Senate Hearing on Improving Oversight, Transparency, and Accountability for Nursing Homes

May 19, 2023
Policy Snapshot

On May 18, 2023, the Senate Special Committee on Aging convened a hearing, “Residents at Risk: The Strained Nursing Home Inspection System and the Need to Improve Oversight, Transparency, and Accountability,” to discuss the need for improvements to the nursing home inspection systems. The hearing focused on the severe staffing shortages at state survey agencies and delays in nursing home inspections that threaten resident safety, and featured testimony from government agencies like HHS OIG, Colorado State Long-Term Care Ombudsman, the Missouri Department of Health and Senior Services, as well as a professor from Purdue University.

The committee chair, Sen. Bob Casey (D-PA), spoke to the shortfalls in the nursing home inspection system and the need to invest in oversight. The committee also released findings from a 2022 investigation on the capacity of state inspection agencies to enforce health and safety standards, “Uninspected and Neglected: Nursing Home Inspection Agencies are Severely Understaffed, Putting Residents at Risk.” The report notes that one in nine nursing homes hasn’t had a comprehensive annual inspection in two years, causing more families to file complaints that states are slow to investigate. The report also notes that 32 state survey agencies have vacancy rates of 20% or more among nursing home inspectors and nine of those agencies have a vacancy rate of 50% or higher.

The committee’s ranking member, Sen. Mike Braun (R-IN), spoke about excessive federal regulations and the barriers they pose to people looking for work in long-term care and his concern that workers would be subject to overtime regulations that contribute to reducing staff flexibility and quality of care.

Many of the witnesses noted the need to improve inspections to help improve the quality of care to ensure conditions and staffing are improved. The need for transparency in nursing homes was also discussed as was the need for quality information and public awareness so the residents and their families can make informed decisions.

Sen. Kirstin Gillibrand (D-NY) inquired about the need for facilities to disclose who their medical directors are. She asked witnesses if having the medical director publicly listed would help hold nursing homes more accountable. Many witnesses agreed that it could help increase the quality of care and add additional safeguards. She also asked if there should be a limit to how many nursing homes medical directors oversee. The witnesses noted that it’s hard to put a number on that because there are lots of factors that come into play.

Overall, the hearing highlighted the need for stronger oversight and enforcement of regulations to protect residents of nursing homes. Witnesses emphasized the importance of increasing inspections, improving access to information, and providing greater opportunities for resident engagement and oversight. These recommendations are a step in the right direction toward ensuring that all residents of nursing homes receive the care and protection they need and deserve.

The Society will be submitting written testimony for the record to help address some of the issues raised during the hearing.

View the full hearing here.