New Federal Nursing Home Safety Bill Would Increase Staffing Minimums, Levy $10K/Day Fines

A new piece of legislation before Congress seeks to protect individuals in nursing homes by implementing more stringent staffing protocols — including increased clinical hours and training — among other safety measures for residents.

Co-sponsored by Rep. Jan Schakowsky of Illinois and Sen. Richard Blumenthal of Connecticut — both Democrats — the Quality Care for Nursing Home Residents Act also has the support of 25 representatives and two senators.

Rep. Schakowsky outlined the bill as calling for more sufficient staffing levels, increased nurse training, and stronger protection for nursing home residents’ legal rights.


More specifically, the bill calls for:

  • Increased baseline staffing levels under Medicare and Medicaid;
  • Heightened training and supervision obligations for nursing staff;
  • Safeguards for whistleblowers for both personnel and residents;
  • Bans coercive arbitration arrangements between nursing homes and residents;
  • Implements a regulated protocol for collecting consent, both written and informed, from residents treated with psychotropic drugs

Staffing has come under scrutiny from lawmakers and the Centers for Medicare & Medicaid Services, with CMS recently amending the five-star rating system to make attaining a top staffing rating more difficult. The issue has also been in the mainstream press for the last year-plus, with a July 2018 New York Times piece revealing that nursing homes had been significantly over-reporting their nurse and caretaker staffing levels for years; CMS responded by slapping 1,400 buildings with the lowest one-star rating for staffing.

Under the Schakowsky-Blumenthal proposal, nursing homes would have to meet the following standards for staffing, or face a freeze on payments and fines of $10,000 per day — as well as potentially having the government temporarily take over the property or terminate its ability to participate in Medicare and Medicaid.

Source: Rep. Jan Schakowsky

The plan would also require facilities to employ three registered nurses as management personnel.

SNN spoke to Schakowsky about her history working on protective measures for residents in nursing homes, and more particularly around the history of this bill.

“I have been working on this issue for a long time. I introduced legislation in the 114th Congress to guarantee that there would be a registered nurse that would always be present in a nursing home — because now the requirement is only eight hours a day, something I think would shock most people,” Schakowsky said.

The representative acknowledged the essential nature of nursing homes, pointing to a resident population of 1.4 million Americans every year — including older Americans, people with disabilities, patients with physical and mental health concerns.

“They all depend on good care,” she said. “But you know, we have seen — and you know I have seen — time and time again that nursing homes in the United States are too often understaffed and mismanaged, and prevent residents from receiving the care they need.”

Pointing to studies on resident abuse citations that “more than doubled between 2013 and 2017,” and news reports about “residents who were maltreated or even sexually abused by nursing home staff,” Schakowsky added that increasing safety measures for residents “has been a critical issue for a long time, and I think the time is now for us to do something about it.”

As the co-founder and now co-chair of the House Democratic Task Force on Aging and Families, the representative said that this issue has been a major fight of her career, “and I think that we need some real changes.”

Mark Parkinson, president & CEO of the American Health Care Association (AHCA) responded to the new bill with concern — pointing to staffing and reimbursement challenges that need a closer look, and suggesting that the bill lacks a practical application to the industry.

“The skilled nursing profession has serious concerns about the practical implementation of the proposals in this bill,” Parkinson said in a statement. “Today, our profession suffers from a critical workforce shortage and setting minimum staffing levels will not solve that issue. We need solutions like loan forgiveness that will help attract more workers to the long term care profession.”

Parkinson also pointed to tight Medicaid reimbursements across the country, which has led to widespread distress for operators.

“In addition, the shortfall in Medicaid funding has already led to facility closures across the country. Without additional funding, it’s impossible for facilities to implement new mandates, such as those included in this bill, without risking more closures,” Parkinson said.

Instead, Parkinson suggested that “real solutions” are needed, such as “the proposals that will allow reinstatement of CNA training programs.”

One such proposal is the Nursing Home Workforce Quality Act, another proposed piece of legislations that would remove a mandatory two-year ban on CNA training that the government levels against providers hit with a civil monetary penalty of $10,000 or above.

Schakowsky responded by saying that “if nursing homes would pay people decently, then there certainly would not be a shortage,” and added that it doesn’t surprise her that the industry, especially in Illinois, is opposing this legislation.

“I would be more than willing to talk to the industry about these issues, but you know, I haven’t seen them come to me and talk about solutions either,” she said. “If the industry wants to come and see me and have some constructive things to say about some items that are in the bill and how we might work together, I would welcome that.”

LeadingAge, which represents non-profit long-term and post-acute care facilities, similarly pointed to funding struggles, quoting one of its members in a statement on the bill: “We don’t even have people to interview, much less hire. Last year [2017], we had 9,000 RN, LPN, and CNA jobs in our state and only 2,500 applicants.”

Katie Smith Sloan, president and CEO of LeadingAge, similarly expressed support for the Nursing Home Workforce Quality Act, and said the Schakowsky-Blumenthal bill doesn’t address the roots of the tough employment market.

“While this legislation’s intent may be laudable, the reality is that our members, like all providers of skilled nursing, face a workforce crisis,” Sloan said in a statement. “There are simply more jobs open than can be filled across the U.S.”

For her part, Schakowsky noted that any legislation aimed at protecting seniors will be met with popular support.

“But they need to know that these concerns are widespread: nursing home neglect and abuse polls off the charts among people who are asked about this,” the representative said. “And so they are going to have to come around to do better, especially since we’ve seen this spike in problems in nursing homes.”