Lawmakers Turn Their Gaze Toward Nursing Home Spending


Lawmakers in the House and Senate are examining whether nursing homes are spending enough money on resident care.

A recent column in the Washington Post argued that the Covid-19 pandemic revealed dire problems in nursing home facilities across the country. The column’s author, Syracuse University law professor Nina Kohn, wrote that these systemic problems, which include understaffing and poor quality of care for nursing home residents, stem in part from “owners who place profit-seeking above their residents’ welfare.” While policymakers have turned their eye towards solutions to the structural flaws in nursing homes, Kohn states that a more concerted effort is necessary to create safer, fairer elder care in the United States.

Kohn argues first that understaffing in nursing homes is enabled by a failed regulatory framework that theoretically requires high standards of care at the federal level, but which suffers from lax enforcement at the state level. “Regulators rarely impose meaningful penalties such as fines, holds on new admissions, or payment suspensions,” Kohn writes, leaving it to nursing homes to fix their problems but failing to follow up on rule violators: “fines are imposed in less than 2 percent of cases in which inspectors find violations, and the fines levied are usually so small that they are little more than a slap on the wrist.” When nursing homes can easily afford to pay fines, they arguably have little incentive to resolve the underlying problems.

A few lawmakers have proposed legislation that would subject nursing homes to greater scrutiny, Kohn notes. For instance, Pennsylvania senator Robert Casey recently sponsored a bill that would require more inspections of “poorly performing facilities,” and which would “make it more likely that chronically deficient nursing homes find their Medicare and Medicaid payments cut off if they don’t improve.” In the House of Representatives, congressmen have questioned the effects of private equity investment on quality of care in nursing homes.


“Regulators rarely impose meaningful penalties” when nursing homes violate regulations, according to a Washington Post columnist.

At the state level, meanwhile, governments in Massachusetts, New Jersey, and New York have introduced laws that mandate nursing homes “spend a certain percentage of revenue on resident care.” The goal of such laws is to keep “unscrupulous providers,” as Kohn describes them, from taking as profit funds that ought to be devoted to residents; they may also “make nursing homes less attractive to private-equity owners.” Kohn argues that such mandates should include required financial disclosures, such that lawmakers can ensure nursing homes are living up to spending requirements.

For more analysis of state and federal policy’s role in nursing home reform, check out Kohn’s column via the Washington Post.

The attorneys at the Law Offices of Thomas L. Gallivan, PLLC work diligently to protect the rights of nursing home residents.  Please contact us to discuss in the event you have a potential case involving neglect or abuse.

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