Senator Warns of ‘Draconian’ Medicaid Cuts in Nursing Home Safety Hearing

Various industry stakeholders on Wednesday took to Capitol Hill for a hearing on safety standards at the country’s skilled nursing facilities, but one leading senator took the opportunity to sound the alarm over potential cuts to the Medicaid program.

The Trump administration could move as soon as next week to publicly restart the fight over Medicaid funding, ranking member Sen. Ron Wyden said in his opening remarks at a Senate Finance Committee hearing titled “Not Forgotten: Protecting Older Americans from Abuse and Neglect in Nursing Homes.”

“We’ll see proposed another draconian cutback on Medicaid,” Wyden, an Oregon Democrat, said. “Medicaid helps cover costs for two out of three seniors in nursing homes. I’m going to fight this proposal with everything I’ve got, because it would turn back the clock on efforts to improve care and it would inevitably lead to more nursing homes closing their doors, which would especially work a hardship in rural America.”


Though the president isn’t set to release his budget blueprint until next week, early reports have indicated that the White House plans to revive a partisan brawl over Medicaid funding that last erupted in 2017, during the larger debate on the Affordable Care Act. Trump and other Republicans have indicated a preference for converting the open-ended Medicaid funding system to a block-grant or captitated model, which could potentially drain hundreds of billions of dollars from the program.

Elder-care industry advocates led a successful charge against the plan by pointing out the vital role that Medicaid, a program traditionally associated with lower-income adults and children, plays in the nursing home landscape: Wyden’s estimate tracks with a 2017 analysis from the Kaiser Family Foundation, which found that Medicaid covers about 62% of nursing home residents.

Still, Wyden and Sen. Chuck Grassley, the Iowa Republican who chairs the finance committee, indicated in their remarks that beefing up nursing home oversight will represent an area of bipartisan teamwork in an otherwise fiercely divided Washington.


“This is a systemic problem that does not seem to respond to whoever’s in control of any bureaucracy here,” Grassley said.

Funding leads to quality care

Wyden and other speakers at Wednesday’s hearing noted the connection between solid funding and harm prevention, with even the most vocal critics of the current oversight system acknowledging the difficult circumstances under which many of the top-performing nursing home employees work.

“I want to thank the CNAs, nurses, and others who work in care facilities and do their jobs right,” Patricia Olthoff-Blank, a witness whose mother died as a result of alleged neglect in an Iowa facility, said in her prepared testimony. “The facilities are often understaffed, and these people work for much less money than they should be paid. Please thank those people if you have a loved one in nursing care.”

Still, the testimony from Olthoff-Blank and fellow witness Maya Fischer — whose mother was raped in the nursing home where she received care for advanced Alzheimer’s — was harrowing, and the representatives from the industry and the Centers for Medicare & Medicaid Services (CMS) faced pointed questions about efforts to protect vulnerable elders.

“On behalf of AHCA, I am appalled and disgusted by the two devastating incidents we will discuss here today,” David Gifford, the American Health Care Association’s senior vice president of quality and regulatory affairs, said. “Chairman Grassley and committee members, thank you for making sure that they are not forgotten.”

Gifford mentioned a variety of ways that the nursing home industry has improved safety over the last decade, including reductions in hospital readmissions and psychotropic drug use, as well as increases in the amount of time that staffers spend with residents. He suggested that instead of expanding the scope of regulations, legislators and CMS should focus on developing programs that help providers attract and retain quality nurses — such as loan forgiveness initiatives — as well as more streamlined data-sharing processes that would allow providers to more easily identify employees with prior histories of abuse or neglect.

“It is AHCA’s position that neither the number of pages of regulations nor the amount of penalties imposed … will stop bad actors from engaging in bad activities,” Gifford said. “Rather, we would recommend focusing on primary prevention strategies to prevent neglect or abuse before it happens.”

The hearing also came on the heels of CMS’s Tuesday announcement of a major overhaul to the Five-Star Quality Rating System, which will see stricter standards for staffing deficiencies, separate ratings for short- and long-term care quality, and other new metrics take effect in April.

“While nursing facilities have made progress towards these goals, there continues to be a strong and persistent need for ongoing improvement efforts around patient safety and quality of care in nursing homes,” Kate Goodrich, CMS’s chief medical officer, said during her testimony.

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