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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.
If predictions are correct, the upcoming Kansas Legislature can likely be summed up by one word: “change.” Leadership changes, a large freshman class of legislators, new committee chairs and a compressed calendar all combine to make 2025 a year full of changes. Added to the mix is a stronger Republican supermajority with an additional 2 seats in the Senate and 3 in the House of Representatives. A quick breakdown by the numbers: The 2025 Senate is comprised of 31 Republicans and 9 Democrats. There are 14 new senators; 13 of whom are Republicans. Almost half of the new senators, 6, previously served in the House. Of the 40 Senators, 27 are men (a gain of 4) and 13 are women. Of the 125 members of the House, 88 Republicans make up the majority with 37 Democrats in the minority caucus. Of the 25 House freshman, 21 are Republicans and 4 are Democrats. Women will make up almost a third of the House, 41, with a gain of 6 House seats in the last election. There are 84 men in the House. One new House member previously served in the Senate. The legislature lost decades of institutional knowledge with the retirement of 19 House members and 14 senators. Many of the retiring legislators were experienced lawmakers who served in leadership positions and committee chairs. Significant procedural changes will impact legislative dynamics. Legislative leaders have adopted a compressed timeline for the 2025 session with plans to adjourn sine die no later than April 12 (the 90th day of the legislative session). Traditionally, the 90th day occurs at the end of April/early May with the ceremonial sine die held in late May. You can view the session calendar here. A new process will change the way the State budget is developed. Instead of using the governor’s budget as the base to begin negotiations, a special legislative budget committee will introduce what is being termed the “legislature’s budget” on Jan. 13, the first day of the session. The special committee met five days during November and December to craft a budget based on the 2024 approved budget, with very few enhancements requested by State agencies. How the budget process and tight time schedule proceeds is still largely to be determined. There are major changes in legislative leadership with the Senate electing Sen. Tim Shallenberger, (R-Baxter Springs) as its new vice president and Sen. Chase Blasi (R-Wichita) as majority leader. Sen. Ty Master (R-Andover) remains Senate president Dinah Sykes (D-Lenexa) will continue as Senate minority leader. In the House, Rep. Brandon Woodard (D-Wichita), takes the reigns as the new minority leader. Committees, too, will look different led by mostly new chairs and/or vice chairs along with new members. In the Senate, a new Committee on Government Efficiency, modeled off the proposed federal Department of Government Efficiency, will explore ways to restructure and reform state government to reduce spending and increase efficiency. All of these changes and multiple moving parts, including the goal to keep a tight rein on the budget, add up to uncertainty related to health and social services issues, including those impacting older adults. With all these variables, this will, in sports terms, be a “building year.” KABC will use this opportunity to build relationships with new and returning policy makers to explore legislation that supports person-centered policies and programs while protecting the rights of aging persons and those with disabilities. We will keep you regularly updated during the 2025 session and opportunities for advocacy but we encourage you to get acquainted with your elected officials. They want and need to hear from you, their constituents. Your experiences and observations about long term care in Kansas helps build their knowledge around these issues with first-hand information about the needs of the people they serve.
When you suspect abuse, neglect, or exploitation of older adults, report as soon as possible! For older adults living at home in the community or in facilities licensed by the Kansas Department of Aging and Disability Services when the perpetrator is not a resident of or staff of the facility, report to the following: Adult Protective Services (APS): 1-800-922-5330 If an emergency, call your local law enforcement agency or 911 The intent of APS is to protect the most vulnerable adults from harm while safeguarding their civil liberties. For more information, visit www.dcf.ks.gov/services/PPS/Pages/APS/AdultProtectiveServices.aspx When someone suspects abuse, neglect, exploitation, or fiduciary abuse of a vulnerable adult, reporting to APS is a critical step in ensuring the individual’s safety and well-being. Here’s what you need to know about the reporting process and what happens after a report is made. Reporter Immunity Individuals who report suspected abuse or participate in follow-up activities, including testifying in administrative or judicial proceedings, are protected under the law. This means they are immune from any civil or criminal liability, provided their report is not malicious. Additionally, employers cannot penalize employees for making a report or cooperating with an investigation. Confidentiality of the Reporter The identity of the person who makes a report is kept strictly confidential. APS will not disclose the name of the reporter or anyone mentioned in the report without written permission from the reporter or a court order. What Does APS Do When a Report is Received? Once a report is submitted, APS takes the following actions to investigate and address the situation: 1. Initial Visit: APS initiates a personal visit with the adult in question within 24 hours to five working days, depending on the risk of imminent danger to the individual. 2. Interview Process: The alleged perpetrator is interviewed unless this action could increase the risk to the adult. APS may also interview relevant individuals, such as service providers, relatives, or neighbors, to gather additional information. 3. Determination of Findings: APS evaluates the allegations and determines whether the report is substantiated or unsubstantiated regarding abuse, neglect, exploitation, or fiduciary abuse. 4. Prevention Plan: APS discusses with the adult, their guardian, conservator, or caretaker the necessary actions to prevent further harm. A service plan is developed with the adult to address unmet needs and ensure their safety. 5. Assistance and Services: APS helps the adult access services essential for maintaining their physical and mental health, such as: Legal services Medical care Safe and appropriate living arrangements Assistance with personal hygiene, food, clothing, or shelter Protection from maltreatment and transportation Services provided are tailored to meet the adult’s needs in the least restrictive way possible. 6. Advocacy: APS advocates for the protection of the adult’s rights and works to ensure they receive the necessary care and support. 7. Involuntary Intervention: If the adult is incapable of protecting themselves due to a major mental or physical disability and there are no other less restrictive options, APS may initiate legal steps such as guardianship or conservatorship. Reporting to APS is a powerful way to help protect vulnerable adults from harm. The process ensures that reports are handled sensitively, with protections in place for the reporter and a thorough investigation to address the individual’s needs. By taking action, reporters play a crucial role in safeguarding the well-being of those who cannot protect themselves.