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.
KABC Testifies before the Kansas Silver Haired Legislature Kansas Advocates for Better Care (KABC) is urging state leaders to provide additional funding to eliminate the waitlist for the Home and Community-Based Services (HCBS) Frail Elderly (FE) Waiver, which helps older Kansans access the services they need to remain in their homes and communities. In testimony submitted to the Kansas Silver Haired Legislature (KSHL) on October 6 th in Topeka, KABC Executive Director Dan Goodman emphasized the importance of preserving access to in-home care and preventing older adults from entering nursing facilities before they need that level of care. The FE waiver waitlist, implemented July 6, 2026, has already affected hundreds of older Kansans. Without additional funding, more people could face delays in receiving essential services, potentially accelerating health declines and increasing the likelihood of premature nursing home placement. KABC is recommending $31 million in additional funding for the FE waiver in fiscal year 2027 to address projected funding shortfalls and help eliminate the waitlist. Kansas Silver Haired Legislature Sets 2027 Priorities On October 7 and 8, 65 delegates representing regions across Kansas gathered on the floor of the Kansas House of Representatives in Topeka for the Kansas Silver Haired Legislature's annual session. During the session, delegates approved five resolutions outlining their legislative priorities for 2027. The resolutions focus on supporting older Kansans' independence, financial security, access to care and participation in civic life. The five priorities are: Fund senior transportation Protect in-home care Increase funding for the FE waiver to help older Kansans receive care in their homes and communities. KABC supports this priority and is urging the state to add $31 million in funding for fiscal year 2027 to eliminate the FE waiver waitlist. Strengthen Medicaid Raise the Personal Needs Allowance Increase the Personal Needs Allowance for nursing home residents who receive Medicaid Protect senior voting rights These priorities address interconnected challenges facing older Kansans, from accessing transportation and affordable care to maintaining independence and financial security. The Importance of Care at Home The FE waiver was established to help older Kansans access community-based services that allow them to remain in their homes for as long as possible, delaying or avoiding the need for more costly institutional care. These services can make a significant difference in an older adult's ability to maintain independence, health and quality of life. When needed support is unavailable, however, individuals and families may have fewer options for managing care at home. Kansas already faces challenges in this area. According to the United Health Foundation's America's Health Rankings, Kansas ranks 47th in the nation for placing low-care residents in nursing facilities. KABC is concerned that limiting access to home- and community-based services could contribute to further premature institutionalization. The Cost of Delayed Access The potential impact of the waitlist is significant. According to KABC's testimony, the state faces a projected $31 million shortfall for the FE waiver in fiscal year 2027, putting access to critical in-home services at risk. Historical data also illustrate the potential scope of the problem. In 2003, a similar FE waiver waitlist affected approximately 20% of eligible participants. The Kansas Department for Aging and Disability Services (KDADS) reports that 9,306 Kansans are currently eligible for the waiver. Applying that historical 20% figure to today's eligible population suggests that approximately 1,861 older Kansans could be affected in fiscal year 2027. While this estimate is based on a historical comparison, it underscores the potential consequences of insufficient funding. Investing in Older Kansans The goal is to help older Kansans receive the services they need when they need them, rather than risk declining health or entering institutional care because community-based options are unavailable. As Dan Goodman emphasized in his testimony, investing in home- and community-based services offers an opportunity to support older adults' independence while potentially avoiding the greater costs associated with premature institutionalization. The Kansas Silver Haired Legislature's 2027 priorities provide a framework for addressing the needs of older Kansans across the state. KABC's support for increased FE waiver funding aligns with the Legislature's call to protect in-home care and ensure older adults have meaningful choices about where and how they receive care. KABC will continue advocating for policies and resources that protect older Kansans' access to quality long-term care, wherever they call home.
On Thursday, September 10th, KABC hosted our annual caregiver training, with speaker Jessica Clossen, and membership meeting. Over 30 people attended! The meeting began with a brief introduction to KABC by Libby Hastings, Communications and PR coordinator. Afterward, Karen Weber, KABC Board Vice President, led the membership meeting. During the membership and business meeting, Karen Weber (Vice President), Dave Ranney (Secretary), Rachel Stahle, Dustin Baker, and Deborah Merrill were unanimously voted to retain their current board positions. During the caregiver training portion, Navigation Memory Care: Knowing When It Is Time & How To Choose, Jessica Clossen discussed important tips for navigating memory care, including: The hidden cost of waiting too long and caregiver burnout Defining memory care Memory care transition guidance What to look for in a memory care setting Staffing and training Culture and activities Dining and daily routines We are so incredibly thankful to Jessica for sharing her time and expertize with our attendees. If you'd like to connect with Jessica Clossen, email her at jclossen@dementia-care-consulting.com or call 913-585-5178 . To view the recording of our 2026 caregiver training and membership meeting, please visit our YouTube page here. A copy of the presentation slides is available here .