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.
On Monday, October 13th, Dan Goodman, Executive Director of Kansas Advocates for Better Care (KABC), delivered testimony before the Robert G. Bethell Joint Committee on Home & Community Based Services & KanCare Oversight. His remarks focused on the urgent need to strengthen Kansas’ long-term care system through sustainable funding and workforce investments. Goodman urged legislators to provide additional funding for the Home and Community-Based Services (HCBS) Frail Elderly waiver , noting projected shortfalls of $27 million in FY26 and $70 million in FY27. Without intervention, hundreds of older Kansans could face placement on a waitlist as early as this fall—delaying access to critical in-home services and increasing the risk of premature institutionalization. He also highlighted the need to support and stabilize the state’s long-term care workforce by exploring innovative approaches used in other states. For example, New Mexico’s Competitive Pay for Professionals program has helped attract and retain workers by linking higher wages to improved reimbursement rates and accountability measures. Goodman suggested Kansas consider similar models to strengthen its caregiving workforce and ensure providers can offer competitive pay. KABC remains committed to advocating for policies that promote quality care, protect older adults, and sustain a strong, well-supported caregiving system across Kansas. Read KABC’s full testimony here: View Testimony (PDF) Watch a full recording of the committee here: YouTube Link
On October 1st and 2nd, the 2025 Special Committee on Health and Social Services met, with the first day devoted to nursing home surveying and credentialing. The joint committee of both House and Senate members heard from the Kansas Department for Aging and Disability Services (KDADS), the Long-Term Care Ombudsman, industry representatives from Kansas and out of state, administrators, and contractors. Notably absent were the voices of consumers, their family members, and facility staff , the people most affected by long-term care policy. The committee heard information about: Survey Backlogs and Staffing Challenges KDADS contracts with the federal government to inspect adult care homes for health and safety compliance. KDADS has struggled for years to meet federal requirements, due in large part to recruiting and retaining nurse surveyor positions. More than half of the 60 approved positions were vacant earlier this year. As a result, Kansas currently averages 19.9 months between nursing home inspections , far beyond the federal requirement of 12-15.9 months. With just over 300 federally licensed facilities in the state, timely inspections are critical to protecting residents. To address this, KDADS eliminated 15 vacant positions and raised starting pay: up to $60,000 for multidisciplinary surveyors and $67,000 for RNs . The agency is also considering incentives to encourage more RNs to work as surveyors. Kansas has one of the highest rates of the most serious deficiencies, known as Immediate Jeopardy (IJ) deficiencies, in the nation , citations for situations where resident health and safety are at serious risk. The committee explored the possibility of privatizing the survey process. Resident Rights at Risk Testimony also revealed troubling practices in some nursing homes, including charging residents $200–$300 per month in “pharmacy provider” or “medication set-up” fees if they choose to use an outside pharmacy. This practice undermines residents’ right to choose their own providers and unfairly penalizes private-pay residents, already shouldering an average of $7,000–$8,000 per month in nursing home costs. Involuntary Discharges and the Ombudsman’s Recommendation The Long-Term Care Ombudsman urged lawmakers to expand discharge reporting requirements. As she noted: “Federal regulations require a notice to be sent to our office for a facility-initiated transfer (involuntary discharge) in federally licensed nursing homes, but that is not the case for state licensed homes, assisted livings, home pluses and residential health care facilities. With the help of our office, we can often help resolve the reason for the discharge notice to prevent a resident transfer or support the resident to ensure a transition occurs safely.” The committee heard concerns from representatives of the nursing home industry and decided to delay making a recommendation on this issue, noting that additional information is needed. KABC has advocated for not only strengthening the reporting requirements but also giving residents of assisted living facilities the same right to appeal an involuntary discharge that nursing home residents enjoy. Raising the Personal Needs Allowance The Personal Needs Allowance (PNA) for nursing home residents is a monthly stipend that Medicaid recipients can use for personal expenses. In Kansas, the PNA is just $62 per month. Many residents express concern that this amount is insufficient to cover basic personal expenses such as haircuts or undergarments. An immediate increase to the allowance is needed, along with an ongoing adjustment to keep pace with rising costs. The Long-Term Care Ombudsman recommended a PNA increase to the national average of $72 with an additional annual Cost of Living Adjustment. KABC’s Position KABC will continue to advocate for: • Strong oversight of nursing homes. • Resident rights protections, including freedom of choice in providers. • Central inclusion of residents and staff voices in all policy discussions. You can watch the hearing on the Kansas Legislature’s YouTube channel here . KABC will continue to monitor these conversations closely as the 2026 legislative session approaches.