Nursing Homes Challenged by Regulatory Requirements

April 1, 2021
April 1, 2021

The long-term care industry is struggling to deal with a variety of issues. Some such as preventing falls and ensuring emergency preparedness have been concerns for these facilities for quite some time; others such as new regulatory oversight and handling the COVID-19 pandemic are new to the mix. The result is that industry leaders are faced with a multitude of new challenges to manage simultaneously. Needless to say, grappling with the pandemic by itself would be more than all-consuming. When we overlay all of these other elements on top of COVID-19, we find many in this industry overwhelmed by the scope and variety of the issues at hand. This article is Part 2 of our attempt to look more closely at some of the serious concerns of organizations across the continuum of care.

Nursing Homes Struggle with the Demands of Required Compliance Surveys and Regulatory Oversight.

The compliance burden for long-term care organizations is significant. In an effort to protect every nursing home resident, the federal government requires that each nursing facility comply with regulations embodied in the Requirements of Participation (RoPs) to receive Medicare or Medicaid payment for services. States are required to conduct on-site surveys in nursing homes to ensure provider compliance with those regulations. In 2019, CMS announced its plan to strengthen “the system it uses to hold inspectors accountable under the State Performance Standards System (SPSS) for examining compliance with federal regulations by skilled nursing facilities (SNFs)” (Connole, 2019). As part of this effort, “State Survey Agencies (SSAs), which inspect SNFs on a regular basis, will see changes in how the agency oversees their work, including through updated SPSS assessment tools and a more rigorous and rapid analysis of SSA performance to ensure inspections are timely and accurate” (Connole, 2019). The focus of CMS oversight appears to be timely and consistent inspections, ensuring patient safety, and the consistent application of citations and fines (Connole, 2019).

This area experiences the back and forth pull between the welfare and interests of long-term care recipients and the organizations themselves. Their adherence with requirements requires resources and a commitment of time that may hamper the ability to provide care. One swing of the pendulum occurred with the Obama Administration’s “2016 rule [that] considerably expanded requirements in several key areas to facilitate person-centered care, care planning, infection control, and quality improvement activities” (Stevenson, 2018). During the tenure of the Trump Administration however, there appears to be some degree of an about-face when it comes to oversight of the long-term care industry. There is clear indication that a middle road may be a better course when it comes to compliance. Industry groups like AHCA have “pressed for a paradigm shift in nursing home oversight efforts, seeking a collaborative—as opposed to adversarial—approach in which providers and regulators work together to achieve better resident outcomes” (Stevenson, 2018). How that works in reality is anyone’s guess. Advocates for residents appear to believe that more is better when it comes to regulation, but have “lamented the fact that the new standards did not also include comprehensive staffing requirements and have previously pointed to uneven and lax enforcement of existing standards as a key barrier to quality nursing home care” (Stevenson, 2018). With the long-term care industry preoccupied by the threat of COVID-19 and its regulators thinking mostly about infection control and prevention, bigger issues of compliance are going to take a back seat for some time to come.


Connole, P., “CMS to Toughen Oversight of State Inspections of SNFs,” Provider: 10/24/19, Retrieved at http://www.
Stevenson, D., “The Future Of Nursing Home Regulation: Time For A Conversation?,” Health Affairs: August 23, 2018, Retrieved at


This blog post continues a series based on our article, Top Issues Across the Care Continuum - Part Two, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. An earlier blog post series was based on our article Top Issues Across the Care Continuum – Part One. Subsequent challenges to be examined during this blog post series include:

  • The Abuse Icon on the Nursing Home Compare Website is Problematic for Many Long-Term Care Organizations.
  • Falls with Injury Are a Serious Concern for Long- Term Care Facilities and the People Who Reside in Them.
  • Emergency Preparedness, While Necessary, Is a Burden for Long-Term Care Facilities.
  • Long-Term Care Faces Even More Requirements with QAPI Phase 2 and Phase 3 Regulations.
  • Changes Related to COVID-19 Will Impact Surveys and Visitation Policies in the Future

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.