Critics say the new risk-based CMS survey system could weaken oversight and mislead families about the quality of care

Federal health officials will scale back annual inspections at about 12% of the nation’s nursing homes starting this fall under a new risk-based oversight system, a move resident advocates warn could allow poor care and abuse to go undetected.

Beginning Sept. 8, the Centers for Medicare & Medicaid Services (CMS) will implement a nationwide risk-based inspection system. Nursing homes that meet quality criteria will receive shorter, streamlined annual inspections. CMS officials said the approach performed comparably to traditional inspections during pilot testing and will identify qualifying facilities with a special icon on the federal Nursing Home Care Compare website.

The Long Term Care Community Coalition, a national nonprofit that advocates for nursing home residents, and the National Consumer Voice for Quality Long-Term Care are urging CMS to withdraw the policy, arguing it weakens one of the government’s most important tools for protecting residents and holding nursing homes accountable.

“For decades, comprehensive nursing home surveys have served as the nation’s primary means for protecting residents from abuse, neglect, substandard care, and violations of their fundamental rights,” the Long Term Care Community Coalition said in a policy alert released Thursday. “Protecting residents requires robust inspections, meaningful enforcement, and unwavering accountability.”

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Annual surveys determine whether nursing homes comply with the federal health and safety standards required to participate in Medicare and Medicaid. Surveyors observe resident care, review medical records, interview residents and staff, and investigate potential violations.

CMS said the streamlined inspections will help state survey agencies make better use of limited resources by spending less time at facilities with strong compliance histories and more time investigating complaints and inspecting higher-risk nursing homes. The agency said funding for nursing home surveys has remained flat since 2015 even as complaint investigations have increased by more than 20%, contributing to inspection backlogs.

A statement from the National Consumer Voice said CMS has not explained whether residents, families, or long-term care ombudsman programs will be notified before a facility receives a streamlined inspection. The group also questioned whether inspectors will be required to consider complaints or concerns raised by ombudsmen before deciding to conduct a risk-based survey.

Both advocacy organizations argue the policy is based on a flawed assumption — that facilities with stronger inspection histories require less oversight.

“As residents, their families, and advocates are aware, quality can change quickly due to a variety of issues, including staffing shortages, management turnover or financial reasons,” the National Consumer Voice said in a statement. “All nursing home residents are entitled to high-quality care, as articulated by federal and state laws.”

The Long Term Care Community Coalition made a similar argument, saying conditions inside nursing homes can deteriorate rapidly because of staffing shortages, management turnover, ownership changes, or financial pressures. By the time problems appear in publicly reported quality ratings or inspection histories, residents may already have suffered serious harm.

The coalition also questioned the quality measures CMS will use to identify lower-risk facilities, arguing inspection histories and other publicly reported metrics do not always capture poor care because violations are sometimes missed or underreported during surveys.

Instead of reducing inspections at some facilities, the coalition said CMS should improve the survey process by making better use of data it already collects, including staffing levels, hospitalization rates, falls, pressure ulcers, and financial information that could help inspectors identify nursing homes at greater risk for poor care or fraud.

Both organizations also criticized CMS’s plan to place a gold trophy icon on the federal Nursing Home Care Compare website to identify facilities eligible for streamlined inspections.

CMS said the icon will help consumers identify higher-performing nursing homes that qualify for the risk-based survey program.

The National Consumer Voice argued the designation could mislead residents and their loved ones into believing a facility provides superior care when it simply means the nursing home qualified for a program designed to address survey funding shortages.

The Long Term Care Community Coalition echoed that concern, saying the designation could give families a false sense of security because those facilities will receive less comprehensive inspections.

“These gold trophies should serve as a warning that a facility has not been vigorously inspected, not as a signal of good care, safety, or dignity,” the coalition said in a statement.

The policy is the latest in a series of federal nursing home oversight changes criticized by resident advocates. The coalition said CMS has also rolled back minimum staffing requirements, delayed financial transparency requirements, and changed how civil monetary penalty funds are distributed.

Meanwhile, in New Jersey, nursing home advocates and government watchdogs have repeatedly urged lawmakers to strengthen oversight of the industry through legislation requiring greater financial transparency, including the disclosure of related companies that often receive millions of dollars in payments from nursing homes. Those proposals have repeatedly stalled in the Legislature. As The Vindicator has previously reported, the nursing home industry has sharply increased its lobbying and political spending in New Jersey in recent years.

Consumer Voice urged CMS to reconsider the policy, arguing that reducing oversight places nursing home residents at greater risk of harm and that the agency should strengthen inspections rather than weaken them.

“This is the time to strengthen oversight, not weaken it,” the Long Term Care Community Coalition statement said.