Ensuring Safety and Quality in America’s Nursing Home: 5 Key Takeaways from CMS’s Five Part Plan

On April 15, the Centers for Medicare and Medicaid Services (CMS) announced some new initiatives as part of their ongoing mission to make sure nursing homes adhere to the highest level of quality and safety.

This comes in response to a report from the U.S. Government Accountability Office that criticized CMS for gaps in federal oversight of nursing home abuse investigations. The report from the government watchdog claims that CMS failed to adequately track nursing home abuse allegations in Oregon and put patients in the state at risk.

While the statement issued by Seema Verma, the current Administrator of CMS, did not address the GAO report, it is clear that the organization is serious about reviewing and improving their nursing home oversight processes in order to rectify some of the glaring issues mentioned in the report.

Why is this important?

CMS, in addition to the administering of Medicare and Medicaid, is responsible for developing and upholding quality standards in long-term care facilities through its survey and certification process. This quality assurance is not only in the interest of protecting nursing home residents and their families, but also the individuals who work in them, like you.

Here are our 5 key takeaways from CMS’s five-part plan, and what it means for you:


1. There will be an effort to improve nation-wide consistency in nursing home oversight.

CMS uses the insight of State Survey Agencies (SSAs) to aid in the oversight of nursing home quality. SSAs are the boots on the ground eyes for CMS; they pay annual visits to facilities to make sure they are meeting health and safety requirements, as well as state licensure requirements.

However, there are overwhelming inconsistencies from state-to-state in how agency surveyors identify facility issues. This causes a large disparity in quality of facilities – so where one well-ranked facility may be in full compliance, another may have a score of issues that places residents and nurses in danger.
Verma writes that the first step is to examine processes of training state agencies from the top down. By re-educating state agencies on the expectations of a compliant facility and arming them with clearer procedures of identifying and reporting unsafe practices, the hope is that not only will more issues be caught sooner, but also that future negligence and abuse can be stopped in its tracks.

2. CMS will get tougher on compliance enforcement.

One major issue that plagues skilled nursing facilities is unsafe staffing ratios. Without safe staff ratios, providers cannot feasibly provide adequate, safe care to residents – putting nurses like you in uncomfortable, and potentially harmful situations. CMS is looking to toughen up on compliance, but by using data, they’re also hoping to be smarter about how they enforce it.

For instance, since late 2018, CMS has shared nurse facility staffing data with SSAs, so that agencies can predict which facilities have potential issues with staffing and can tailor their reviews – namely by conducting surveys unannounced at times that are statistically understaffed.
CMS is looking for ways to hold nursing homes more accountable with penalties for lack of compliance. The trickle-down effect of this tougher line on compliance means that nursing homes will be safer places for you to work.

3. There will be an increase in quality transparency.

Nursing Home Compare is a CMS-run website that shares quality and safety data to help the public make educated decisions on where they receive care, where they send their families for care, and where they work. While CMS currently shares important payroll-based journal (PBJ) data and quality ratings on their site, they have made a commitment to publish even more data.

When a facility is deemed unsafe, the public has a right to know. So, Verma promised that CMS will not only publish but also actively spread the word when nursing homes fail to meet minimum quality standards. CMS also recognizes that transparency means not only publishing more data, or making data more readily available, but publishing data that the public can understand and use to make informed decisions.

4. Quality can improve once old ways are removed.

“This is not business as usual — we are pushing beyond the status quo,” wrote Verma. While CMS has always been responsible for ensuring quality, just as healthcare practice continues to evolve, so should the methods by which we measure the quality of our healthcare facilities.

Part of pushing past the status quo comes with the hard look CMS takes on its current processes and asking how they can be improved.

One way is to score providers on outcomes, not on their adherence to facility processes. This helps facilities push past practices that are done because they always have been and evolve towards practices that are done because they actually improve patient outcomes.

Money can also be a key driver to improve quality. CMS fines facilities a Civil Money Penalty (CMP) for non-compliance and these dollars could be put to good use. CMS plans to invest these dollars “to reduce adverse events, improve staffing quality and improving quality of care for residents with dementia.”

5. CMS will prioritize patients (and providers) over paperwork.

While proper documentation is essential in any healthcare setting, patients lose out when paperwork forces nurses to spend more time in front of a computer and less time bedside. Studies also cite administrative burden as one of the leading reasons for nurse burnout. (Read more about our thoughts on nursing burnout here.)

But how do you minimize burden while keeping patients safe? CMS is promising to take the challenge head-on. When implementing new rules and requirements for quality and safety, they want to focus on taking the most efficient approach to training and compliance. Verma emphasizes this point, stating that “going forward, we will continue to think about how we can streamline processes and eliminate obsolete, unnecessary, or duplicative provisions and we are interested in hearing from all stakeholders on ways to improve our programs.”


At IntelyCare, we are in a unique position as a partner of both nursing professionals and skilled nursing facilities, two stakeholders at the very epicenter of this issue. While it’s troubling to see the myriad of problems that nursing homes face come to light, we’re encouraged by the words and promises of Verma and her team.

We believe it is a step in the right direction to acknowledge that our nation’s nursing homes could be better and that there are initiatives in the works to make them better. We can always do better for our most vulnerable population, whether it’s by improving the quality of their care or the conditions of their caregivers.

We look forward to watching these changes unfold, and hope a safer nursing home experience, for you and your patients, is on the horizon.

IntelyCare was created by nurses, for nurses. We’re here to take care of those who take care of everyone else; our staffing solution gives nurses the opportunity for a better, more flexible schedule to help reduce nurse stress. At IntelyCare, we’re driven to offer nurses and CNAs healthcare’s best working experience. Apply today.


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