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CMS Issues Major Updates to Nursing Home Care Guidelines
Libby Hastings • November 22, 2024
If you have a loved one in a nursing home, there’s important news about changes that could impact their care. The Centers for Medicare & Medicaid Services (CMS) has issued significant revised guidance for nursing home surveyors, with updates spanning everything from admission and discharge policies to medication use and infection prevention practices. These changes, effective February 24, 2025, aim to enhance the health, safety, and quality of life for residents in long-term care facilities.
What’s Changing?
CMS’s new 900-page revised long-term care surveyor guidance document includes updates to critical care areas such as:
- Medication Use and Chemical Restraints: A key focus is reducing the unnecessary use of psychotropic medications. Facilities must prioritize non-drug treatments unless clinically inappropriate and cannot use psychotropics as “chemical restraints” for staff convenience. Residents and families also gain stronger rights to be informed and make decisions about medication use.
- Infection Control: Enhanced measures, including updates for preventing the spread of multidrug-resistant infections and COVID-19, will improve safety for residents.
- Admission and Discharge Practices: New guidance on prohibiting the requirement of families or third parties to guarantee payment in admission agreements and clarify when discharges or transfers are considered inappropriate.
- Personalized Pain Management: Updated pain management guidance aligns with the latest CDC standards, focusing on individualized treatment plans tailored to residents’ needs.
Medication Rights: A Focus on Psychotropics
CMS is strengthening protections against the misuse of psychotropic medications, such as antipsychotics. These medications should only be used when necessary and with clear medical justification.
“This change will help to streamline the survey process, increase consistency, and strengthen our message that facilities must prevent the unnecessary use of psychotropic medications,” CMS said in a memo signed by David Wright, director of quality, safety and oversight. Residents also retain the right to refuse or accept treatment after being fully informed of their options.
Surveyors, who inspect nursing homes for compliance, are now required to:
- Investigate cases where antipsychotics are prescribed without sufficient medical documentation.
- Interview medical directors over their role in the use and abuse of unnecessary medication, especially for residents diagnosed with conditions like schizophrenia without proper evidence.
Strengthening Oversight and Care Standards
Beyond medication use, CMS is addressing broader care issues:
- Enhanced Accuracy: New instructions help ensure health assessments accurately reflect residents’ needs.
- Health Equity: Facilities must now consider factors like race, socioeconomic status, and language when addressing health disparities and developing quality improvement plans.
- Physical Environment: Newly certified facilities gain more flexibility in meeting certain room and bathroom requirements.
What Families Should Know
These updates mean more transparency, better oversight, and stronger protections for residents:
- At the request of nursing facility residents, families should be involved in care decisions and ask about how these changes will affect their loved ones.
- Nursing homes must provide safer, higher-quality care without the use of unnecessary antipsychotic medication, with greater accountability for medical directors and staff.
- Surveyors will have clearer tools to identify noncompliance, ensuring facilities meet residents’ needs.
Looking Ahead
The updated guidelines take effect in February 2025, giving nursing homes and their staff time to adjust. Training on these changes is already underway.
The Kansas legislative session is in full swing, making it the perfect time to engage with your lawmakers and advocate for policies that improve long-term care in our state. Whether you're a seasoned advocate or just getting started, knowing how to effectively communicate with legislators is key to making a difference. We believe that every voice matters, and lawmakers want to hear from the people they represent. To find your legislator, visit the Kansas legislative website. When you visit www.kslegislature.org , there is an option on the left side of the website to “Find Your Legislator”. You may search by name, chamber, party, or select “Seach by Your Address”. This will lead you to Plural , a platform to find bill information and your local legislators by typing in your home address. Tips for Effective Advocacy Be Friendly – Legislators are people too! Approach them with sincerity and honesty. While time may be limited, be sure to focus on the issue you're there to champion. Be Prepared – This is your chance to educate. Start with a clear, concise explanation of the issue, and provide only factual information. Be Respectful – Not everyone will agree with your position. Some lawmakers may have concerns about costs, feasibility, or other factors. Treat them with respect, as they may be allies on future issues. Be Direct – Answer questions openly and honestly. Share the full picture, including both the challenges and the solutions. Ask for a Specific Action – Make it clear what you want your legislator to do. Common advocacy actions include: Sponsoring a bill Urging committee leadership to take action on a bill Speaking for or against a bill during debate Holding a public event to raise awareness Writing a letter to state agencies about oversight and implementation of a law Establish a Relationship – Don't just reach out when you need something. Contact your legislators regularly, thank them when they support your issues, and stay engaged. Building a relationship increases the likelihood they will listen when you advocate for change. Say Thanks – Gratitude goes a long way! Always follow up with a thank-you note or email after a meeting, even if the legislator disagrees with your position. Advocacy is about persistence, education, and relationship-building. By using these strategies, you can help ensure that long-term care remains a priority for Kansas lawmakers. Want to learn more? Check out KABC’s full Advocacy 101 guide here .
On Thursday, January 30th, Dan Goodman, Executive Director, presented testimony before the House Social Services Budget Committee. His remarks focused on essential recommendations for the Kansas Department of Aging & Disability Services (KDADS) budget, underscoring the urgent need for a Statewide Resource Guide for Older Kansans. Dan’s testimony emphasized Kansas’s rapidly aging population, with projections showing that more than 20% of Kansans will be 65 or older by 2030. With state resources already stretched thin, KABC urged the committee to prioritize investments in solutions that diversify and enhance access to long-term care services across Kansas. Highlighting the Statewide Resource Guide KABC’s flagship recommendation was a comprehensive Statewide Resource Guide for Older Kansans, modeled after the highly successful Douglas County Senior Resource Directory. The proposal seeks $190,000 to develop and distribute a directory that would serve as an essential tool for older Kansans and their families. The funding would cover: Initial Setup & Information Coordination: $85,000 One-Time Master Printing for Statewide Distribution (35,000 copies): $105,000 The guide would provide accurate, accessible, and up-to-date information on long-term care services and resources, with an online version that could be printed on demand. This initiative aligns with the Senior Care Legislative Task Force’s final recommendations and would empower Kansans to make informed decisions about care options. Dan emphasized the proven success of the Douglas County Senior Resource Directory, which KABC developed with grant funding through the Douglas County Community Foundation. Since its launch, the directory has been accessed online by over 700 individuals and distributed to hundreds of older adults, caregivers, and local businesses. Expanding this model statewide would ensure that every Kansan—regardless of where they live—has access to vital information when they need it most. Other Budget Priorities KABC Supports KABC also backed several of KDADS Governor’s budget recommendations, including funding increases for: HCBS Frail Elderly Waiver Growth HCBS Brain Injury Waiver Growth Nutrition Services Incentive Program Stay tuned for updates as we continue to advocate for these critical investments during the legislative session!