The Trump administration – reversing guidelines put in place under The president – is scaling back the use of fines against nursing homes that harm residents or place them in grave injury risk.
The shift in the Medicare program's penalty protocols was requested through the nursing home industry. The American Health Care Association, the industry's main trade group, has complained that under Obama inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.
“It is critical that we have relief,” Mark Parkinson, the group's president, wrote in a letter to then-President-elect Donald Trump in December 2021.
Since 2021, nearly 6,500 nursing homes – 4 of every 10 – have been cited at least one time for any serious violation, federal records show. Medicare has fined two-thirds of these homes. Common citations include neglecting to protect residents from avoidable accidents, neglect, mistreatment and bedsores.
The new guidelines discourage regulators from levying fines in certain situations, even when they have resulted in a resident's death. The guidelines will even probably lead to lower fines for many facilities.
The alternation in policy aligns with Trump's promise to reduce bureaucracy, regulation and government intervention in business.
Dr. Kate Goodrich, director of clinical standards and quality in the Centers for Medicare & Medicaid Services (CMS), said inside a statement that unnecessary regulation was the primary concern that medical service providers raised with officials.
“Rather than spending time using their patients, the providers are spending some time complying with regulations that will get when it comes to taking care of their sufferers and doesn't boost the quality of care they offer,” Goodrich said.
But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.
“They've virtually emasculated enforcement, that was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.
Medicare has different ways of applying penalties. It may impose a specific acceptable for a particular violation. It may assess a fine for every day that a nursing home was in violation. Or it can deny payments for brand new admissions.
The average fine recently has been $33,453, but 531 nursing facilities amassed combined federal fines above $100,000, records show. In 2021, Congress increased the fines to element in several years of inflation which had not been taken into account previously.
The new rules happen to be instituted gradually all year round.
In October, CMS discouraged its regional offices from levying fines, even just in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents' health and safety or systemic errors should still merit fines.
A July memo from CMS discouraged the administrators of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.
Dr. David Gifford, the American Healthcare Association's senior v . p . for quality, said daily fines were intended to prompt quick remedies but were pointless when put on past errors that had already been fixed when inspectors discovered them.
“What was happening is you were seeing massive fines accumulating because they were applying them on the per-day basis retrospectively,” Gifford said.
But the modification means that some nursing homes might be sheltered from fines above the maximum per-instance fine of $20,965, for egregious mistakes.
In September 2021, for instance, health inspectors faulted Lincoln Manor, an elderly care facility in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The individual died.
CMS fined Lincoln Manor $282,954, including $10,091 each day for 28 days, from the time the nursing home noticed the issue using the wound until supervisors had retrained nurses to prevent similar errors. An administrative law judge called the penalties “quite modest” because of the “appalling” care.
The fines were issued prior to the new guidelines took effect; if the agency had issued a one-time fine, the maximum could have been less than $21,000.
Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not react to an interview request.
Advocates for nursing home residents state that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, an advisor for California Advocates for Nursing Home Reform, said the alterations be “some egregious violations and injuries to residents are now being penalized – finally – in a level that will get the industry's attention and isn't just the cost of doing business.”
In November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 1 . 5 years. Homes must still stick to the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and also to ensure that every home has adequate resources to assist residents with major psychological problems.
Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are available looking for opportunities to reveal that the nursing facilities are not living up to some extremely tight standards.” He explained while the motivation for tough regulation was understandable, “the fines don't help you to hire people and make it easier to stay in business.”
In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.
“We publish nearly 11,000 pages of regulation each year,” the agency's administrator, Seema Verma, said in a speech in October. That documents are “taking doctors away from what matters most: patients.”
Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing facilities along with other entities that care for seniors, said the group's members had been struggling to deal with regulations.
“If you're a 50-bed rural facility out West or in the Dakotas,” she said, “you not have the resources to get everything done from the to Z.”