An Replace on President Biden’s Lengthy-Time period Care Initiatives – Visitor Columns

Angela Rinehart

President Joe Biden delivered his State of the Union address on March 1, 2022. He clearly announced his intention to “set higher standards for care homes” to “ensure your loved ones receive the care they deserve and expect.”

President Biden focused on four key goals related to long-term care facilities and providers:

  1. Set a new minimum staffing quota to protect residents
  2. Reduce room overcrowding
  3. Strengthen Value Based Compensation (“VBP”) to ensure taxpayers pay for quality care
  4. Reinforce protection against unnecessary medications and treatments

The Centers for Medicare & Medicaid Services (“CMS”) has released new and updated guidance and requirements to advance President Biden’s goals. This column focuses on two of those objections: overcrowded rooms and unnecessary medications and treatments.

Reduce room overcrowding

Norris Cunningham

In CMS’ Revised Long-Term Care Surveyor Guidance, issued June 29, 2022, the agency asked providers to consider changes to their physical environment to allow for maximum double occupancy in each room. In addition, CMS encouraged facilities to explore ways to provide more single rooms for residents.

CMS explained several benefits of limiting rooms to double or single occupancy, including:

  1. Increased privacy for residents for daily activities such as dressing and visiting friends and family (§483.10(h)).
  2. Promoting a livable environment (§483.10(i)).
  3. Improving infection control and prevention by reducing the risks associated with multiple residents in the same room and facilitating the isolation or quarantine of infectious residents.

While families can certainly be happy with this recommendation, there are obvious concerns about a facility’s ability to make such a change.

Changes in the physical environment would require physical facility changes if facilities intended to maintain current occupancy levels. Otherwise, more single rooms without expanding the physical facility will require an adjustment in resources, a reduction in occupancy, and as a result, the facility’s revenue will decrease, taking away other residents’ resources. Any drop in sales in an industry already facing higher costs for labor, materials and other expenses will almost certainly impact the quality of care.

Reinforce protection against unnecessary medications and treatments

The updates also include improvements to the CMS guidelines for mental health and substance use disorders and build on the agency’s behavioral health strategy to better meet the unique needs of residents of LTC facilities with mental health and substance use problems. CMS has also clarified the minimum level of knowledge and skills required of the facility’s staff to ensure that policies and practices do not conflict with residents’ rights or other attendance requirements.

In recently announced updated eligibility rules, CMS addresses the unnecessary use of non-psychotropic medications and antipsychotics and advocates gradual dose reductions for residents who may have entered the facility with such medications. CMS further addresses the rights and available services for residents with mental health needs, including an emphasis on situations where physicians or facilities may have misdiagnosed or miscoded a resident.

Specifically, in the updated Expert Guide, CMS notes that CMS is aware of situations where physicians may have misdiagnosed residents with a condition for which antipsychotics are an approved use (e.g., new diagnosis of schizophrenia), which then the resident of Remaining Antipsychotic Quality Measure.

For these situations, CMS advises that this practice may require referrals by the facility and/or the survey team to state medical boards or nursing boards. Therefore, facilities and their staff must be on high alert that surveyors pay special attention to these practices.


A factsheet on the new and updated guidance on the health and safety of care home residents is available on the CMS website.

The online SOM will be updated on or after October 24, 2022 when these changes become effective. With these ongoing changes and updates to an already heavily regulated industry, there are certainly many questions. It is recommended that the management of the long-term care facility work closely with the legal counsel to interpret these updates and regulations and ensure compliance.

Angela Rinehart is Associate Lawyer in the Health Care and Litigation groups of Stoll, Keenon, Ogden (SKO). She joined the firm in 2022 following the merger with Katz Korin Cunningham PC. Contact them at [email protected].

Norris Cunningham is a member of the Indianapolis office of Stoll, Keenon, Ogden (SKO) and specializes in healthcare. He co-founded Katz Korin Cunningham PC which merged with SKO in 2022. Contact him at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest articles are those of the author and not necessarily those of McKnight’s Long-Term Care News or its editors.

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