Adequate, coordinated federal and state oversight and enforcement

The Centers for Medicare & Medicaid Services, the states, and all other regulators should vigorously enforce all regulations in long-term services and supports (LTSS) facilities and home care within their respective purviews. They should all work to ensure the health and safety of nursing home residents and other LTSS recipients. Regulators should pay particular attention to infection control regulations. 

Policymakers should conduct oversight and take steps to address the impact on residents of private equity ownership of nursing homes and other long-term services and supports providers. This includes its impact on the quality of care, staffing, and resident rights.

Federal and state governments should ensure the collection and public reporting of comprehensive, accurate data during an epidemic/pandemic and other public health crises or natural disasters. 

Federal and state governments should work together to establish uniform data collection requirements for assisted living facilities during epidemics/pandemics. 

Data collection should include race, ethnicity, sexual orientation and gender identity, and other key identity characteristics and demographic information. When requesting data that may be sensitive to individuals, policymakers should follow best practices. Clear nondiscrimination policies and emphasis that disclosure is voluntary should be posted. Individuals retain the right not to respond.

States should rigorously enforce mandatory minimum standards and make other efforts to promote quality and ensure quality outcomes for individuals in residential care settings. 

States should empower ombudsmen to have immediate access to all residential care settings without advance notice. 

Each state should designate a lead agency to coordinate policy, including licensing, monitoring, quality improvement, and enforcement efforts in all residential care settings. 

Licensing standards and monitoring should reflect residents’ level of disability and the provider’s performance history. 

States should require public agencies to ensure that the same social and medical services available to people residing in the community are also available to residents of assisted living and other residential care settings. 

During public health emergencies affecting LTSS facilities, cases and deaths should be reported publicly. Staff and resident data should be reported separately. Other best practices for demographic data should be followed, including reporting data by race, ethnicity, or zip code. 

States should report cases and deaths by facility so the public may make informed decisions regarding admissions and transfers.