affairs Subcommittee on Economic Policy, Senator Warren spoke about the need to protect companies and communities from destructive private equity practices as the industry’s growth continues to explode.
- In August 2021, Senator Warren and lawmakers launched an investigation into private equity ownership of for-profit hospice companies and subsequent reductions in the quality of care.
- In March 2021, Senator Warren released Genesis’s response to her January 2021 letter and sent a letter to the company, revealing new information that the company CEO - who left the company in near bankruptcy in January 2021 - has been awarded $8 million in salary and bonuses since the start of the pandemic. Senator Warren raised new questions about why the company lavishly rewarded its CEO after more than 2,800 of its residents died of COVID-19 and despite the fact that he left the company in dire financial conditions.
- In January 2021, Senator Warren sent a letter to Genesis Healthcare, Inc. (Genesis), one of the nation's largest nursing home chains, asking why their top executives, including their recently retired former CEO, have received millions of dollars in bonuses after more than 2,800 of their residents died of COVID-19 and despite the fact that the company has accepted $300 million in taxpayer-funded aid.
- In November 2019, Senators Warren and Sherrod Brown (D-Ohio), and Representative Mark Pocan (D-Wisc.) wrote to four private equity firms that invested in companies providing nursing home care and other long-term care services, citing reports that show private equity investment has played a role in the declining quality of care in nursing homes and requesting information about each firms' management of this sector.
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