Administration Takes New Steps to Improve Nursing Home Quality

October 21, 2022 by Dan McCue
Administration Takes New Steps to Improve Nursing Home Quality
(Photo by Gert Stockmans via UnSplash)

WASHINGTON — The Biden administration is taking new steps to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes and make them safer.

The new initiatives follow up on President Joe Biden’s promise during his State of the Union address in March to improve the safety and quality of care in the nation’s nursing homes.

They are intended to complement the administration’s investments in home and community-based services to prevent unnecessary nursing home admissions and help nursing home residents transition back home when possible.

Among the steps announced on Friday are a more aggressive approach to taking enforcement actions against the worst-performing nursing homes.


The Special Focus Facilities Program, overseen by the Centers for Medicare and Medicaid Services, already provides more frequent inspections of these nursing homes.

Effective immediately, CMS will begin using escalating penalties for violations, including considering facilities with citations for dangerous violations in two successive inspections for termination from Medicare and/or Medicaid funding.

Under today’s changes, CMS will also increase the requirements that nursing homes in the SFF Program must meet to be successful and graduate from the program. 

Even after a facility graduates from the program, CMS will continue close scrutiny of the facility for at least three years — helping ensure these nursing homes consistently maintain compliance with safety requirements.

CMS is also increasing its engagement with these poor-performing nursing homes, through direct and immediate outreach by CMS officials upon their selection as an SFF, to help them understand how to improve and to access support resources like CMS Quality Improvement Organizations.

In conjunction with these efforts, the Department of Health and Human Services and Department of Labor on Friday announced a wide variety of funding opportunities intended to create more “good-paying, union jobs” in the nursing home industry.


Beginning Friday and extending through Jan. 6, nonprofit health care organizations, industry organizations or trade groups, labor unions, labor management organizations, education and training providers, workforce development entities, and Native American tribal governments can apply for the DOL’s Nursing Expansion Grant program, which will provide $80 million in grants to help address bottlenecks in training the U.S. nursing workforce and expand and diversify the pipeline of qualified nursing professionals. 

Specifically, administration officials said these funds will help: 

  •  Increase the number of clinical and vocational nursing instructors and educators.
  • Train frontline health care professionals and paraprofessionals, including direct care workers, to advance along a career pathway and attain recognized postsecondary credentials, including licensed practical nurses and registered nurses.

The program will emphasize training those from historically marginalized and underrepresented populations, which helps to address the growing health equity gap in medically underserved communities.

The Department of Health and Human Services also announced the availability of $13 million in grants to expand nursing education and training. 

These funds made available through the Health Resources and Services Administration will help expand the number of nursing preceptors — experienced licensed clinicians who supervise nursing students during their clinical rotations. 

Expanding preceptors will help support the goal of nursing schools admitting more students by providing more opportunities for well-supported clinical rotations and, ultimately, career paths. 

By the end of this year, DOL’s Employment and Training Administration’s YouthBuild will make available approximately $90 million in grant funding for eligible nonprofit organizations or consortia eligible to provide education or employment training under a federal program, in order to provide job training and educational opportunities for at-risk youth, with over one-third of recent grantees offering health care-related training.

In the first half of 2023, ETA’s WORC Initiative Grants will make available up to $35 million in grants to enable impacted communities to develop local and regional workforce development solutions aligned with existing economic development strategies and community partnerships to promote new, sustainable job opportunities and long-term economic vitality, all to support dislocated workers, new entrants to the workforce, and incumbent workers for good jobs in high-demand occupations including behavioral health, dental health and health IT.


The new efforts build on a number of other actions taken by the Biden administration this year, including cracking down on illegal debt collection by nursing homes; increasing transparency on who owns Medicare-certified nursing homes; incentivizing quality performance through Medicare and Medicaid funding, launching an enhanced Nursing Home Five-Star Quality Rating System; integrating data on nursing homes’ weekend staffing rates for nurses and information on annual turnover among nurses and administrators; and updated federal guidance to nursing home inspectors, including, among other things, requiring infection control specialists to be on site.

Dan can be reached at [email protected] and at https://twitter.com/DanMcCue.

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