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January 25, 2022

In this Issue:

  1. OIG Report Details Problems with CMS Oversight of State Survey Agencies
  2. How Private Equity and Other Ownership Practices Harm Nursing Home Residents
  3. Assistance with Ordering Free At-Home COVID-19 Tests
  4. Upcoming NORC Webinars on Certification Training Curriculum and Emergency Preparedness
  5. Updated National Ombudsman Reporting System Training Materials
  6. Former Owner of National Nursing Home Chain Faces Federal Labor and Tax Charges

OIG Report Details Problems with CMS Oversight of State Survey Agencies

Last week, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released a report, CMS Should Take Further Action to Address States with Poor Performance in Conducting Nursing Home Surveys (OEI-06-19-00460), detailing problems with the Centers for Medicare & Medicaid Services’ (CMS) oversight of state survey agencies.  The report looked at the years 2015-2018 for all fifty states plus Puerto Rico and the District of Columbia. OIG found that over half of state survey agencies repeatedly failed to meet federal performance measures, with some states never meeting certain standards. The OIG made several recommendations, with which CMS mostly agreed.

To conduct its investigation, OIG reviewed performance evaluations, CMS’s use of remedies, and spoke with CMS’ central office and regional offices to conduct its investigation.

Key findings from the report include:

  • Over half of states failed to meet the same performance measure or measures over 3 or 4 years.
  • The most common type of state performance failure was timeliness of surveys.
  • CMS relied on corrective action plans to address performance failures, but many of these plans were missing from CMS files and lacked detail. As a result, these plans did not lead to improvements in many states.
  • CMS heavily relied on remedies such as training and technical assistance to survey agencies.
  • When CMS did impose financial penalties, it frequently offset these penalties by increasing funding in other areas.
  • CMS rarely escalated issues of poor performance to senior state officials and infrequently imposed formal sanctions.
  • 8 out of 10 regional offices used performance benchmarks to incentivize state compliance, which involved withholding federal match funds for survey and enforcement until states met certain benchmarks.  OIG found this to be effective in at least one state.

A timely and strong enforcement system is critical for assessing whether residents are receiving the care and services to which they are entitled under the Nursing Home Reform Law.  Congress and CMS must allocate the necessary funding for the survey and enforcement system in order to ensure that nursing homes fully comply with federal standards.

Read a full summary of the report and its recommendations.

How Private Equity and Other Ownership Practices Harm Nursing Home Residents

Over the past several years, private equity firm ownership of nursing homes has drawn significant attention from advocates, academics, and legislators. A study released in February 2021 found that private equity ownership of nursing homes increased the short-term mortality of Medicare residents by 10%, resulting in 20,150 more deaths over a twelve-year period. Private equity nursing home owners are concerned with profit. They use complicated, but legal, economic practices to divert Medicare and Medicaid dollars away from residents care and into their own pockets. However, many of the economic practices of private equity firms are used by many nursing home operators in the United States.

This past November, at the Consumer Voice's Annual Conference, experts Eileen O'Grady and Ernest Tosh gave an overview of how private equity ownership of nursing homes harms residents, and also shed light on economic practices common to almost all nursing homes. These practices result in little accountability for the billions of taxpayer dollars nursing homes receive each year and result in poor care and negative outcomes for residents.

Visit our website to view excerpts from this presentation and to learn more about private equity and what can be done to protect nursing home residents.

Assistance with Ordering Free At-Home COVID-19 Tests

As a part of the White House initiatve, free COVID-19 test kits are now available by ordering online.  The Eldercare Locator and the Disability Information and Assistance Line (DIAL) can assist older adults and people with disabilities with placing orders if they need additional help, connect people to accessible instructions, and help with administering the tests. Both phone lines are staffed Monday-Friday from 9 a.m. to 8 p.m. (Eastern).

  • Older adults can call the Eldercare Locator at 800-677-1116 Monday-Friday or visit the website to chat live or browse resources.  
  • People with disabilities can contact DIAL by calling 888-677-1199 or by emailing

Upcoming NORC Webinars on Certification Training Curriculum and Emergency Preparedness

The National Long-Term Care Ombudsman Resource Center (NORC) is holding two upcoming webinars for long-term care ombudsman programs:

Introduction to Initial Certification Training Curriculum for Long-Term Care Ombudsman Programs - Wednesday, January 26th at 3:00pm ET - The webinar will cover the basic curriculum for initial certification training based on the requirements included in the Administration for Community Living Long-Term Care Ombudsman Program Training Standards including a curriculum overview; preparation checklist and training tips; trainer guide; trainee manual; PowerPoints; and supporting materials (e.g., Glossary of Key Words, List of Training Video URLs).
Register Now

Are You Ready? Ombudsman Program Emergency Preparedeness and Response - Wednesday, February 23rd at 3:00pm ET - Participants will learn how Ombudsman programs may better serve residents of long-term care facilities by being prepared for emergencies and how to best respond to them. Beverley Laubert, National Ombudsman Program Coordinator, Administration for Community Living, will share the federal perspective regarding the role of Ombudsman programs in emergency preparedness and response and two states will discuss recent disasters and their practices before and after the disasters. Also, NORC will share a new training resource for basic Emergency Preparedness and guidance for the Ombudsman program’s role in assisting residents.
Register Now

Updated National Ombudsman Reporting System Training Materials

Long-term Care Ombudsman programs report their activities such as facility visits, complaints received and investigated, information and assistance provided, and community education to the Administration for Community Living (ACL)/Administration on Aging (AoA) to be summarized in the National Ombudsman Reporting System (NORS).

The National Long-Term Care Ombudsman Resource Center (NORC) updated the four-part NORS training materials in December 2021 to reflect revisions in ACL’s NORS tables. Ombudsman programs are encouraged to use these materials during initial certification training and as continuing education training to ensure NORS consistency.

The materials with UPDATED next to them on the NORS Training page were revised; long-term care ombudsman programs are advised to use these versions for training as the links have changed.

Former Owner of National Nursing Home Chain Faces Federal Labor and Tax Charges

Following an NBC News investigation, the former owner of national nursing home chain, Skyline Healthcare, is facing 22 federal charges of labor violations and failure to pay federal taxes.  Joseph Schwartz, who oversaw the care of more than 7,000 older adults through his company which owned or ran more than 100 facilities in 11 states, faces charges in New Jersey, Nebraska and Arkansas.  The company had also faced a slew of documented cases of extreme neglect.

Schwartz's son Louis Schwartz owns the facility in Adover, NJ once known as Andover Subacute II where 17 bodies were discovered stuffed into a small morgue during the early stages of the COVID-19 pandemic.  The facility is now part of a state attorney general's investigation into “facilities with high numbers of Covid-related deaths and below-average track records for health inspections, staffing, and quality of care.”

Read more in the article from NBC News.

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