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September 13, 2022

In this Issue:

  1. Senator Casey Requests Information from State Survey Agencies on How Staffing Shortages Have Affected the Nursing Home Inspection Process
  2. New Consumer Voice Report - High Staff Turnover: A Job Quality Crisis in Nursing Homes
  3. DHS Finalizes "Public Charge" Rule
  4. CMS RFI on Accessing Healthcare, Provider Experiences, and Advancing Health Equity
  5. CFPB Resources on Nursing Home Debt Collection Practices
  6. Webinar for Aging Network Professionals on Understanding Grandparent Scams

Senator Casey Requests Information from State Survey Agencies on How Staffing Shortages Have Affected the Nursing Home Inspection Process

Senator Bob Casey (D-PA) sent letters to state survey agencies in all states requesting information on staffing shortages, how that has impacted the work of the agency, and what other measures have been employed to conduct inspections.  State survey agencies are responsible for enforcing federal nursing home standards related to care, adequate staffing and safeguarding residents from abuse and neglect.  In his letter, Senator Casey noted that the inspection workforce was down by as much as 50% in some states, and 4,500 nursing homes were overdue for annual standard surveys.

The letter requests information from state survey agencies for the previous five calendar years on:

  • The scope and activities of the agency's nursing home survey and certification program and issues, challenges or dynamics unique to the state
  • The extent to which staff turnover has affected the agency's ability to conduct its work
  • The agency's ability to hire and retain nurses as surveyors
  • The extent that the agency has used contractors to conduct surveys or other tasks such as informal dispute resolution
  • Feedback on what the Centers for Medicare & Medicaid Services (CMS) could do differently including changes to policies, guidance, or technical assistance that would assist the agency in conducting timely surveys
  • How the agency has used the Coronavirus Aid, Relief, and Economic Security (CARES) Act funding
  • Workforce data on nursing home surveyors


For more information, read the article in McKnight's.

New Consumer Voice Report - High Staff Turnover: A Job Quality Crisis in Nursing Homes

Data from the Center for Medicare & Medicaid Services (CMS) shows that, on average, nursing homes experience 52% turnover of direct care staff each year, with roughly 30% of homes experiencing over 60% staff turnover.

A new Consumer Voice report, High Staff Turnover: A Job Quality Crisis in Nursing Homes, shows that nursing homes with higher staff turnover:

  • Provide poorer care
  • Have higher instances of resident abuse
  • Have higher numbers of substantiated resident complaints

What the nursing home industry describes as a staffing crisis is a job-quality crisis. The average annual income for a certified nursing assistant (CNA) is $25,200. 34% of nursing home direct care nursing staff rely on public assistance. Nursing home direct care staff work in highly-stressful environments, where they provide skilled care to our most vulnerable citizens, but are paid inadequate wages and are provided poor benefits. These and other factors contribute to nursing homes having to replace every other nursing staff worker each year.

In our new report, we look at nursing staff turnover across the country and its negative effect on quality of care and quality of life for residents. In the report, we examine the causes of high staff turnover and offer solutions to the various causes.

DHS Finalizes "Public Charge" Rule


The Department of Homeland Security (DHS) has finalized its "public charge" immigration rule.  The rule defines the criteria in which a person can be denied a visa and/or legal residency because they are likely to become a "public charge," likely to become primarily dependent on the government for subsistence.  Under the new rule, participation in most public benefits, including the Administration for Community Living (ACL)'s programs, will not adversely impact a citizenship or residency determiniation.  According to ACL, the only public benefits considered in a public charge determination are:

  • Long-term institutionalization funded by the government (for example, Medicaid-financed care in a nursing facility). Receiving Medicaid Home and Community-Based Services (HCBS) or other Medicaid health care benefits will not affect a public charge determination.
  • Direct cash assistance programs, including Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF).

For more information, read ACL's blog.

CMS RFI on Accessing Healthcare, Provider Experiences, and Advancing Health Equity


The Centers for Medicare & Medicaid Services (CMS) released a Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs Request for Information (RFI) seeking public input on accessing healthcare and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency. CMS is seeking to better understand individual and community-level burdens, health-related social needs, and opportunities for improvement that can reduce disparities and promote efficiency and innovation across its programs. CMS is requesting information related to strategies that successfully address drivers of health inequities, including opportunities to address social determinants of health and challenges underserved communities face in accessing comprehensive, quality care.

CMS encourages comments from all interested stakeholders, in particular, patients and their families, providers, clinicians, consumer advocates, and healthcare professional associations. Comments are also encouraged from individuals serving and located in underserved communities, and from all CMS stakeholders serving populations facing disparities in health and healthcare. Comments must be received by November 4, 2022.

Respond to the RFI.

CFPB Resources on Nursing Home Debt Collection Practices


The Consumer Financial Protection Bureau (CFPB) Director Rohit Chopra held a field hearing last week on nursing home debt collection practices.  The discussion included advocates, service providers, community leaders, and members of the public; Consumer Voice Director of Public Policy Sam Brooks spoke at the event.  The focus of the hearing was on the practice of some nursing homes of pursuing payment for nursing home stays from family members or other loved ones. Despite the prohibition of requiring a third party to guarantee payment for a nursing home resident’s stay, this practice continues.  The hearing featured testimony from family members who had been affected by this practice and offered consumers strategies on how to combat this illegal practice.

At the event, CFPB announced several new resources:

  • Issue Spotlight highlighting some of the difficulties and experiences heard from caregivers about being pursued over friends’ or family members’ alleged debts from nursing home facilities.
  • Joint letter from CFPB and the Centers for Medicare & Medicaid Services (CMS) confirming that a nursing care facility may not require that a third-party caregiver personally guarantee payment of a nursing home resident’s bills as a condition of the resident’s admission to the facility.
  • Consumer Financial Protection Circular highlighting that attempts to collect debts from caregivers may violate the Fair Debt Collection Practices Act and the Fair Credit Reporting Act.

Webinar for Aging Network Professionals on Understanding Grandparent Scams


Join the Administration for Community Living Office of Elder Justice and Adult Protective Services (OEJAPS) Resource Centers for a webinar tomorrow September 14th at 3:00pm ET entitled "Understanding and Fighting the Grandparent Scam: What Aging Network Professionals Should Know to Empower Older Adults."  In this webinar, aging services professionals will learn how to identify this fraud, empower grandparents to resist this scam, partner up with law enforcement to go after the scammers and help those who have experienced this scam to recover from their losses and regain their agency.

Register Now

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