The Department of Health and Human Services (HHS) restructuring plans announced Thursday could impact several departments serving the nursing home sector, leaving operators on edge.

The department plans to cut around 10,000 full-time employees, including 300 at the Centers for Medicare and Medicaid Services (CMS), in the latest round of cuts. Combined with HHS’ previous efforts, the restructuring will reduce the workforce from 82,000 to 62,000 full-time employees, the department said.

HHS also plans to consolidate regional field offices, shrinking them by half, which could impact surveys and their timely completion and reporting.

And besides CMS, cuts at the Centers for Disease Control and Prevention (CDC) – whose disease trackers have been invaluable tools for infection prevention and control – could result in disruptions as well, adversely impacting nursing homes’ management of disease outbreaks, experts said.

Operators, who spoke to Skilled Nursing News, said they were worried on many fronts and staying in close contact with lawmakers to make sure that nursing homes were not left stranded as a result of the downsizing.

“There’s inexact science being applied here. Whether it’s the cuts to HHS, CMS, or any other agency, these cuts happen in a broad stroke,” said Steve LaForte, director of corporate affairs and general counsel with Cascadia Healthcare, told Skilled Nursing News.

Besides the abrupt nature of the process, LaForte voiced fear of the unknown during the “flux period.”

“It concerns Cascadia and it concerns the whole sector because we want to believe that whatever is going to happen to get to greater efficiency is going to happen without undue disruption,” he said. “We care for the vulnerable adults, the seniors, and unlike other sectors that they’re changing, there’s no room for error here.”

To ensure that nursing homes are insulated from serious ramifications, LaForte said that it is important for the sector to pursue conversations with lawmakers proactively. To that end, Cascadia has been actively engaging with the members of the Senate Finance Committee.

“We have to keep our voice in the mix and stay vigilant,” LaForte said. “Now is a time when we have to double down on the advocacy that we’re doing. I plan to spend multiple hours up on the Hill talking to our Congress members and Senators about these issues.”

What’s at stake?

At LeadingAge, the largest association of nonprofit providers of aging services, the HHS job cuts, the downsizing of divisions, and shuttering of regional offices, are raising worries. The advocacy group said that the “dramatic scale” of the reductions on a tight timeline fails to allow a thorough examination of short- and long-term impacts to the long-term care sector.

The HHS fact sheet stated an aim to streamline functions by consolidating 28 divisions into 15 new divisions — including a new department called the Administration for a Healthy America (AHA) — noting redundancies across departments. HHS also plans to centralize core functions such as human resources, information technology, procurement, external affairs, and policy. Meanwhile, its regional offices will be reduced from 10 to five offices.

The move to cut HHS field offices to half the current number may hinder how CMS runs surveys, certifications, and enforcement activities, LeadingAge officials said. After all, CMS offices are responsible for overseeing the nursing home survey process, ensuring provider compliance, and addressing disputed citations.

“Cutting the staff responsible for carrying out agency and department activities raises obvious questions,” Katie Smith Sloan, president and CEO of LeadingAge, said in an emailed statement. “We are closely monitoring the execution of [Thursday’s] announcement. We urge HHS to ensure that older adults and the providers who serve them will not be an afterthought in this reorganization.”

For now, the cuts have opened up a Pandora’s box of questions for LeadingAge leaders.

“How will the work that our members rely on get done? How will their ability to serve older adults, and ensure quality care, be impacted? And will [the HHS] announcements limit older adults’ and families’ ability to access care and services?” asked Smith Sloan.

Infection prevention

​​The CDC workforce will be cut by about 2,400 employees, while the National Institutes of Health (NIH) will face losses of 1,200 workers.

“[The CDC will be] responsible for national disaster and public health emergency response … reinforcing its core mission to protect Americans from health threats,” the HHS fact sheet stated.

The CDC tracks disease through monthly statistics and is also responsible for distributing vaccines, providing guidance, and offering financial support. While it remains unclear how changes to many of these functions will impact nursing homes, certain committees within the CDC, such as the Healthcare Infection Control Practices Advisory Committee (HICPAC), are reportedly on the chopping block. HICPAC lends its expertise in combating evolving infectious diseases that pose serious public safety risks.

Infection prevention experts are deeply troubled by the cuts.

“The CDC’s funding cuts are likely to have a profound adverse effect on the ability of long-term care facilities to prevent and control infections. Many facilities do not have full-time Infection Preventionists, so there are no staff who have the knowledge to apply best practices when trying to control outbreaks of infections or to work with public health departments,” Deb Burdsall, consultant for the Association for Professionals in Infection Control and Epidemiology (APIC), told Skilled Nursing News. 

With the cuts in people and funding, nursing homes are once again going to be isolated, and missing crucial financial support and expertise to guide infection prevention programs, Burdsall said.

‘Operating in silos’

In announcing the cuts to HHS, Sec. Robert F. Kennedy, Jr., said in a YouTube video that the plan to consolidate all of these departments was aimed at making them more accountable to the “American taxpayer and the American patient.”

“When I arrived, I found that over half of our employees don’t even come to work,” Kennedy said in the video. “HHS has more than 100 communications offices and more than 40 IT departments and dozens of procurement offices and nine HR departments. In many cases, they don’t even talk to each other. They’re mainly operating in silos.”

While the job cuts – and the abrupt nature of the cuts – have been a source of confusion, LaForte remains hopeful that there is a silver lining when it’s all said and done, especially in reducing regulatory burdens.

“We have had a really active, positive dialog with a number of members of the Finance Committee … I know that those senators are all very thoughtful, deliberate, and both informed and understanding of the issues that Medicare, Medicaid and CMS face,” said LaForte, adding, “I look at this as a bipartisan issue,” with both Republican and Democratic senators representing states where Cascadia has nursing homes, favoring the upholding of protections for long-term care for older adults.