1. Mechcatie, Elizabeth BSN


Moratorium elicits concern among nursing home advocates.


Article Content

The Centers for Medicare and Medicaid Services (CMS) has imposed an 18-month moratorium on penalizing nursing homes for certain safety violations, part of the second phase of new regulations for nursing homes implemented in November 2017, according to a CMS announcement. The eight safety rules affected include requirements for developing a baseline care plan within 48 hours of a resident's admission, antibiotic stewardship, and limiting as needed the administration of psychotropic drugs. In the November 24, 2017, memorandum, the CMS says that the 18 months can be used to "educate facilities" on the new standards.

Figure. Photo  blick... - Click to enlarge in new window Photo (C) blickwinkel / Alamy Stock Photo.

But critics say the moratorium will adversely affect the safety and health of residents. Nursing homes have been aware of these requirements since 2016 and "CMS's delay is a direct response to the demands of the nursing home industry and signals another step in the industry's effort to dismantle meaningful enforcement against deficient nursing homes," the Center for Medicare Advocacy said in a response to the CMS announcement.


The moratorium "makes no sense" and will delay needed improvements, said Charlene Harrington, professor emeritus of social and behavioral sciences at the University of California, San Francisco, School of Nursing and author of several published articles on nursing homes. "These are all basic things that every nursing home should be doing, so it's just ridiculous to allow an 18-month moratorium," she told AJN. Also troubling, Harrington said, is the change in how nursing homes are to be penalized for infractions; in some cases, fines are being reduced to a level that may provide little incentive to improve performance. She referred to a July 2017 CMS memo to state survey agency directors stating that a nursing home can be given a one-time fine, instead of the costlier daily fines, for violations identified at the time of an inspection but which were present earlier. Daily fines are still recommended for newly identified violations.-Elizabeth Mechcatie, BSN